Talking about urgency, leakage, pelvic floor dysfunction and other issues might be uncomfortable. But it’s the first step toward treatment.

Talking about urgency, leakage, pelvic floor dysfunction and other issues might be uncomfortable. But it’s the first step toward treatment.

Women with urological problems might not know how common — and treatable — they are, which keeps them from seeking proper care.

Incontinence after pregnancy

The scenario: This unintentional leakage after laughing, coughing, sneezing or jumping most often occurs in women in their late 30s and older, typically after having children. Excess bodyweight can also contribute to developing leakage.

The solution:  Dr. Nimeh begins with a physical exam and evaluation. Opting for the “least invasive thing first,” he’ll discuss physical and behavioral therapies, including reducing water and caffeine intake as well as trying exercises for the pelvic floor muscles to build strength. Surgical options are available if the problem persists or worsens.

Overactive bladder

The scenario: Having to pee at all hours and with little warning can be a nuisance. The cause, typically is simply a side effect of growing older — and it affects men and women alike. Although doctors still aren’t sure what causes it, lifestyle factors such as caffeine intake, drinking habits and diuretic medications that rid the body of water can play a role.

The solution: Behavioral modifications come first: cutting caffeine and alcohol and, if possible, altering the time of taking a diuretic. Physical therapy and medications also are considered. Dr. Nimeh may suggest nerve therapy, which involves a needle placed in the ankle (“kind of like acupuncture”) to transmit electric stimulation targeting the nerves that control bladder function. More invasive options include Botox injections and an implantable bladder pacemaker.

Urinary tract infection

The scenario: Painful, sometimes cloudy or foul-smelling urine, often accompanied by urgency, frequency, burning and pain with urination — and often occurring several times a year.  Women too frequently receive antibiotics for this issue without confirming a UTI (a practitioner might also miss an overlapping issue, such as overactive bladder). Worse, antibiotic resistance can develop if overprescribed.

The solution: Dr. Nimeh helps women determine what might be causing a relapse. “Fluid intake is important, as is managing your bowels. Constipation can be a big contributor.” He also rules out anatomic problems that may be a factor. Research has shown the benefit of vaginal estrogen cream for postmenopausal women to alter their pH levels and promote healthy bacteria growth.

Pelvic floor dysfunction

The scenario: The pelvic floor is a “bowl” of muscles supporting the bladder, vagina and rectum. Those muscles, particularly after childbirth, get disrupted and can become irritated and inflamed.” The muscles need to relax to urinate well and pass a bowel movement. Tension also can cause pain during intercourse, painful or frequent urination and lower back pain.

The solution: Because most women aren’t taught how to relax those muscles, some proactive effort is required. Dr. Nimeh typically directs a patient toward pelvic floor therapy — weekly sessions that help a woman identify and unclench the affected area. Some people hold stress in their pelvis and don’t even realize it. Vaginal medications or muscle injections may help, too.

Pelvic organ prolapse

The scenario: Weak spots in the walls and muscles of the vagina can cause adjacent organs to fall out of their normal positions — essentially a hernia of the vagina. Our best understanding is that injury to the pelvic floor muscles during childbirth causes the loss of support and prolapse. Signs of trouble: a sensation of a bulge in the vagina or discomfort when sitting.

The solution: If the patient is bothered or in pain, surgery can follow. Still, it’s not a condition that has to be surgically corrected; it all depends on the patient’s symptoms. A silicone or rubber diaphragm (known as a pessary) inserted into the vagina to support the pelvic floor is an option as well.