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Do you avoid your favorite activities because you are afraid of losing urine? Are you always trying to find the nearest bathroom when you leave the house? Do you accidentally release urine when you laugh, cough or sneeze? If you answered yes to any of these questions, you are not alone. Millions of women experience the same symptoms every day.

Urinary incontinence isn’t something you think about much—until it affects your life. While it doesn’t always indicate a severe medical problem, it can be a time-consuming and embarrassing condition. At Urogynecology Center NoVa, double board-certified Dr. Maria Canter can help you to diagnose and treat your urinary incontinence so that you can regain control of your bladder, and your life.

What Is Urinary Incontinence

Urinary incontinence is a condition that causes the involuntary leakage of urine from the bladder. The brain and the bladder work together to control the urinary function. The bladder works by storing urine within it until you are ready to empty it, and the muscles in the lower region of the pelvis hold the bladder in place. Typically, the muscle of the bladder is relaxed to hold the urine inside it. Your sphincter muscles are closed around the urethra, which is the tube that carries the urine out of the body. When the urethra is kept closed by the sphincter, urine does not leak.

Normally, when you are ready to urinate, your brain will send a signal to the bladder that tells the bladder muscles contract to force urine out of the urethra. The sphincter opens up when the bladder contracts to release the urine. Urinary incontinence occurs when bladder muscles suddenly tighten or the sphincter muscles are not strong enough to pinch the urethra shut.

The two most common types of incontinence in women are stress urinary incontinence and urge incontinence, also known as overactive bladder. Stress urinary incontinence occurs when stretched or weakened pelvic floor muscles allow urine to escape, usually during exercises like walking or bending or even from sneezing, coughing or laughing. With urge incontinence, your brain signals to your bladder to empty even when it isn’t full or the bladder muscles are too active and contract to pass urine before your bladder is full.

Whether you have stress urinary incontinence, urge incontinence or a combination of the two, Urogynecology Center NoVa offers many different treatment options for incontinence that will restore your confidence and quality of life.

How is Urinary Incontinence Diagnosed?

Urinary incontinence is diagnosed by taking a thorough medical history, a physical exam and completing a bladder diary. A urine culture may also be collected to ensure that an infection is not causing the problem. At times, diagnostic testing may be indicated. This may include:

  • Urodynamic Testing: Urodynamic testing is a diagnostic procedure performed in-office. A small catheter is placed into your bladder and in the vagina or the rectum. These catheters monitor the pressure of your bladder during bladder filling and emptying. You may be asked by Dr. Canter to stand, sit or cough during this exam. This exam can help determine the reason for your leakage of urine and/or the reason for your inability to empty the bladder effectively.
  • Cystoscopy: A cystoscopy involves Dr. Canter inserting a thin tube with a tiny camera into your urethra and bladder. Medication may be used to numb your skin and urinary organs. This in-office procedure can be performed to identify damaged tissue, lesions, bladder stones, polyps and diverticula in the bladder and urethra.

Treatments for Urinary Incontinence

The right treatment for your urinary incontinence will depend on the type of incontinence you have, its severity as well as the underlying causes of the condition. At Urogynecology Center NoVa, you and Dr. Canter will work together to create a treatment plan that is customized to your unique needs and goals. Your plan may start with steps you can do yourself at home and progress to more intensive treatments if your symptoms do not alleviate. It is essential to be patient with the treatment process, as it can take up to a month or longer for different therapies to provide improvements.

Urogynecology Center NoVa offers the following treatment methods for urinary incontinence:

Dietary Changes

Certain foods and drinks can make bladder leakage or urinary incontinence worse. With dietary changes, a list of food and beverages will be removed from your diet for a few days and then reintroduced to your diet to assess if they could be aggravating your bladder symptoms. Drinks with caffeine, carbonation or alcohol, for example, can fill the bladder quickly and cause problems with incontinence. Limiting your intake of these may help put less strain on your bladder and provide some relief.

Bladder Training

In training your bladder, you can help to control overactive bladder or urge incontinence by going to the toilet at set times each day. Dr. Canter will have you start tracking how often you go to the bathroom each day in a bladder diary and slowly add about 15 minutes between your bathroom visits. By incrementally increasing the amount of time between your bathroom visits, your bladder can be trained to hold more urine before it signals to your brain that you need to go again.

Kegel Exercises

Your pelvic floor muscles work to support your uterus, bladder, small intestine and rectum, but can weaken with age, pregnancy or childbirth. Kegel exercises, also referred to as Kegels or pelvic floor muscle training, are exercises for your pelvic floor muscles that help to reduce or prevent stress urinary incontinence. Four out of ten women have improved their urinary incontinence symptoms after trying Kegels, though it can take up to four to six weeks before you notice any improvement in your symptoms. Kegels work differently for everyone and may eliminate your symptoms, lessen your symptoms, or not provide any improvements depending on your condition.

Pelvic Floor Physical Therapy

In pelvic floor physical therapy, you will meet with a specialist to learn exercises and techniques that are known to improve the strength of the pelvic floor muscles. Pelvic floor physical therapy can be useful for improving stress urinary incontinence, urge urinary incontinence, urinary urgency, urinary frequency and fecal incontinence.

Pelvic Floor Rehabilitation

Pelvic floor rehabilitation treatments involve the passive stimulation of the pelvic floor muscles using noninvasive devices such as the ApexM or Emsella. These treatments can help identify and strengthen the muscles of the pelvic floor responsible for stress urinary incontinence, urinary frequency, urinary urgency and fecal incontinence.

  • ApexM: ApexM is an FDA-approved, over-the-counter vaginal probe that can be used in the comfort and privacy of your own home. The probe works to treat both stress and urge incontinence by strengthening the pelvic floor and calming bladder spasms to decrease urgency.
  • Emsella: is an FDA-cleared chair device that uses high-intensity focused electromagnetic (HIFEM) energy to stimulate your pelvic floor muscles for you. This gentle 28-minute treatment is performed twice weekly for three weeks and allows you to remain fully clothed during the in-office procedure. The muscle contractions that occur during an Emsella treatment are the equivalent of doing 11,000 Kegels in one sitting. Studies have shown a decrease in pad usage and an increase in quality of life out as far as six months after treatment.

Medications

Medications for urinary incontinence are designed to help relax the bladder muscle as well as increase the total amount of urine your bladder can hold. There are currently two types of medications available to treat urinary urgency, urinary frequency and urge-related urinary incontinence: anticholinergic drugs and mirabegron. Anticholinergics work to calm an overactive bladder and can be helpful for urge incontinence. Mirabegron treats urge incontinence by relaxing the bladder and increasing the amount you can urinate at one time to help empty your bladder more completely. Depending on which medication is tried, it can take two to eight weeks to see an effect.

Viveve Radiofrequency

Certain patients may be candidates for Viveve — a noninvasive energy-based probe device that is placed inside the vagina and emits radiofrequency (RF) waves. The probe is rotated circumferentially for about 50 minutes. As the RF waves travel through the tissue, they generate heat that results in the remodeling of your natural collagen. Viveve is a one-time treatment that involves no needles, injections or downtime. Current feasibility studies demonstrate an overall 73 percent decrease in stress urinary incontinence for six months post-treatment in premenopausal women with at least one full-term vaginal delivery. Ask Dr. Canter about any current or upcoming clinical trials for Viveve.

Pessary

A pessary is a soft, flexible ring-shaped device made of plastic or silicone that is placed inside of your vagina to help support the bladder, uterus and rectum. Typically, a pessary is used for patients who have had a pelvic organ prolapse that is causing their incontinence. Pessaries are made in many different shapes and sizes, so a pessary fitting will need to be performed in-office to determine which pessary will work best for you. Most pessaries can last for several years, but you will need to remove and reinsert them regularly. Pessaries can be worn long-term but should not be worn for longer than three months.

Periurethral Injections

Periurethral injections are a procedure performed with a cystoscopy. A tiny needle is used to inject a substance into the urethra that bulks up the organ to reduce stress urinary incontinence that occurs with activity.

Slings

Sling surgery is the most common surgical procedure used to treat stress urinary incontinence. In a sling procedure, Dr. Canter will place a thin ribbon of mesh or your own tissue through a vaginal incision near the urethra. The sling acts as a hammock to support your urethra and hold the bladder in place to reduce urinary incontinence that occurs with activity. The procedure is performed on an outpatient basis and typically takes about 20 to 30 minutes to complete. Most patients resume their regular schedule within a few days to a week of their procedure.

Neuromodulation

Neuromodulation is a technology in which stimulation is sent to the nerves responsible for controlling urinary urgency, urinary frequency, urge-related urinary incontinence, fecal incontinence and urinary retention. There are currently two primary forms of neuromodulation:

  • Sacral Neuromodulation – TThis form of neuromodulation involves placing a small wire attached to a battery placed under the skin. The wire and battery are similar to a pacemaker and are inserted into the hip pocket area. Electrical stimulation is sent from the wire to the area of the nerves that help control bladder and bowel function. You will be provided with a remote that communicates with the battery so that you can control the stimulation, turn it off and on and try various stimulation programs. This is a popular option for patients because the battery only needs to be replaced every four to six years and doesn’t require many follow-up visits.
  • Tibial Nerve Stimulation – This form of neuromodulation is external. An acupuncture needle is gently inserted into the inside of the ankle. An external battery is then attached to the needle and works to deliver stimulation that gives a fluttering sensation in the foot while the battery is connected. This energy is applied for 30 minutes. Since this option is not implanted, it requires repeat treatments weekly for 12 weeks, and then monthly.

Botox

Botox, or botulinum toxin, is an injectable medication that can be injected directly into part of the bladder to improve urinary urgency, urinary frequency, and urge urinary incontinence. It is generally prescribed to patients who do not respond to urinary incontinence medications. The medication works to relax the bladder muscle and increase the amount of urine your bladder can hold. The procedure takes just a few minutes and is usually done in-office using a numbing medication in the bladder. The effects of Botox injections can last for 3 to 12 months, but most patients observe four months of efficacy. Repeat treatments will be needed every four to six months to continue benefiting from the effects.

If urinary incontinence interfering with your lifestyle and well-being, it may be time to explore your treatment options. Dr. Maria Canter and her talented all-female staff will help you to put the control back in your hands so that you can live your life to the fullest without limitations.

The information about urinary incontinence was reviewed by Dr. Maria Canter. If you have any questions, please don’t hesitate to contact us using our contact form below.

Call Urogynecology Center NoVa today to schedule a consultation.703-293-5239