Urinary Incontinence
Urinary incontinence can affect daily activities, confidence and quality of life, but effective care is available. Our specialists focus on understanding the cause of urine leakage and guiding women toward personalized, evidence-based treatment options.
Urogynecology and pelvic medicine
If you have pain, pressure or leaking “down there,” there’s no need to suffer in silence. Our Pelvic Medicine specialists can help you with both surgical and nonsurgical options.
Symptoms like these could be the sign of a pelvic floor disorder—a group of conditions that happen when the muscles, ligaments, and tissues holding the pelvic organs in place become weak and cannot hold up the pelvic organs properly. The pelvic organs are the vagina, uterus, bladder, urethra, and rectum.
Pelvic floor disorders are surprisingly common. They affect about a quarter of all women, more than 40 percent of women ages 60 to 79, and half of women ages 80 and older. We offer surgical and nonsurgical options that strengthen pelvic muscles, restore pelvic anatomy, and enhance your quality of life.
Pelvic floor disorders occur when the muscles, ligaments, and tissues that support the pelvic organs weaken or fail to hold organs in place. These organs include the vagina, uterus, bladder, urethra and rectum. Pelvic floor disorders are common and can significantly impact quality of life. Atlantic Health specialists offer both surgical and nonsurgical treatment options to help restore pelvic support and improve symptoms.
Pelvic floor disorder symptoms
You might have a pelvic floor disorder if you experience any of these symptoms:
- Pain, pressure, or discomfort in the pelvic area
- A feeling of heaviness or aching in the vagina
- Seeing or feeling something coming out of the vagina
- Trouble urinating or pain while urinating
- The feeling of having to urinate urgently or frequently
- Leaking urine when you cough, laugh, or exercise
- Having many urinary tract infections
- Leaking stool
- Constipation
- Having trouble making it to the bathroom on time
Common pelvic floor conditions treated
Atlantic Health clinicians can diagnose and manage a wide range of pelvic floor disorders, including:
- Urinary incontinence: Loss of bladder control
- Fecal incontinence: Loss of bowel control
- Pelvic organ prolapse: When muscles and ligaments weaken and an organ drops below its normal position, including:
- Uterine prolapse
- Rectocele
- Cystocele
- Enterocele
- Vaginal vault prolapse
- Pelvic pain: Pain in the pelvic, genital, rectal, abdominal, hip or low back region
- Painful intercourse and post-childbirth pelvic weakness
Treatment options
Pelvic floor therapy
The pelvic floor is a group of muscles that stretch from the pubic bone to the tail bone, acting as a sling or hammock to hold up the pelvic organs. These muscles benefit from exercise just like any others. If they become weak, the pelvic organs drop, which can cause urinary incontinence [EC1] and other issues. If they become too tight, they can cause pain.
Our OceanFirst Rehabilitation Center offers a Pelvic Floor Program[EC2] designed specifically to treat pelvic floor conditions by targeting and strengthening these muscles. Our specially trained therapists evaluate and treat pelvic floor disorders with gentle physical therapy interventions, which typically improve symptoms after a few visits.
Pelvic floor therapy begins with a comprehensive evaluation, and then a physical therapist guides you with specific exercises to help restore the musculoskeletal balance of your pelvis, hip, and trunk regions – so you can regain a healthy and independent lifestyle. Treatment may include:
- Pelvic floor exercises to strengthen pelvic muscles and improve control
- Yoga-based movements to increase strength and body awareness
- Biofeedback/surface EMG to help you know that you’re contracting the right muscles
- Education on lifestyle changes that decrease bladder irritability
- Maintaining a bladder diary to aid in retraining your bladder
- Relaxation and deep breathing techniques
Proactive Support After Childbirth
During pregnancy and childbirth, women’s bodies can shift and change. The three months after childbirth — called the fourth trimester — is an important time for women to regain their muscle strength, as pushing during childbirth often results in weakened pelvic floor muscles. Our Pelvic Floor Program can help strengthen strained and weakened muscles before problems like urinary incontinence begin.
Pessaries
A pessary is a nonsurgical treatment option for certain women with organ prolapse. A urogynecologist can fit you for this device, which is inserted into the vagina to lift up the pelvic organs. A pessary is a good option for women who are awaiting surgery, do not want surgery, or are unable to have surgery.
Pessaries can be worn all the time or just during the day. They should be checked and cleaned periodically, which can be done at the urogynecologist’s office.
Medicines and lifestyle changes
Sometimes medicines can help relieve symptoms for those with certain pelvic floor disorders. For example, medicines that soften stools can be used for certain bowel conditions, and medicines that control muscle spasms or unwanted bladder contractions can help with some types of urinary incontinence.
Changes in diet and lifestyle can also help in some cases. For example, eating more fiber may help with bowel problems. Losing weight can also reduce symptoms for those with certain pelvic floor disorders.
Surgical treatments
Over the past decade, significant advances have been made in the surgical treatment of pelvic floor disorders. Many of these procedures can now be done on an outpatient basis, enabling you to return home from the hospital on the same day.
The type of surgery needed depends on each specific disorder. For example, in organ prolapse, the first step is for a urogynecologist to distinguish which organ or organs are causing the problem. Then, a solution can be offered that meets your unique expectations and lifestyle.
At Atlantic Health, pelvic floor disorders can be treated in a variety of ways, including:
- Vaginal surgery: Surgery through an incision in the vagina.
- Minimally invasive laparoscopic surgery: Surgery is performed through tiny incisions, meaning less scarring and a quicker recovery.
- Minimally invasive robotic laparoscopic surgery: In robotic surgery, our surgeons use the da Vinci® robotic surgery system to work through the arms of a robot with unmatched visualization and dexterity, along with the benefits of less pain, less scarring, and a quicker recovery for patients. We use the da Vinci Xi® robotic system – the latest technology in minimally invasive surgical treatment options.
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Urinary incontinence
The medical team at Atlantic Health’s Division of Urogynecology and Pelvic Reconstructive Surgery answer some frequently asked questions about urinary incontinence.
Urinary incontinence
Urogynecology is a subspecialty within obstetrics and gynecology that focuses on disorders of the female pelvic floor such as pelvic organ prolapse (bulging out of the uterus and/or vagina), urinary incontinence, fecal incontinence and constipation. [EC1] After completing a residency in obstetrics and gynecology, urogynecologists complete fellowship training where they spend several years focusing only on these disorders
Many women incorrectly assume that urine leakage is normal. While the problem of urine leakage is very common, it should never be considered normal. The most commonly quoted study estimates that 11 million American women currently suffer from leakage of urine. However, this estimate may be low. A study of 2,800 postmenopausal women with an average age of 67 found that 56 percent of women experienced urinary incontinence at least weekly.
Urinary incontinence is a symptom, not a disease, with many possible causes. The key to treatment is identifying which type of urinary incontinence you have through a careful medical interview and physical exam. Sometimes doctors need to perform tests called urodynamics to diagnose the problem. Urodynamics are necessary if a woman is considering surgery to correct incontinence.
The two most common types of urinary incontinence are stress incontinence and urge incontinence.
Stress incontinence is urine leakage that happens during an activity that causes pressure (or “stress”) on the bladder such as laughing, lifting, coughing or sneezing.
Urge incontinence is urine leakage that occurs before a woman has a chance to urinate. Women with this type of leakage may also experience frequent urges to urinate and frequent nighttime waking to urinate.
Stress incontinence can be effectively treated with pelvic floor exercises, devices that "block" the loss of urine, or surgery. There is also a new medication called Duloxetine that will soon be available for the treatment of stress incontinence. Urge incontinence is commonly treated with medications, biofeedback, or electrical stimulation to the nerves that control the bladder. A new treatment for urge incontinence places an electrical stimulator, similar to a pacemaker, under the skin.
There is no surgery for incontinence with a 100 percent success rate, but two procedures – the retropubic urethropexy and the suburethral sling – work 75 to 95 percent of the time.
A suburethral sling called "Tension Free Vaginal Tape" (TVT) is considered by surgeons to be the best option for most women and can be positioned on an outpatient basis under local anesthesia.
Some potential complications of surgery for incontinence include difficulty emptying the bladder and the development of urge incontinence.
Most of the negative press about sub-urethral slings can be traced back to one or two poorly-designed products that are no longer on the market. The best synthetic slings are made of a loosely-woven polypropylene mesh designed especially for placement under the female urethra, providing the necessary support, while still allowing for excellent “tissue-in-growth.” In other words, your body will grow into the sling material within a few weeks after surgery. While problems with this approach can occur, they are very rare. It is recommended that you consult with your doctor for more information about the type of sling he or she will use.
We don't fully understand all the factors that cause urinary incontinence, so it is difficult to recommend ways to prevent the problem. Pelvic muscle exercises (PME) – also known as Kegel exercises – are probably the best way to prevent stress incontinence. Also, avoid eating or drinking anything known to irritate the bladder.
Some of our specialty, diagnostic, surgical and non-surgical treatments are provided through Morristown Medical Center and Overlook Medical Center. Physician services are provided through Atlantic Medical Group > [EC3]