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Urogynecology

Urinary Incontinence


As a result of pregnancy and childbirth, menopause and the structure of the female urinary tract, women experience urinary incontinence twice as often as men. Older women experience urinary incontinence more often that younger women, but incontinence is not inevitable with aging.

Incontinence occurs because of problems with muscles and nerves that help to hold or release urine. Fortunately, many kinds of urinary incontinence are treatable, and Albany Med offers expert diagnosis and management of this condition.

Treatment options for female urinary incontinence may include medications, exercises, physical therapy, surgery or urinary catheterization.

Conservative Therapy for Stress Urinary Incontinence
Non-surgical techniques aimed to restore the functional relationship between the pelvic floor muscles and the lower urinary tract may be treatment options for women with stress urinary incontinence. Women with this condition present the inability to prevent urine from leaking during activities.

Therapies include:

  • Pelvic Floor Muscle Exercise: By training the large pelvic floor muscles necessary for normal urinary function, the pelvic floor muscles can be strengthened and restored due to weakening caused by vaginal deliveries, episiotomies, chronic cough, and constipation. The pelvic floor muscle exercises are participatory, proactive, simple, noninvasive, cost-effective and  free of side effects.
  • Biofeedback: Achieved through verbal cues, palpation of pelvic floor movements, or use of manometry or electromyography (EMG), biofeedback is aimed to reverse the symptoms of urine loss by changing the physiologic stimulants that cause the loss.
  • Electrical Stimulation: Electrical stimulation is the activation of the pelvic floor muscles using a vaginal probe or surface electrodes in women with extreme weakness, or those who cannot perform a voluntary contraction of the pelvic floor.
  • Behavioral and Lifestyle Interventions: Conducted through a detailed clinical and social history, education on bladder health and prevention of faulty bladder habits are behavioral and lifestyle interventions that help to correct urinary incontinence. Voiding diaries, or charts, will be reviewed and followed to help focus on areas that potentially could exacerbate symptoms of incontinence. Recommendations in fluid intake, diet and scheduled voiding are used to increase success for the patient. 

Urodynamics
After a thorough evaluation, our physicians may also recommend a patient undergo urodynamic testing with one of our specially trained nurses. Urodynamics is the study of the transport, storage, and evacuation of urine by the urinary tract. Urodynamics is made up of numerous tests that provide the doctor with invaluable information about the function of the lower urinary tract. It also proves to be a useful guide for devising a treatment plan.

The goal is to approach symptoms holistically and provide the physician with as much information as possible for a successful treatment. A number of components are used in urodynamic testing, as well as conservative approaches to treat urogynecological disorders.

A nurse will discuss symptoms with the patient, perform the study, meet the educational needs of the patient, and then develop a plan of care with the physician.

Testing options include:

  • Uroflowmetry is the evaluation of the effectiveness of voiding urine. Examples of problems associated with the vxcoiding of urine include decreased force of stream, hesitancy, straining to void, and incomplete bladder emptying.
  • Cystometry measures the bladder’s response to being filled by evaluating the filling pressure, sensation, presence of involuntary/unstable contractions, compliance, capacity and control over voiding. This is done by using a multichannel air-charged catheter study.
  • Urethral Pressure Profilometry is a diagnostic test for stress urinary incontinence. The results of the test show the pressure along the length of the urethra in a graphic form. 
  • Voiding Pressure-Flow Study is a multichannel invasive assessment during the voiding of urine. It defines voiding dynamics and evaluates voiding flow abnormalities that may exist. Examples include obstructions or abnormal bladder contractions.
  • Electromyography studies the muscle activity of the pelvic floor muscles during bladder filling and voiding of urine. Electrodes are placed on the skin overlying the muscle of interest. The goal is to determine if the pelvic muscles are coordinated or uncoordinated with the bladder during voiding.

Testing is strongly considered prior to surgical correction for women with:

  • Combination of stress- and urge-related symptoms
  • Stress urinary incontinence
  • Poorly characterized history of incontinence
  • History of prior surgical procedures involving the pelvis
  • Suspicion of a neurological disease