Incontinence

What are the common forms of incontinence?

Stress incontinence is when you lose a little urine as you laugh, cough, sneeze, and with physical activity. This usually affects younger women who are premenopausal and is more frequently linked to pregnancy and childbirth.

Urge incontinence is a sudden need to urinate that is so strong you might have difficulty making it to a toilet in time. This type is more common in older women who are no longer menstruating (postmenopausal).

How common is incontinence?

Many women experience incontinence, which tends to increase with age. At the age of 50, about 30% of women are affected, and by the age of 80, this condition impacts around 60% of women.

Do I need to see a doctor if I have trouble controlling my bladder?

You should see a doctor if you are bothered by it and want treatment.

How do you treat incontinence?

The treatment depends on the type and severity of incontinence. There are a variety of treatments including physical therapy, medications, bladder retraining, lifestyle modifications, and surgery.

Overactive bladder

How do I know if I have an overactive bladder?

An overactive bladder can cause frequent and urgent urination, sometimes leading to incontinence. It’s more common in older women who are postmenopausal.

How is it different from incontinence?

Overactive bladder can include incontinence, but not everyone with overactive bladder has incontinence.

What causes an overactive bladder?

Medications, surgery, infections, menopause, radiation, and neurological conditions can cause an overactive bladder, but most of the time there is no specific cause.

How do you treat this condition?

Doctors treat overactive bladder with lifestyle changes, physical therapy, medications, office procedures, Botox injections, and/or an internal bladder stimulation.

Urinary Tract Infections

How do I know if I have a urinary tract infection (UTI)?

Symptoms of a UTI include sudden urinary urgency, frequency, or pain during urination. The short female urethra and the presence of bacteria in the vulva increase the likelihood of UTIs in women. Recurrent UTIs often start after becoming sexually active.

What causes UTIs?

Urinary tract infections are quite common in women. This is mostly due to their anatomy. The female urethra is short and the vulva is covered in bacteria so it is not difficult for the bacteria to get into the bladder. On average, it is only a few inches from the urethra to the anus. For these reasons, 50 to 60% of women will get at least one UTI during their lifetime and about 10% of women experience them chronically.

What are recurrent UTIs and why do some women get them?

For many women, chronic UTIs start when they become sexually active. During sex, the bacteria from the vulva can get into the bladder. Most of the time, the bacteria will not be able to grow and multiply but if they do, women will experience the pain and discomfort of a UTI.

When do I need to see a doctor?

You should see a doctor if you think you have a urinary tract infection or if you have them repeatedly.

Treatments We Offer

At Coastal Women’s Health, we tailor treatments to your specific condition and symptoms. We use a wide variety of state-of-the-art treatments. These include:

Pessary:

This device, made of silicone, can be placed in the vagina to address prolapse and stress incontinence. It can also keep the prolapse from getting worse. Once it has been fitted, you won’t notice it is there.

Medications:

We provide medications tailored for specific types of incontinence.

Behavioural treatment and education:

Our approaches include pelvic floor exercises (kegel exercises or pelvic muscle rehabilitation) and bladder retraining to address incontinence and improve quality of life.

Physical therapy:

We offer various physical therapy techniques, including kegel exercises, which involve tightening and loosening the muscles you use to hold your urine in.

Gynaecologic surgery:

We perform a variety of procedures, such as:

Scarless gynaecologic hysterectomy: A vaginal approach known for safety, cost-effectiveness, and minimal scarring compared to robotic or laparoscopic methods.
Colporrhaphy: Surgical repair for defects in the vaginal wall.
Dilation and curettage: A procedure involving the sampling of uterine tissue.
Endometrial ablation: Removal of the lining of the uterus.
Hysterectomy: Removal of the uterus, which may involve the cervix, ovaries, fallopian tubes, and surrounding structures.
Laparoscopic hysterectomy: A minimally invasive procedure using a camera and instruments threaded through small incisions to remove the uterus.
Tension-free transvaginal tape procedure: A quick 20-minute minimally invasive outpatient method for bladder control.
Minimally invasive prolapse surgery: Repairing a dropped (prolapsed) vagina or uterus using the patient’s tissue.
Myomectomy: Surgical removal of fibroids from the uterus.
Oophorectomy: Removal of one or both ovaries.
Pelvic floor reconstruction: A procedure to address pelvic organ prolapse.
Tubal ligation: A contraceptive procedure commonly referred to as “tube tying”.

Bladder Control Problems

Loss of bladder control, known as urinary incontinence, impacts both men and women but is more common in women. It affects 30-50% of women, and while common, it is not considered normal at any age.

This condition can significantly impact various aspects of life, including physical and social activities, work, travel, intimacy, and overall quality of life.

Urinary Incontinence Treatment

Urinary incontinence can have a significant effect on your quality of life. At Coastal Women’s Health, we understand that it can undermine your sense of well-being, and your ability to live your life the way you want.

After experiencing these problems, women may begin to stop exercising or participating in physical or social activities, further reducing health and quality of life. Work activities, travel and intimacy also may suffer. The good news: 80 to 90% of women who seek treatment for urinary incontinence experience significant improvement.

Treatment Options

A wide array of treatment options exist, ranging from behavioural and diet changes to surgical options.

Non-surgical options include neuro stimulation of the pelvic floor (Interstim) and PINS (peripheral tibial nerve stimulation).
Surgical options at Coastal Women’s Health include suburethral sling, pubovaginal sling and TVT tension free vaginal tape.

Our urogynaecology program will evaluate your symptoms and review treatment options appropriate for your urinary incontinence.

Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the pelvic floor lacks support, leading to a bulging of the vaginal wall. It’s estimated that nearly 50% of women between 50 and 79 experience some form of prolapse. Common symptoms include pressure in the vagina, the sensation of “sitting on a ball,” difficulties with urination or bowel movements, and discomfort during intercourse.

Pelvic Organ Prolapse Causes

Injuries to the muscles or fascia of the pelvic floor are typically caused by women having children, especially vaginal or operative vaginal deliveries (e.g. with forceps).
Menopause, aging and intense repetitive physical activity can also lead to pelvic organ prolapse.
Other factors that lead to increased pressure in the abdomen (such as obesity, chronic constipation and chronic coughing) can worsen or lead to pelvic organ prolapse.
In some cases, prolapse is a hereditary disorder that runs in families.
Some women are born with weaker tissues and are therefore at risk to develop prolapse. For example, Caucasian women are more likely than African American women to develop pelvic organ prolapse.

Pelvic Organ Prolapse Symptoms

Women with pelvic organ prolapse often have no symptoms. However, the following are common complaints of women with pelvic organ prolapse:

A bulging, pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements
The feeling of “sitting on a ball”
Needing to push stool out of the rectum by placing fingers into or around the vagina during a bowel movement
Difficulty starting to urinate, a weak or spraying stream of urine
Urinary frequency or the sensation of being unable to empty the bladder
The need to lift up the bulging vagina or uterus to start urination
Urinary incontinence (leaking) and/or faecal incontinence
Pain with intercourse
Vaginal dryness or irritation

Pelvic Organ Prolapse Treatment at Coastal Women’s Health

An array of treatment options for pelvic organ prolapse exist, including the non-surgical option of a pessary. A pessary is inserted into the vagina to reduce the prolapse inside the vagina.

Surgical options at Coastal Women’s Health include robotic sacrocolpopexy and vaginal surgery.

Our urogynaecology program will evaluate your prolapse and review treatment options appropriate for your situation.