The urologists at the DuPage Medical Group Bladder Health Clinic specialize in incontinence, pelvic organ prolapse, recurrent urinary tract infections (UTIs) and bladder pain. Our physicians are leaders in the treatment of bladder health issues and provide you with personalized treatment plans. Bladder Health Clinics are held at our Lisle Medical Office Building on selected Saturdays for consultations and procedures.
Urinary incontinence, also known as involuntary urination, is considered any leakage of urine or difficulty with bladder control. This is a very common and embarrassing problem and can range from occasionally leaking urine when you laugh, sneeze or cough to having such a sudden, strong urge to urinate that you can’t get to the bathroom on time. Urinary incontinence is underreported and affects more people than you might expect. Many people choose to just deal with urinary incontinence, and don’t know treatment is available, or have no desire to seek treatment. Incontinence falls into two categories:
Urge incontinence occurs when you have a strong or sudden need to urinate. The bladder spasms and you lose urine. Most people feel the urge to urinate when they have roughly 1 cup of urine in their bladder. Two muscles help to prevent the flow of urine. With urge incontinence, you leak urine because your muscles contract at the wrong time. In many cases of urge incontinence, there is no specific cause. Stress Incontinence Stress incontinence is the involuntary release of urine during any activity that puts pressure on your bladder and can occur in both men and women. Some activities that place stress on your bladder include:
- Lifting weights
- Bending over
Stress incontinence occurs when your pelvic floor muscles become weakened. These muscles work as a sling to support your bladder and control the flow/release of urine. Your pelvic floor muscles weaken as you age, but pelvic surgery and injury to the pelvic area also contribute to incontinence For women, childbirth is a main contributing factor. Prostate cancer and its treatment can cause stress incontinence in men.
Treatment for urge incontinence will depend on your symptoms and how they affect your daily life. There are five main treatment options:
Pelvic Floor Muscle Strengthening (Kegels) & Biofeedback
You may be instructed in a general exercise program or you may be referred to a women’s health physical therapist to learn specific exercises that are appropriate for you. These exercises tone and strengthen your pelvic muscles as well as muscles that surround the opening of the urethra, vagina and rectum. Specific exercises can be very effective in controlling leakage. Biofeedback is sometimes used to help retrain your pelvic floor muscles. If you have a significant amount of weakness, you may be a candidate for pelvic floor muscle stimulation.
Behavioral & Lifestyle Changes
- Quitting smoking. Smoking can lead to a chronic cough that strains the pelvic floor muscles.
- Smoking may also damage the bladder and urethra.
- Losing weight. Excess weight puts extra pressure on the pelvic floor muscles and the bladder and pelvic contents.
- Making certain dietary changes. Some foods and fluids may irritate your bladder. You will learn what your bladder irritants are and how to avoid them.
- Learning how to lift properly. Heavy lifting can increase pressure in the abdominal cavity and on the bladder. Lifting properly can protect your internal organs and decrease urine leakage.
You will be taught about normal and abnormal voiding patterns and may be told to void at set times. You will also be taught urge control techniques, why leakage occurs and how to avoid it.
Medication can be used to treat urge incontinence. There are no medications that can treat stress incontinence.
In some cases of incontinence, surgery may be appropriate. You and your doctor will need to decide if surgery is the right option for you and what type will best suit your needs.
Many women face vaginal prolapse, or pelvic organ prolapse (POP), which occurs when one of the pelvic organs stretches or expands to protrude through the vaginal opening. Vaginal prolapse is very common; it affects nearly one in three women who have had a child. And POP won’t just go away on its own.
Pelvic organ prolapse is a condition that occurs when muscles and ligaments that support your pelvic organs weaken. Your pelvic organs include your bladder, uterus (womb) and rectum. A prolapse occurs when the ligaments weaken and cause your pelvic organs to slip from their natural position.
Vaginal childbirth, especially multiple pregnancies, obesity, chronic constipation, chronic heavy lifting or a prior hysterectomy are the primary causes of vaginal prolapse. Prolonged labor and large babies can weaken pelvic floor muscles that support the vagina. Women who may not completely recover from childbearing may develop vaginal prolapse. Menopause can also affect the muscle tone of the pelvic region.
Many women do not experience any signs or symptoms of vaginal prolapse. Most common symptoms include:
- Feeling of fullness or discomfort in their vagina
- Visible vaginal bulge or protrusion
- Feeling of “something falling out of the vagina”
- Difficulty urinating or defecating
As with many medical conditions, most physicians start with conservative approaches, like pelvic exercises. If the condition does not improve, or conservative methods fail, there are surgical treatment options available.
- Pelvic floor exercises – these exercises help to strengthen the pelvic floor muscles and decrease the symptoms of pelvic organ prolapse. While these may strengthen the pelvic floor, they will not fix any actual anatomic abnormality.
- Pessary – a plastic device inserted vaginally, like a diaphragm, to help support your pelvic organs. This device can be removed at any time by you or your physician.
The goal of surgery would be to recreate the natural anatomic support for the vagina and reduce the prolapse through the vagina.
- Vaginal approach – A vaginal incision is made to reposition the pelvic organs that have fallen to the normal location in the pelvis. A hysterectomy may be performed if necessary.
- Abdominal approach – Typically performed as a minimally invasive surgery using the da Vinci robotic surgical system (similar to laparoscopic surgery). Small abdominal incisions are made to allow the surgeon to reposition the pelvic organs back in the pelvis. A hysterectomy may be performed if necessary. Robotic surgery has many advantages over traditional surgical methods including less pain, less blood loss, shorter hospital stay, shorter recovery time and fewer visible scars.
Urinary tract infections (UTI) are the second most common type of infection in the body. Recurrent urinary tract infections are defined as three or more symptomatic, culture-proven UTIs in one year or a persistent, symptomatic UTI that does not respond to treatment. Typical symptoms include: pain or burning with urination, urinary frequency or urgency, bloody urine, or fever.
A UTI can affect any part of your urinary system. When an infection only affects your bladder, it’s usually a minor illness that can be easily treated. However, if it spreads to your kidneys, you may suffer from serious health consequences and may even need to be hospitalized.
Although UTIs can happen to anyone at any age, they are more prevalent in women. In fact, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates that one in five young adult women have recurring UTIs.
Most common causes:
- Sexual intercourse- bacteria from the vagina can get pushed inside the urethra
- Menopause- lack of estrogen in the vagina produces an environment that is more favorable for growth of pathogenic bacteria. Estrogen is a woman’s natural defense against bladder infections.
- Stones- in the kidney or bladder can harbor bacteria
- Spermicidal use and douching- can kill the “good bacteria” that help ward off bladder infections
- Incomplete emptying of the bladder- stagnant urine in the bladder can be a medium for bacterial growth
Bladder pain or interstitial cystitis (IC) is a chronic condition that occurs when your bladder becomes irritated or inflamed (creating a full feeling) and causes your brain to think it is time to urinate when it is not truly full. This also causes the bladder wall to stiffen, which makes it hard for the bladder to fully expand when it fills with urine.
The main symptom of interstitial cystitis is pain. Generally this pain is strongest when the bladder fills and lessens when the bladder empties. You can also experience pain in your lower back, abdomen or groin as well as bladder pressure. This condition is more common in women, and can cause you to urinate more frequently or have an urge to urinate and only pass a little bit each time. Those with severe cases may urinate as often as 60 times a day.
While there is no way to eliminate interstitial cystitis, there are medications, behavioral modifications and therapies that may provide relief.
Treating IC usually requires using more than one treatment at a time, and not uncommonly with multiple specialists.