Urinary incontinence, or the inability to stop urine from leaking, is not an inevitable part of aging. Nor is it something you need to live with. Doctors have identified many treatments for the condition, and we offer them all at Maimonides Pelvic Floor Center. We’re Brooklyn’s only full-service pelvic floor center, providing care for both women and men.
What Is Urinary Incontinence?
Urinary incontinence is a type of bladder control problem that affects your ability to hold or release urine. We treat all types of incontinence, including:
Stress incontinence: Coughing, sneezing, laughing, running or other movements squeeze the bladder and cause urine to leak. While being the most common bladder control problem affecting women, men who have had prostate surgery also have a higher risk of developing stress incontinence.
Urge incontinence: Also called overactive bladder, this causes a frequent, urgent need to urinate. You may leak urine before reaching the toilet and, may only eliminate a small amount of urine. Weak urinary tract muscles or nerve damage can cause urge incontinence.
Mixed incontinence: Some people experience both stress and urge incontinence. Others experience both urinary and fecal incontinence.
What Causes Urinary Incontinence?
Weakened pelvic floor or urinary tract muscles can contribute to urinary incontinence. Nerve damage can, too. Other factors that increase the risk of bladder control problems include:
Gender: Half of all women experience urinary incontinence at some point in their lives. The condition affects about one-third of men.
Age: Urinary tract muscles naturally weaken with age, making it more difficult to hold in urine.
Pregnancy and menopause: The strain of carrying a baby and giving birth can weaken pelvic floor muscles. Loss of estrogen during menopause also relaxes these muscles.
Prostate problems: Certain prostate cancer treatments and other prostate problems can affect bladder control in men. The risk of prostate problems increases with age.
Health issues: Conditions such as diabetes, obesity and birth defects can lead to urinary incontinence.
Diagnosing Urinary Incontinence
Diagnostic testing takes place in our state-of-the-art urodynamic lab. Our specialists use the most advanced methods to pinpoint the cause of incontinence. These tests include:
Cystoscopy: Your doctor uses a hollow tube with a lens called a cystoscope to examine the urethra and bladder.
Bladder function tests: These tests gauge how well the bladder, urethra and the sphincter (muscles that control urination) hold and release urine.
Dynamic pelvic floor MRI: This scan uses a magnetic field and radio waves to create detailed cross-sectional images of the pelvic floor muscles.
Fluoroscopy X-rays: During this test (also called cystography), your doctor uses a contrast dye to see the bladder more clearly while a moving X-ray beam sends images of the bladder to a computer screen.
Computed tomography (CT) scans: These scans provide images of the bladder and pelvic floor region.
Nonsurgical Treatments for Urinary Incontinence
We offer a complete range of treatments for urinary incontinence. Our doctors always start with treatments that help you avoid surgery.
You can make certain changes to improve urge incontinence, such as: urinating at set times, extending the amount of time between bathroom breaks, cutting back on alcohol and caffeinated beverages.
For urge incontinence, your doctor may recommend an injection of botulinum toxin type A into the bladder’s muscles. The injection blocks or calms nerve communication to the bladder and urinary sphincter muscles.
Mild electrical impulses can strengthen pelvic floor muscles and help with urge incontinence. The treatment, called percutaneous tibial nerve stimulation (PTNS), also blocks nerve signals that contribute to the problem. Most people receive this 30-minute office procedure once a week for 12 weeks. They then receive occasional follow-up treatment.
For urge incontinence, certain prescription medications can calm an overactive bladder or relax the bladder muscle to increase bladder capacity.
Pelvic floor exercises (Kegels) with biofeedback
By working with a pelvic floor specialist, you can learn exercises (often called Kegels) to strengthen pelvic floor muscles. We use sensors placed in the vagina to ensure you properly engage the right muscles, an approach called biofeedback.
For women with incontinence caused by pelvic organ prolapse, a small plastic ring can hold up the bladder to prevent urine leakage. You insert the ring, called a pessary, into the vagina every day or just leave it in.
Urethral bulking agents
Your doctor injects a special protein (collagen) or water-based gel around the urethra. These substances stop leakage by thickening the area and putting pressure on the urethra. Bulking agents are most effective for stress incontinence.
Surgical Treatments for Urinary Incontinence
We also offer surgical expertise when other procedures don’t relieve incontinence. If appropriate, we use minimally invasive surgical techniques that require smaller incisions. You experience less blood loss during surgery, less pain during recovery and less scarring. You can also return to normal activities sooner.
Bladder neck suspension
Your doctor pulls up part of the bladder and secures it to ligaments near the pubic bone. This procedure for stress incontinence provides support for a sagging bladder.
We’re experts at implanting neurostimulator systems to treat both urinary and fecal incontinence. The device also treats urinary retention, or the inability to completely empty the bladder. Your doctor places this small pacemaker-like device under the skin in your buttocks. The device sends electrical impulses to the sacral nerve, which sits in the pelvis and controls the bladder and urinary sphincter muscles. At Maimonides, you can try out the device before having it implanted.
Inflatable artificial sphincter
This procedure treats stress incontinence, as well as incontinence caused by prostate cancer treatments. It uses a small system implanted inside your body that includes a pump. When you squeeze the pump with your fingers, it opens a cuff that sits around the urethra, allowing urine to pass.
Your doctor uses synthetic material or your own tissue to create a hammock-like sling that supports the urethra. The sling keeps the urethra closed in people who have stress incontinence due to pelvic organ prolapse or incontinence caused by prostate cancer treatments.
To make an appointment at the Maimonides Pelvic Floor Center, call 718-PELVIC-1 (718-735-8421) or request an appointment online.