Urinary incontinence is more common in women than men and can range from leaking a few drops to complete loss of control. Many women are embarrassed to discuss this problem and are fearful that any treatment will be difficult, painful or unsuccessful. Urinary urgency and frequency is also a common problem and, although the TV commercials about ” Gotta Go, Gotta GO” are amusing, the need to restrict your activities and remain at close distance to a toilet at all times is not. Many patients tell me that they cannot sit through something like a church service or, if they go out shopping they need to find the store restroom first.
Urinary leakage, urinary frequency or pain can be caused by several different problems only a few of which would require surgical treatment. “Dropped bladder” is a fairly common problem and can be entirely without symptoms or be associated with voiding difficulties or pelvic discomfort, this problem also has several different treatment options.( See the page on Prolapse.)
Evaluation for the causes of urinary problems requires a careful history of the symptoms, a review of possibly related medical disorders and careful examination. Often I will ask you to keep a 48 hour record of urination, and have a set of non-painful (in-office) measurements referred to as “cystometrics” which are used to understand whether the problem is in the urethra, the bladder, the pelvic floor or a combination of these . Cystoscopy may also be needed; this procedure is also done in the office.
Pessaries are a time honored and simple method of treatment for pelvic prolapse and are often an effective non-surgical solution for both incontinence and prolapse. Muscle strengthening can be helpful and different tools are available to improve strength in the pelvic floor.
Surgical procedures to correct incontinence and prolapse are sometimes needed. I have 30 years of experience doing these types of surgeries ranging from old fashioned procedures that have been used for decades to the newest techniques not available 10 years ago, these repairs can be done abdominally and transvaginally. When an abdominal approach is needed I prefer minimally invasive surgical techniques and use DaVinci robotic equipment to do both abdominal sacrocolpopexies and also the older traditional repairs when appropriate.
Some types of incontinence and voiding problems can only be treated by addressing spasm and”incordination” of the pelvic floor reflexes using sacral neural modulation with Interstim. I am also trained in this theraputic modality.
Medtronic Interstim Information
Recurrent urinary tract infections have many different causes and may be from an unrecognized vaginal infection, pelvic floor hernia or blockage of the bladder outflow tract. Once the cause of the recurrent infections has been identified it is usually possible to prevent the problem altogether.
We understand that urinary tract infections are uncomfortable and very inconvenient for you. Once you are an established patient, the office is set up so that you may come without an appointment to be tested and, if appropriate, receive immediate treatment. Pelvic floor physical therapy can be done in the privacy of your own home using newly available InTone pelvic floor trainer.
Intone Toner information