The Institute for Women's Health

Most bladder control problems start after childbirth and, if untreated, tend to get worse over time. There are different types of bladder problems and they more than one type can affect women at the same type, making it yet more important to customize the treatment approach to optimize results.

Patients may complain of:

  • Leaking urine with certain movements (coughing, sneezing, laughing, lifting, bending, exercising)
  • Leaking urine while looking for a toilet with urgency
  • Leaking urine all the time
  • Leaking urine without noticing when it happens
  • Needing to go to the bathroom very frequently
  • Waking up at night several times to urinate
  • Blood in the urine
  • Repetitive urinary tract infections (UTI) or bladder infections
  • Pain in the bladder
  • Incomplete bladder emptying

The most common bladder problems we encounter are:

  • Stress urinary incontinence
  • Urgency urinary incontinence
  • Overactive bladder
  • Recurrent urinary tract infections
  • Blood in the urine
  • Descent of the bladder onto the vagina

Other bladder problems our doctors treat are:

  • Interstitial Cystitis (Painful Bladder Syndrome)
  • Vesicovaginal fistula
  • Complications of prior bladder/vaginal surgeries (with or without mesh)
  • Recurrent bladder problems after prior treatments or surgeries

Stress Urinary Incontinence

Stress urinary incontinence is a type of involuntary urine leakage that occurs with certain types of movements (typically coughing, sneezing, laughing, lifting, bending or running). So the stress it refers to is not mental, it is stress (pressure) on the bladder.

Normally we don’t leak because there are muscles around the urethra (the “bladder tube”) that are engaged automatically when the bladder is stressed (with cough, sneeze, etc) and block the involuntary passage of urine. But that mechanism of continence can weaken and fail leading to those bothersome urine accidents.

The main risk factors to develop stress urine incontinence are age (more likely the older you get), childbirth (more likely the more children you deliver), obesity (more pressure on the bladder), a history of certain prior pelvic surgeries and chronic constipation.

Fortunately there are many treatment options for stress urine incontinence. These are:

  • Kegel exercises
  • Pelvic floor muscle training with biofeedback
  • Pessaries for incontinence
  • Periurethral injections
  • Surgery

 

Our doctors will tell you the pros and cons of each method based on your personalized assessment.

 


Surgeries for Stress Urinary Incontinence

In Female Pelvic Medicine and Reconstructive Surgery there is no “one surgery fits all”. There are multiple surgeries that can be done to treat Stress Urinary Incontinence. Some of them are done vaginally and some are done abdominally (when our doctors choose the latter, he does them laparoscopically, using a camera and instruments through a very small incisions). They can involve the use of synthetic or biologic grafts (“mesh”) or not. They can take a few minutes to a few hours. Most are done as outpatient procedures, some require admission to the hospital.

The choice of the procedure will be based on the severity of your symptoms, your individualized evaluation (possibly with urodynamic testing), if you have had prior surgery for incontinence or prolapse and a detailed discussion with our doctors about the advantages and disadvantages of each one of the procedures he can offer.

Types of surgery:

Synthetic midurethral slings

  • Retropubic
  • Transobturator
  • Single Incision (“mini slings”)

Autologous slings

  • Rectus fascia
  • Fascia lata

Colposuspension (Burch procedure)