Q: One week after a spinal, I experienced slight incontinence with coughing. If nerve was injured or affected, what can be done? Years later, I now have frequent urinary leakage beginning.
A: Dr. Bradley: This is most likely a coincidence, but is unrelated. There are many causes of frequent urination including diabetes, urinary tract infection (UTI), too much caffeine or water. A very common cause of urinary frequency is due to an overactive bladder. There are tests (urodynamics) that can be ordered by your gynecologist. These tests are very easy and help determine the cause of frequent urination. Additionally, daily medication may also decrease urinary frequency and urgency.
Q: What can I do to get a full night sleep? I am up 4 or more times going to the bathroom every night.
A: Dr. Natalie_Bowersox: I would make an appointment to see your physician. Getting up that many times during the night can be due to many reasons ranging from pregnancy to drinking too much fluid in the evening, to issues with bladder control.
Q: After my third child, I now have issues with urinary incontinence. More so, I have to go to the bathroom all the time. I will go, and then ten to twenty minutes later I have to go again. When I do go, there is not a lot of volume, which I would expect the opposite to be true? I have tried doing the Kegel exercises, but they don’t seem to work. What else can I do?
A: Dr. Natalie_Bowersox: I think this would be a great time to discuss this with your gyn. Some of us do treat incontinence or they may refer you to a urogynecologist (a GYN with additional training in urologic problems) to evaluate your concerns. Sometimes medications can help treat the symptoms that you are experiencing and can make a big difference.
Q: When I go to the bathroom, I almost always have to urinate again within about 10 minutes. Does this mean I am not fully emptying my bladder the first time? What can I do about this? It is very annoying; especially when I am going somewhere, have a meeting at work, etc.
A: Dr. Megan_Tarr: Urinary urgency without incontinence is often best approached with the use of vaginal pelvic floor physical therapy and behavioral therapy. Many times, women with urinary urgency feel that they are not completely emptying their bladder. After it is assured that a woman is completely emptying her bladder, it is important to assess how much she is drinking during the day and to make sure that she does not have a urinary tract infection. With proper training through physical therapy, women can often gradually prolong their intervals between voiding, as some of this becomes a behavioral issue.
Q: Do you have any suggestions to help a woman empty her bladder completely when urinating?
A: Dr. Megan_Tarr: In order to answer this question, I would have to know why you feel that your bladder is not emptying completely. If it is due to a past incontinence surgery, you may find that sitting backwards on a toilet or attempting to relax your pelvic floor muscles while urinating may be helpful. Sometimes, a specialized pelvic floor physical therapist can teach you how to train your pelvic floor muscles to relax more completely during voiding. Alternatively, if you have pelvic organ prolapse, you can simply reduce the prolapse bulge with your fingers and more fully empty your bladder.
Q: I am 52 and prone to urinary tract infections. What can I do decrease/stop getting them?
A: Dr .Megan_Tarr: When women have recurrent urinary tract infections, it is very important to obtain urine specimens for culture at each doctor visit. This tells us if the urinary infection is cleared with antibiotic treatment or if it is a persistent infection with the same/different organisms. After reviewing the causative organism, some physicians will initiate women on daily suppressive antibiotic therapy for several months at a time. It is also important to make sure that the woman is emptying her bladder well. In addition, foreign bodies in the urinary tract, such as stones or mesh from a past pelvic surgery can also harbor microbes and result in recurrent urinary tract infections.
Q: How are stress incontinence and overactive bladder different?
A: Dr. Megan_Tarr: Stress incontinence refers to urine leakage that occurs with an elevation of intra-abdominal pressure (during coughing, sneezing, lifting, or laughing). Urge incontinence is urine leakage that occurs after one feels an "urge" to urinate. Many women have symptoms of both. As urogynecologists, we like to differentiate them because they are treated differently.
Q:: At what point should I seek the advice of my doctor? I am 50 and have to wear pads every day due to urinary leakage. I am annoyed with the problem!
A: Dr. Megan_Tarr: Although urinary incontinence is more common as women age, it should not be considered a "normal" part of aging. Feel free to seek a consultation for this issue at any time in your life. If it is bothersome to you, please seek treatment.
Q: Does atrial fibrillation contribute to frequent urination? Will slowing the heart rate reduce the urges?
A: Dr. Megan_Tarr: This is a bit of a complex question. The atrial fibrillation may be causing the heart to excrete atrial natriuretic peptide (which often occurs in sleep apnea), which will ultimately cause the kidneys to excrete more urine. This may then cause you to urinate more frequently, due to the increased urine production. There are many complex hemodynamic changes that occur with cardiac function and the medications used to treat cardiac issues, so it is not certain that treatment of the atrial fibrillation will improve your urinary symptoms.
Q: I have three children that were born naturally. I now have some incontinence, but mostly very frequent urination. I have been told that pregnancy can cause this. How is this? I know that therapy can help with the incontinence, but can it also help with the frequent urination?
A: Dr. Megan_Tarr: Urinary urgency is best helped with pelvic floor physical therapy. These specialized therapists do myofascial release (just like when you have a back massage) and help retrain the muscles to both relax and contract when you need them to do so. We believe that urinary urgency is often due to spasm of the pelvic floor muscles, and your brain cannot discern this spasm from urinary urgency.