• Urinary Incontinence

    Urinary Incontinence

Urinary Incontinence

Stress Incontinence

Loss of urine when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. Stress urinary incontinence occurs when the sphincter muscle at the bladder is weakened. The problem is especially noticeable when you let your bladder get too full. Physical changes resulting from pregnancy, childbirth and menopause can cause stress incontinence.

Urge Incontinence

This is a sudden, intense urge to urinate, followed by an involuntary loss of urine. Your bladder muscle contracts and may give you a warning of only a few seconds to a minute to reach a restroom. With urge incontinence, you may also need to urinate often. The need to urinate may even wake you up several times a night. The bladder becomes "overactive", or it contracts even when your bladder is not full. Urge incontinence is often called an overactive bladder.

Overflow Incontinence

If you frequently or constantly dribble urine, you may have overflow incontinence. This is an inability to empty your bladder, which leads to overflow. With overflow incontinence, sometimes you may feel as if you never completely empty your bladder. When you try to urinate, you may produce only a weak stream of urine. This type of incontinence is common in people with a damaged bladder or blocked urethra. Nerve damage from diabetes also can lead to overflow incontinence.

Mixed Incontinence

If you experience symptoms of more than one type of urinary incontinence, such as stress incontinence and urge incontinence, you have mixed incontinence. Usually one type is more bothersome than the other is.



Urgent PC therapy is a non-drug, non-surgical option to treat patients with Overactive Bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence. Therapy consists of 12 weekly sessions in your doctor’s office, followed by a refresher treatment about once a month to maintain improvements. During each 30-minute session, a thin needle electrode is placed near the patient’s ankle and is connected to an external device that provides mild stimulation. Up to 80% of patients improve with treatment. Most patients don’t experience side-effects. If side-effects occur they are typically temporary and include mild pain and skin inflammation at or near where the needle is placed.

Behavioral Modifications

Some patients are able to make behavioral changes in their day-to-day life to alleviate bladder control problems. Typically, we recommend each patient suffering from urinary incontinence attempt behavioral modifications first to avoid medications or surgery. The first step in behavioral modification is to keep a voiding diary, which will help us get a better understanding of your voiding patterns. We will give you a voiding diary during your first visit to our specialty center.

The voiding diary will allow you to record over a 3 day period the time you voided along with the type of fluid intake, severity of urge, severity of leakage, and the activity that caused you to leak.

Excessive Fluid Intake
Your voiding diary may tell us that you tend to leak after you consume a high volume of fluids. Drinking too much fluid of any kind makes you urinate more often. Drinking too much fluid over a short period of time can overwhelm your bladder and create a strong sense of urgency.

Lifestyle Changes

Some foods and fluids can irritate your bladder. Examples would be caffeine and alcohol, which act as diuretics thus increasing urine production. If your bladder diary shows an increase in urine leakage after consuming caffeine, then we may have you cut caffeine out of your diet for a period of time to see if you stop leaking. Often, simply cutting down on your intake may help you.

Bladder Training
Bladder training or timed voiding involves adjusting your voiding habits by going on a set schedule even if you do not have the urge to urinate gradually increasing the time between urination. This allows your bladder to fill more fully and gives you more control over the urge to urinate. We will use the results of your voiding diary to come up with a schedule for your bladder training.

Extending the time between your urination intervals involves using your bladder diary to come up with an approximate amount of time that goes by in between the time that you void. The point of this exercise is to extend that interval by 10 minutes, so if you go to the restroom every 80 minutes then you must go every 90 minutes instead. If you ever feel like you are going to have an accident, do not wait for your scheduled voiding time.

The next step is to gradually increase the interval of time between your trips to the restroom. Your goal is to continue lengthening this interval until you reach intervals of two to four hours. Please be patient as it may take some time to reach these goals.

Medical Therapy

For some patients, conservative treatment in the form of behavioral modification does not help with urinary leakage. The major types of medications used to manage urinary incontinence are called anticholinergics. Often, these drugs are only effective in patients that have urge incontinence caused by overactive bladder or a bladder control problem marked by sudden, intense urinary urges and urine leakage. There are fewer options for patients with stress urinary incontinence or leakage of urine that occurs with coughing, sneezing, laughing, exercising, or lifting something heavy.

Overactive bladder is one of the causes of urge incontinence characterized by abnormal bladder contractions, which make you want to urinate even when your bladder is not full. Anticholinergic medications block the action of a chemical messenger (acetylcholine) that sends the signals that trigger these contractions. Examples of anticholinergic drugs include Ditropan, Gelniqe, Detrol, Enablex, Vesicare, Sanctura, and Toviaz.

The most common side effects of taking anticholinergics is dry mouth. Other less common side effects include constipation, heartburn, blurry vision, rapid heartbeat, flushed skin, and urinary retention.

Physical Therapy

Patients who desire physical therapy are typically referred to a practitioner who are experienced in female pelvic floor disorders. With a physical therapist, patients learn how to recruit the correct muscle groups and build adequate strength to improve their symptoms. This may require one to two months of sessions with a physical therapist as well as a long-term commitment to continue pelvic floor exercises.


Stress urinary incontinence is treated either with a mid-urethral sling or peri-urethral bulking. Both procedures are minimally invasive and are typically done in our surgery center at our main location in Fresno. However, prior to undergoing surgery, patients undergo urodynamic testing to not only confirm urinary incontinence, but also to evaluate the bladder in both storage and voiding phases. This test provides valuable information that will help determine the appropriate course of treatment.

Mid-Uretral Sling
A small, one-centimeter wide portion of mesh is placed underneath the urethra. As patients return to physical exertion, such as coughing, sneezing, running or lifting, the urethra compresses on the sling, which in turn prevents the leakage of urine.

Peri-Urethral Bulking
Using a cystoscope (scope allowing your physician to assess the lining of the bladder) a synthetic bulking agent is injected on each side of the urethra at the level of the bladder neck to narrow the urethral opening to prevent leakage.


  • I was experiencing pelvic pain and bladder frequency - especially at night. Dr. Steinberg referred me to physical therapy for my pelvic floor pain. After I was personally recommended, I no longer feel like my insides are falling out. Dr. Steinberg listens to your problem and recommends the best treatment for you. Surgery was not an option for me. I feel like Dr. Steinberg and his staff really care about you. I am now getting urgent PC therapy and can see improved results in frequency. I now only get up two to five times per night, instead of five to eight. I no longer feel sleep deprived. I have recommended Dr. Steinberg to two friends and they both have thanked me.


  • I saw Dr. Steinberg because my bladder problems were getting out of hand. Dr. Steinberg was gracious and made sure he understood the problem. He made the best choice for me-PTNS. Dr. Steinberg shows the same compassionate characteristics that other doctors show. He listens, he asks question and he prescribes the best procedure for the problem. I have seen great improvements in my bladder. The doctor and his staff are very nice. Their goal is to help the patient with bladder problems. PTNS is not scary. The medical assistant does her best to make sure the treatment is properly working, and the patient is comfortable.”


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