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Do you avoid some of your favorite exercises because you are afraid of losing urine? Do you leak urine if you laugh cough or sneeze? You are not alone. Many women experience the same symptoms. Fortunately, we have many options to help improve your quality of life and restore your confidence.

Urinary incontinence

The involuntary loss of urine. Urinary incontinence may occur with laugh, cough, sneeze, sex and standing up, for example. This type of urinary incontinence is called stress urinary incontinence. When the loss of urine is associated with a sudden urge, this is called urge urinary incontinence. Urge urinary incontinence is often associated with overactive bladder symptoms. Some women may experience both types of urinary incontinence.


Urinary incontinence can be diagnosed by taking a history, a physical exam and completing a bladder diary. Urine culture is usually sent to make sure an infection is not causing the problem. At times, diagnostic testing may be indicated. This may include:

  • Urodynamic testing: A diagnostic procedure that is done in the office. A tiny catheter is placed in the bladder and in the vagina or the rectum. These catheters monitor pressures during bladder filling and bladder emptying. You may be asked to sit, stand and cough during this test. This test can help determine the reason for leakage of urine and/or the reason for inability to empty the bladder well.
  • Cystoscopy: A tiny camera used to inspect the urethra and bladder. This procedure can be performed to identify lesions, bladder stones, polyps and diverticuli in the bladder and urethra.

Treatments for urinary incontinence

Dietary Changes

A list of foods and drinks that are removed from the diet for a few days and then reintroduced to assess if that food or drink could be aggravating bladder symptoms.

Bladder Training

Training your bladder to hold urine longer by doing pelvic floor exercises when you have an urge to urinate and allowing that urge to pass prior to urinating. The amount of time holding your urine increases incrementally over time.

Kegel Exercises

Exercises of the vaginal muscles that strengthen the pelvic floor. These exercises have been shown to improve urinary incontinence, urinary frequency/urgency as well as fecal incontinence.

Pelvic Floor Physical Therapy

Meeting with a specialist in pelvic floor physical therapy to learn exercises and techniques that are known to improve the pelvic floor muscles. Pelvic floor physical therapy can be used to improve stress urinary incontinence, urge urinary incontinence, urinary frequency, urinary urgency and fecal incontinence.

Pelvic Floor Rehabilitation

The use of passive stimulation of the muscles using a device such as an ApexM or a chair such as the Emsella. This treatment can be helpful for identifying and strengthening the muscles of the pelvic floor area responsible for stress urinary incontinence, urinary frequency, urinary urgency and fecal incontinence.

  • ApexM is an FDA approved vaginal probe used in the privacy of your own home. This probe is designed to improve urinary incontinence associated with activities such as running, laughing and coughing.
  • Emsella is an FDA approved chair that stimulates your pelvic floor muscles for you. You simply sit in the chair for 28 minutes twice weekly for three weeks and monitor as your symptoms improve over time. Studies have shown a decrease in pad usage and increase in quality of life out as far as 6 months after treatment.


Currently there are two types of medications that treat urinary urgency, frequency and urge related urinary incontinence: Anticholinergic drugs and Mirabegron. Depending on which medication is tried, it can take 2-8 weeks to see an effect.

Viveve Radiofrequency

Certain patients may be candidates for the use of an energy base device placed in the vagina that emits radiofrequency waves. As these waves travel through the tissue, they generate heat that results in remodeling of your own natural collagen. There are no needles and no injections. A simple small probe is placed in the vagina and rotated circumferentially over the course of about 50 minutes. Viveve is a one-time treatment with no downtime and no restrictions. The current feasibility study demonstrates an overall 73% decrease in stress urinary incontinence at 6 months after treatment in premenopausal women with at least one full-term vaginal delivery. Ask about current and upcoming clinical trials.


A ring of plastic or silicone that can be placed in the vagina to support the urethra. In some women, the pessary may sit underneath the level of the middle urethra such that the urethra can kink around it during activity and decrease urinary incontinence. Since there are various shapes and sizes, a pessary fitting is usually done in the office to determine which pessary might be best for you.

Periurethral Injections

A procedure done during a cystoscopy in which a tiny needle is used to inject a substance into the urethra to bulk up the urethra to reduce urinary incontinence that occurs with activity.


A surgical procedure in which a thin ribbon of mesh or tissue is placed through a vaginal incision near the urethra to reduce urinary incontinence that occurs with activity. It is a 20 to 30-minute outpatient procedure. Most patients resume their normal schedule in a few days to a week.


A technology in which a 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 main forms of neuromodulation. These are Sacroneuromodulation and Tibial Nerve Stimulation.

  • Sacroneuromodulation – This form of neuromodulation involves placing a small wire attached to a small battery under the skin. The wire and battery are like a pacemaker and are placed in the hip pocket area. An electrical stimulation is sent from the wire to the area of the nerves that help control bladder and bowel function. You are given a remote that communicates with the battery so you can control the stimulation, turn it off and on and try various stimulation programs. This is a popular option for because the battery is replaced every 4-6 years and not many visits are required once your programs are set.
  • 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 delivering a stimulation that gives a flutter 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 treatment weekly for twelve weeks and then monthly.


Botulinum toxin is a medication that can be injected into part of the bladder to improve urinary urgency, urinary frequency and urge urinary incontinence. The procedure is only a few minutes long and is usually done in the office using a numbing medication in the bladder. The effects can last 3-12 months, but most patients notice 4 months of efficacy. The procedure is usually repeated every 4-6 months.

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