Bladder/Urinary Problems

Urinary Retention

Urinary Retention can occur for many reasons. The failure to be able to pass urine can result in severe abdominal, pelvic and back pain.

Many times this is an emergent situation and needs to be treated by having a urethral catheter inserted to drain the bladder of urine. At times, a catheter is left in place to allow for constant urine drainage.

Patients may have urinary retention in a much less acute situation. Sometimes patients do not fully empty their bladder when they urinate and therefore have retention of urine.

Evaluation of this condition begins in the clinic. Many times the provider will ask the patient to urinate in the office and then will perform a bladder scan (similar to an ultrasound) to see if there is any residual urine in the bladder.

If this volume is too large, your provider may want to treat the retention with medications, biofeedback or, in severe cases, Interstim

Urinary Incontinence (Male and Female)

Urinary Incontinence is the inability to hold your urine in your bladder. This can happen to men and women, although women are more likely to develop it. According to the National Association for Continence (NAFC), and based on expert opinion, 25 million adult Americans experience transient or chronic urinary incontinence. NAFC estimates that 75 percent to 80 percent of those sufferers are women, 9 million to 13 million of whom have bothersome, severe symptoms.

There are several causes for urinary incontinence and multiple treatments. Incontinence can become severe enough that it can impact your daily life. Many patients find that they stop being as physically active, they stop traveling or being social, some have intimacy issues with their significant other, and even some note they have issues with their professional life.

There are many treatments available to lessen, if not cure, this problem. NAFC estimates that two-thirds of men and women from age 30 to 70 have never discussed bladder health with their doctor. Speak to your provider to discuss this issue and get your lifestyle back.

There are four types of incontinence:

  • Stress. This is unintentional leaking when putting pressure on the bladder by picking up something heavy, exercising, changing positions, coughing, sneezing or laughing.
  • Urge. This is when you feel you have to urinate, make the choice to head to the restroom, and on the way you leak urine. Rarely can these patients make it to the restroom quickly enough without leaking urine.
  • Mixed. This is a combination of stress and urge. This can occur due to the bladder being unable to hold the volume of urine your body produces.
  • Overflow. This is leaking that results due to a bladder that never completely empties. There can be multiple reasons this happens. It can be a neurological system problem or an anatomical problem. Your physician can help determine this through testing.

Treatment Options

Kegel Exercises

Kegel exercises are exercises of the pelvic floor muscles. These can be done anywhere at anytime. These exercises are generally recommended prior to any medical or surgical intervention.

It can be difficult to locate the pelvic floor muscles. It is best described that if you were to about to pass gas through your rectum and wanted to stop, these are the muscles you would need to use to prevent that from happening.

Some give an example that during urinating, if you stop your stream, the muscles that tighten to do this are the pelvic floor muscles. Those two descriptions should help you identify the pelvic floor muscles. We do not recommend stopping your urine stream as an exercise; this should only be used initially to identify the muscles you need to strengthen.

The typical routine for strengthening these muscles is to squeeze for 10 seconds and relax for 10 seconds, repeat this for the count of 10. Do these at various times during the day. It is recommended to do all 10 reps in lying, sitting and standing positions.

One should be mindful not to contract abdominal muscles, leg muscles or buttock muscles to complete the pelvic floor exercises. These muscles will tend to tighten, but concentrate on breathing normally and relaxing them and let the pelvic floor muscles do all the work.

Make sure you have an empty bladder when performing the exercises. You should not perform more than 60 in one day.

Biofeedback of the Pelvic Floor Muscles

This therapy is intended to assist patients in learning how to strengthen and relax the pelvic floor muscles.

There are electronic and mechanical measuring devices that assist a patient in visualizing how these muscles are responding to their mental signals. The contraction and relaxation phases are graphed on a computer screen in real time.

This provides feedback on how the patient is doing, and the patient can make immediate corrections if needed. Generally, the patient is seen in the office once a week for a six- to eight-week treatment plan.

Patients do the repetitive exercises at home; this is a critical part of the treatment plan and must be done to provide the best outcome. The patient is re-evaluated at each visit.

InterStim Therapy

Interstim is a first and second phase nerve stimulation therapy for bladder disorders and pelvic pain. It is an FDA-approved procedure, which has been shown to help women with urinary retention and overactive bladder. Learn more about Interstim.

TVT (transvaginal tape) Sling

TVT (transvaginal tape) sling is a treatment that may be recommended by your physician to treat stress incontinence with a minimally invasive outpatient procedure.

The TVT procedure is done under general anesthesia, and you will also be given local numbing medication.

A small incision is made in the vaginal wall under the urethra. The sling is inserted on each side, and a small puncture is made at the groin on both sides where the tape is pulled up. This tightens the sling to support the urethra.

The puncture sites are covered with bandages and the small incision in the vaginal wall is sutured closed with dissolvable sutures.

The procedure typically takes around 30 minutes. Recovery is around two to six weeks, and many women find that their symptoms are either completely remedied or drastically minimized almost immediately after the procedure. Post-procedural pain is usually minimal.

Single Incision Sling

A single incision sling is a treatment that can be recommended by your physician to treat stress incontinence. It only requires your provider to make a 1.5-centimeter vaginal incision to insert the sling under the urethra. There are no external incisions. The limited incision can potentially decrease pain and post-procedure recovery time.

Most patients can return to work within a few days, with a restriction on lifting and intercourse for four to six weeks. As with all treatment plans, your physician should discuss with you the most appropriate treatment plan for your situation.