Two common kinds of bladder leakage
Two common conditions Dr. Su treats in women are stress urinary incontinence and overactive bladder. They feel different and are treated differently, and many women have some of both.
| Stress urinary incontinence | Overactive bladder | |
|---|---|---|
| What happens | Urine leaks when pressure on the bladder rises | The bladder muscle squeezes when it should not, causing a sudden urge to go |
| Typical moments | Coughing, sneezing, laughing, lifting, exercise | A sudden, strong urge that is hard to hold off, sometimes with leaking on the way to the bathroom |
| Other signs | Leaks are often small and linked to movement | Going often during the day, and getting up at night to urinate |
| Why it happens | The muscles and tissues that support the urethra (the tube that carries urine out) have weakened, often after childbirth or with age | Often no single cause is found; it becomes more common with age |
| Procedures Dr. Su performs | Mid-urethral sling, urethral bulking (Bulkamid) | Intravesical Botox, sacral neuromodulation (InterStim) |
First steps that often help
For many women, simple measures make a real difference, and they are usually tried before any procedure:
- Pelvic floor exercises (Kegels) strengthen the muscles that support the bladder and urethra. A pelvic floor physical therapist can teach you to do them correctly.
- Bladder training means going to the bathroom on a schedule and slowly stretching the time between trips.
- Everyday habits such as cutting back on caffeine, alcohol and fizzy drinks, drinking less in the evening, and avoiding constipation can ease urgency.
- Medicine can calm an overactive bladder for many women.
At your first visit, Dr. Su asks about your symptoms and checks a urine sample to rule out infection. She may ask you to keep a bladder diary for a few days, writing down what you drink, when you urinate and when you leak. It is one of the clearest ways to tell which kind of leakage you have.
Procedures Dr. Su performs
When first steps are not enough, these procedures can help.
Intravesical Botox
Botox is injected into the bladder wall through a thin camera (cystoscope) to relax an overactive bladder muscle. The effect wears off over time, so treatment is repeated. A small number of women have trouble emptying the bladder for a while afterward and may need to use a catheter until it settles.
Sacral neuromodulation (InterStim)
A small implanted device sends mild electrical pulses to the sacral nerves in the lower back, which help control the bladder. A trial period usually comes first, so you can see whether it helps before the device is placed for the long term.
Mid-urethral sling
A narrow strip of mesh is placed under the urethra through a small incision in the vagina. It supports the urethra like a hammock when you cough, laugh or lift.
Urethral bulking (Bulkamid)
A gel is injected into the wall of the urethra through a thin camera, helping it close more tightly. There are no incisions. Some women need a top-up injection later.
What Dr. Su does not treat
Dr. Su does not fit pessaries or perform surgery for pelvic organ prolapse, including sacrocolpopexy. Prolapse is when the bladder, uterus or rectum drops into the vagina, often causing a bulge or a feeling of pressure. If you need prolapse care, Dr. Su can refer you to a specialist who provides it.
Other reasons to see a urologist
Urinary tract infections that keep coming back. Many women get an occasional UTI. If you have had two or more in six months, or three or more in a year, it is worth an evaluation. Dr. Su can look for anything that makes infections more likely, such as a bladder that does not empty fully or a kidney stone, and talk with you about ways to prevent them. A UTI with fever, chills or pain in your back or side can be a kidney infection and needs medical care the same day.
Blood in the urine. Even a single episode should be checked, even if it goes away. Read more about blood in the urine and bladder cancer.
Kidney stones. Dr. Su treats kidney stones in women and men.
Questions patients ask
Is leaking just part of getting older or having children?
It is common, but you do not have to live with it. Many women improve with treatment, often starting with exercises and changes in daily habits.
Will I need surgery?
Usually not at first. Pelvic floor exercises, bladder training and medicine help many women. Procedures are for when those steps are not enough, and several of them are minimally invasive.
Is a sling the same as the vaginal mesh I have heard about?
No. The mesh products removed from the U.S. market in 2019 were ones placed through the vagina to repair pelvic organ prolapse. A mid-urethral sling uses a small strip of mesh for a different purpose, treating stress incontinence. Dr. Su will go over its benefits and risks with you so you can decide.
I feel a bulge in my vagina. Can Dr. Su help?
A bulge is often a sign of pelvic organ prolapse. Dr. Su does not perform prolapse surgery or fit pessaries, but she can evaluate any urinary symptoms you have and refer you to a specialist for the prolapse.