Incontinence, diagnosed properly.
Bladder leakage has different causes and different treatments. We perform a comprehensive evaluation to understand what's causing your symptoms, because the right treatment depends on knowing what type of incontinence you have.
You’re not alone, and you don’t have to live with this
Urinary incontinence, involuntary leakage of urine, affects millions of women. It’s common, but that doesn’t mean you have to accept it as normal. Effective treatments exist, and most women can achieve significant improvement or complete resolution of their symptoms.
The key to successful treatment is understanding what type of incontinence you have, because different types require different approaches.
Common types
Stress urinary incontinence (SUI). Leakage that occurs with physical activity: coughing, sneezing, laughing, lifting, or exercise. This happens when the muscles and tissues supporting the bladder and urethra have weakened, often due to pregnancy, childbirth, menopause, or aging.
Key characteristic: leakage with activity or exertion.
Urge urinary incontinence (overactive bladder). A sudden, intense urge to urinate followed by involuntary leakage. You may feel like you can’t get to the bathroom quickly enough. Often associated with urinating frequently (more than 8 times per day) and waking at night to urinate.
Key characteristic: “gotta go” urgency followed by leakage.
Mixed incontinence. Many women have features of both stress and urge incontinence. Identifying which component is more problematic helps guide treatment priorities.
The right treatment depends on the right diagnosis
Treatments that work well for stress incontinence often don’t help urge incontinence, and vice versa.
A woman with stress incontinence might benefit from pelvic floor exercises or a surgical procedure. A woman with urge incontinence might need medications or bladder training. A woman with both needs a treatment plan that addresses both components in the right order.
Without proper evaluation, you might try treatments that don’t address your actual problem, waste time and money on inappropriate therapies, miss other conditions contributing to your symptoms, or undergo procedures that won’t help.
Our goal is to understand your specific situation before recommending treatment.
Comprehensive evaluation
We take the time to thoroughly evaluate your symptoms, because understanding your condition is the first step to treating it effectively.
Our evaluation includes
- Detailed symptom history. When do you leak (with activity vs. with urge)? How often do you urinate? Do you wake at night? How much does this affect your daily life? What have you tried before?
- Medical and surgical history. Previous pregnancies, childbirth, surgeries, medical conditions, and medications can all affect bladder function.
- Physical examination. A pelvic examination helps assess the strength of your pelvic floor muscles, look for prolapse, and evaluate other factors.
- Voiding diary (optional). A record of your fluid intake, urination frequency, and leakage episodes provides objective data.
- Additional testing (if indicated). Post-void residual measurement, urinalysis, urodynamic testing, or cystoscopy depending on your situation.
After evaluation, we’ll explain what’s causing your symptoms and discuss treatment options specifically suited to your type of incontinence.
A full range of treatment options
We start conservative and progress to more involved treatments only if needed. The right approach depends on your type, severity, preferences, and history.
| Type | Treatment | What it is |
|---|---|---|
| Stress | Pelvic floor training (Kegels) | Strengthen the muscles supporting the bladder. Technique matters; we provide guidance or refer to a pelvic floor PT |
| Stress | Pessary | A vaginal device that supports the bladder neck. Good non-surgical option to avoid or delay surgery |
| Stress | Urethral sling surgery | A supportive sling placed under the urethra. Highly effective when conservative measures don’t work |
| Urge | Behavioral therapy | Bladder training, fluid management, dietary changes (caffeine, alcohol) |
| Urge | Pelvic floor PT | Targeted exercises with a trained therapist; helps stress incontinence too |
| Urge | Medications | Anticholinergics (oxybutynin, tolterodine, solifenacin) or beta-3 agonists (mirabegron, vibegron) |
| Urge | Botox injections | Botulinum toxin into the bladder muscle, when first-line treatments fall short |
| Urge | Neuromodulation | PTNS or sacral nerve stimulation for difficult cases |
For mixed incontinence, we prioritize treatment based on which component is most bothersome, then take a staged approach.
Why choose Sterling Urology for incontinence care
We diagnose before we treat. Many women come to us after trying treatments that didn’t work, often because the treatment didn’t match their type of incontinence. We take the time to get the diagnosis right.
Urological expertise. As a board-certified urologist, Dr. Greene has specialized training in the evaluation and treatment of urinary incontinence and related conditions.
Full range of options. From conservative therapies to advanced procedures, we offer comprehensive treatment options and help you understand which approach is best for your specific situation.
Patient-centered approach. We explain your options clearly, involve you in decision-making, and respect your preferences about treatment.
Insurance-friendly. We accept most major PPO insurance plans and Medicare.
Questions we hear most.
Is urinary incontinence a normal part of aging?
Is incontinence something I should be embarrassed about?
What's the difference between stress and urge incontinence?
Do Kegel exercises really work?
Will I need surgery?
How effective is surgery for stress incontinence?
What are the side effects of bladder medications?
How long does treatment take?
Is incontinence treatment covered by insurance?
Ready to address your incontinence?
Urinary incontinence affects your quality of life, your confidence, and your daily activities. It doesn't have to. The first step is a comprehensive evaluation to understand what's causing your symptoms. You'll be treated with dignity and respect, and we'll work together to find a solution.