Bladder Problems

What are some disorders of the urinary system?

Disorders of the urinary system range in severity from easy to treat to life threatening.

Overactive Bladder

Overactive bladder affects nearly 1 in 5 people. Overactive bladder refers to urinary urgency (having to rush to the bathroom), urinary frequency (urinating more than 7 times in a 24 hour period), and can be accompanied by urinary incontinence (leakage). It is essential that if you are urinating more than this amount you get a basic evaluation to rule out other causes. There are a variety of treatment options available, ranging from behavioral therapies, to exercise therapies, and medical therapies. For refractory or severe cases, we offer acupuncture therapies, Botox injections in the bladder, and nerve stimulation (Sacral Neuromodulation, or Interstim).

Urinary incontinence, loss of bladder control, is the involuntary passage of urine. There are many causes and types of incontinence, and many treatment options. Treatments range from simple exercises to surgery. Women are affected by urinary incontinence more often than men.

Stress Urinary Incontinence

Stress incontinence refers to leakage of urine due to coughing, sneezing, laughing or physical activity. It may
also be triggered by changes in position, for example—getting in and out of a car, getting out of bed. We have a
variety of options available to treat stress incontinence, including in-office Pelvic Muscle Rehabilitation
(PMR), Biofeedback and in-office urethral bulking. We also perform midurethral sling procedures which are
considered the gold-standard surgical procedure for stress incontinence.

Urge Urinary Incontinence

Urge Incontinence refers to the loss of urine after the sudden desire to urinate. This problem is often treated
initially with dietary and behavioral modifications. There are also a variety of medical therapies available,
including anticholinergic therapies (Detrol, Ditropan, Sanctura, Enablex, Vesicare, Toviaz, Gelnique) and beta-agonist
therapies (Myrbetriq). When medical therapies don’t work, we have numerous other options including Botox injections,
Interstim Sacral Neuromodulation, or Percutaneous Tibial Nerve Stimulation (PTNS).

Urinary tract infections (UTIs) are caused by bacteria in the urinary tract. Women get UTIs more often than men.
UTIs are treated with antibiotics. Drinking lots of fluids also helps by flushing out the bacteria.
The name of the UTI depends on its location in the urinary tract. An infection in the bladder is called cystitis.
If the infection is in one or both of the kidneys, the infection is called pyelonephritis. This type of UTI can
cause serious damage to the kidneys if it is not adequately treated.

Painful bladder syndrome/Interstitial cystitis (PBS/IC) is a chronic bladder disorder also known as
frequency-urgency-dysuria syndrome. In this disorder, the bladder wall can become inflamed and irritated. The
inflammation can lead to scarring and stiffening of the bladder, decreased bladder capacity, pinpoint bleeding,
and, in rare cases, ulcers in the bladder lining. The cause of IC/PBS is unknown at this time. Dr. Ingber is an
expert on IC, and has published book chapters on this topic. We have a variety of options available to treat this
condition, from in-office exercise and relaxation therapies, to medical and surgical options. The first step is
obtaining a baseline evaluation.

Kidney stones is the term commonly used to refer to stones, or calculi, in the urinary system. Stones form in the
kidneys and may be found anywhere in the urinary system. They vary in size. Some stones cause great pain while others
cause very little. The aim of treatment is to remove the stones, prevent infection, and prevent recurrence. Both
nonsurgical and surgical treatments are used. Kidney stones affect men more often than women.

Proteinuria is the presence of abnormal amounts of protein in the urine. Healthy kidneys take wastes out of
the blood but leave in protein. Protein in the urine does not cause a problem by itself. But it may be a sign
that your kidneys are not working properly. Often times, referral to a nephrologist (medical kidney doctor) may
be necessary.

Renal (kidney) failure results when the kidneys are not able to regulate water and chemicals in the body or remove
waste products from your blood. Acute renal failure (ARF) is the sudden onset of kidney failure. This condition
can be caused by an accident that injures the kidneys, loss of a lot of blood, or some drugs or poisons. ARF may
lead to permanent loss of kidney function. But if the kidneys are not seriously damaged, they may recover. Chronic
kidney disease (CKD) is the gradual reduction of kidney function that may lead to permanent kidney failure, or
end-stage renal disease (ESRD). You may go several years without knowing you have CKD.

Urinary retention, or bladder-emptying problems, is a common urological problem with many possible causes. Normally,
urination can be initiated voluntarily and the bladder empties completely. Urinary retention is the abnormal holding
of urine in the bladder. Acute urinary retention is the sudden inability to urinate, causing pain and discomfort.
Causes can include an obstruction in the urinary system, stress, or neurologic problems. Chronic urinary retention
refers to the persistent presence of urine left in the bladder after incomplete emptying. Common causes of chronic
urinary retention are bladder muscle failure, nerve damage, or obstructions in the urinary tract. Treatment for
urinary retention depends on the cause.

Vesicovaginal Fistula

Some women have had leakage after surgical procedures (e.g. hysterectomy) or obstetrical trauma. This may be a
sign of a fistula, or an abnormal communication between the bladder and vagina. Dr. Ingber is a leader in fistula
repair, as he travels often to Africa, training other physicians on repairing these conditions. Evaluation for
fistula is simple and can be done in the office setting.