Rahel Ghenbot, MD, is a urogynecologist board-certified in obstetrics and gynecology at Inova Urogynecology in Leesburg. Dr. Ghenbot specializes in minimally invasive surgery to treat urinary and fecal incontinence, pelvic organ prolapse and abnormalities of the urogenital tract.
Far too many women suffer in silence with urinary incontinence (loss of bladder control). Maybe you were told that a little leakage is just normal as you age. Or you might think the only fix is major surgery. Both statements are false.
Urinary incontinence is a common — but complex — condition. And it’s not normal or “just part of life.” There are different types, and each type has its own causes and treatments. An experienced healthcare team can successfully treat most cases of incontinence without major surgery.
At Inova Health System, we provide the range of treatments for all types of incontinence, including nonsurgical methods and minimally invasive procedures. Offering many different options empowers you to choose what’s best for your needs and lifestyle.
Urgency urinary incontinence and overactive bladder (OAB)
If you have overactive bladder, you frequently feel a strong and sudden urge to urinate that you can’t control. You might leak urine when you feel this urge, or you might have trouble making it to the bathroom.
Overactive bladder (OAB) is usually the cause of urgency incontinence. This condition affects more than 40 percent of women in the U.S. The main cause of OAB is often unknown. But we know that when you have OAB, the bladder muscles contract even when they aren’t supposed to. These contractions feel like an urge to urinate.
What are my treatment options for urgency incontinence?
Urgency incontinence treatment can improve your bladder’s ability to store urine for an adequate period of time, reducing urgency, frequency and leakage. Your doctor can explain the treatments that may work best for you, including:
- Pelvic floor physical therapy: Pelvic floor physical therapy involves special exercises to improve the function of the muscles in your pelvis that can affect your bladder. Inova’s highly trained physical therapists customize the exercises for your unique needs. Our therapists also teach everyday habits, like breathing exercises and postures, that help with bladder control. With multiple locations around northern Virginia, it’s easy to find a pelvic floor therapist near your home or work.
- Bladder training: A urogynecologist or pelvic floor therapist teaches you to urinate (void) on a schedule, gradually increasing the time between voids. With practice, bladder training allows you to hold urine for longer amounts of time. We also teach ways to suppress the urge to urinate.
- Medications: Prescription medicines for urgency incontinence calm the frequent bladder contractions. These medications can reduce urgency and urine leakage. A provider who specializes in OAB can prescribe the medication that’s best for you.
- Botox® injections: Botox® is a nonsurgical treatment that stops certain nerve impulses in the bladder muscle. This treatment can stop leakage and urgency for several months. Specialists use local anesthesia to numb the area around your bladder to maximize your comfort during the procedure.
- Posterior tibial nerve stimulation (PTNS): During these weekly in-office treatments, your doctor places a thin, acupuncture-like needle near your ankle. This needle stimulates the tibial nerve, which sends signals to your bladder and helps control how it works. A special device sends electrical impulses through the needle, blocking the nerve signals that irritate your bladder.
- Sacral neuromodulation: Commonly called a bladder pacemaker, this device regulates signals from your spinal cord to your bladder. Your doctor implants a small device under the skin in your lower back. The device sends painless signals that “re-program” the nerves that cause the urge to urinate.
- Lifestyle changes: Some people with OAB benefit from changing their diet or fluid intake. Caffeine, alcohol, spicy foods and constipation can irritate the bladder and make urgency incontinence worse. Quitting smoking and losing excess weight can also help. Inova’s specialists work closely with you to determine which diet or lifestyle changes could benefit you.
Stress urinary incontinence (SUI)
One-third of adult women experience stress urinary incontinence at some point. You might have SUI if you leak urine when you cough, sneeze, jump or laugh.
Stress urinary incontinence is often a result of damaged or weakened pelvic floor muscles. Normally, these muscles act like a sling to support your bladder and urethra (tube where urine comes out). If your pelvic floor muscles don’t work properly, your bladder and urethra can’t hold urine in like they should.
What are the treatments for stress urinary incontinence?
Your treatment for SUI depends on what’s causing it and your preferences. SUI is usually a muscle problem, not a nerve problem, so it requires different treatments than urgency incontinence. But many women have a mix of urge and stress incontinence and might benefit from more than one treatment.
See your doctor to discuss your options for treating SUI, which may include:
- Pelvic floor physical therapy: Pelvic floor physical therapy can strengthen weakened or stretched-out pelvic muscles. A stronger pelvic floor helps you hold in urine when something puts pressure on your bladder or urethra. Inova’s pelvic floor therapists customize your exercises based on your unique anatomy and symptoms.
- Pessary: A pessary is a removable silicone ring that you place inside your vagina to support your urethra and prevent leaks. A urogynecologist or gynecologist can fit you with a pessary that’s just the right shape and size for your body.
- Transurethral bulking agents: During this procedure, your doctor injects safe, medical-grade material to “bulk up” the area around your urethra. The material prevents or reduces incontinence without incisions. Inova’s urogynecologists and urologists are experienced in the latest and most effective bulking agents. With our expertise, we use transurethral bulking alone or with surgery, depending on your needs.
- Surgery: If your SUI symptoms are severe or other options haven’t worked for you, surgery may be an option. The most effective surgery for SUI involves a mesh sling to support your bladder and urethra. The key to successful surgery is knowing exactly where and how to place the mesh. Our team has extensive training and expertise in this technique.
- Lifestyle changes: If you have constipation, eating more fiber and drinking enough water can help prevent leaks from SUI. Losing excess weight and quitting smoking can also help. Your doctor can recommend specific changes.
Many women experience stress, anxiety and depression from bladder leaks. They might live with incontinence for months or even years because of embarrassment or being told it’s “no big deal.”
You deserve to enjoy life to the fullest without worrying about your bladder. Treating urinary incontinence can improve your physical and emotional well-being and boost your confidence. Take a bladder control assessment to see if it’s time to consult a doctor.
Schedule an appointment with Inova’s urogynecologists
Don’t let urinary incontinence hold you back. You’re not alone, and you don’t have to live with it. Our urogynecologists guide you through all your options so you can choose what’s best for you. We customize your treatment based on your goals and preferences.