Incontinence and Pelvic Organ Prolapse
Millions of women of all ages suffer from incontinence or overactive bladder in silence and embarrassment, not knowing where to turn for help. By turning to the experts at Mount Sinai, women who have suffered the physical and emotional effects of pelvic floor disorders such as urinary incontinence, pelvic organ prolapse, overactive bladder, stress incontinence, vaginal laxity, labial enlargement, mesh complications, and complications from previous surgery have had their lives restored.
What is Female Incontinence?
- Women with urinary incontinence have difficulty controlling urine passage
- Urinary incontinence affects millions of women
- Some women have leakage every day, others occasionally
- Some women are more troubled by it than others.
In general, there two types of urinary incontinence:
- Stress urinary incontinence (SUI)
- Urge urinary incontinence (UUI)
Women who have both components are said to have mixed incontinence. Women who are not sure which component they have are said to have unaware incontinence.
Facts about stress urinary incontinence (SUI)
- SUI is an involuntary loss of urine that occurs during physical activity, such as coughing, sneezing, laughing, or exercise.
- It occurs in all age groups.
- Sometimes, SUI is accompanied by a weakening in the entire pelvic floor resulting in the herniation of the bladder (cystocele), rectum (rectocoele) or uterus (uterine prolapse) into the vagina.
- A weak urethral sphincter or a malfunction in the urethral sphincter may cause SUI.
- Previous childbirth and pelvic surgery are the most common risk factors.
Facts about urge urinary incontinence (UUI)
- Leakage accompanied by a strong urge to urinate.
- Insuppressible involuntary bladder urinary contractions.
- Running water or excessive cold may trigger UUI.
- Greater at night or first thing in the morning .
- Most common in older women.
- Neurological injuries (such as spinal cord injury or stroke).
- Neurological diseases (such as multiple sclerosis).
- Infection, inflammation, or bladder outlet obstruction.
Diagnosis and workup
Incontinence is sometimes easily diagnosed based on a personal history and physical exam. Patients who only leak with a cough or laugh or who demonstrate leakage with a full bladder most likely have SUI. Other patients may need further testing (see below) to find the cause of their leakage. Many patients require one or more of these tests during their initial evaluation.
- Post void residual -measurement of the amount of urine left in the bladder after urinating. Patients who do not empty their bladders will sometimes have leakage from urine overflow.
- Urinalysis and urine culture -a procedure to look for a urinary tract infection.
- A pad test - the patient collects her pads over a 24-hour period to determine the incontinence's severity.
- Video urodynamics - a test that places a small catheter in the bladder, filled with a water-based x-ray detectable dye . Bladder pressures are measured during filling and voiding and x-rays are taken .To see if the sphincter is weak a bladder test is done.
- Cystoscopy is an endoscopic look inside the bladder.
Our Urogynecologists (surgeons who are trained in the treatment of pelvic floor disorders) use a wide variety of conservative treatment options including dietary changes, pelvic floor muscle exercises, medication, biofeedback, counseling, physical therapy and electrical stimulation. We also use an Interstim Sacral Nerve Root Stimulator, a tiny pacemaker for the bladder which is placed in the lower back to control urinary urgency and frequency.
For women whose quality of life is bad enough, surgery to reconstruct the vaginal supportive tissues is an option. We treat patients utilizing the latest technology as a matter of course and minimally-invasive techniques – including the use of Robotics - whenever possible.
We also provide religious and culturally- sensitive care to a large number of Orthodox Jewish women.
We Can Help
To make an appointment, please call us at 212-241-7952.
To make an appointment with a Mount Sinai urogynecologist, please contact us at 212-241-7952.
Division Director, Gynecology and Urogynecology
Assistant Professor, Obstetrics, Gynecology and Reproductive Science
Incontinence & Pelvic Organ Prolapse
Maternal Fetal Medicine
Prenatal Care & Childbirth Preparation
Reproductive Endocrinology and Infertility