Cleveland Clinic

While women may find this topic embarrassing to discuss, it’s important to address.

Your urinary system — made up of your kidneys, ureters, bladder and urethra — does several jobs. These include filtering, storing and removing waste from your body. However, millions of women experience urinary incontinence.

“The journey to a successful pregnancy has many steps. It starts with being healthy before pregnancy. Maintaining a healthy weight, eating a healthy diet and taking part in regular physical activity may all increase your chances for conception, a healthy pregnancy, less complications during delivery, and most importantly having a healthy baby,” says Jacqueline Zuponcic, DO, an Ob/Gyn at Cleveland Clinic Akron General.

The American College of Obstetricians and Gynecologists (ACOG) also recommends a “preconception counseling” appointment for women who are ready to begin attempting pregnancy. At this appointment, we review your medical history, medications, and risks that you may have — all to help optimize your chances for a healthy new pregnancy.

If you don’t already have a provider, it’s important to choose one you are comfortable with. The team at Akron General includes board-certified obstetrician/gynecologists and advanced practice nurses, as well as maternal-fetal medicine specialists and anesthesiologists who are available 24/7.

“It’s important to begin prenatal care early, with your first visit about eight weeks into your pregnancy, and monthly prenatal visits until around 28 weeks,” says Dr. Zuponcic. “As your due date approaches, you will have more frequent visits so we can closely monitor your health and that of your baby.”

Regular prenatal visits are essential to help you and your baby stay well, to manage any conditions or complications that may arise, and to discuss any questions or concerns you may have along the way.

During pregnancy, testing helps ensure the health of both mom and baby. Akron General offers state-of-the-art ultrasound technology and specialized testing such as amniocentesis, RH sensitization and percutaneous umbilical sampling, and now access to fetal echocardiogram services onsite from Cleveland Clinic Children’s pediatric cardiologists.

Help for those with fertility issues

“For some, conception requires special attention and care. An estimated 1 in every 6 to 7 couples have trouble conceiving. Infertility is defined as the failure to conceive after trying for one year. Women should see a healthcare provider at that time. However, women older than 35 should seek help after just six months of trying since fertility declines with age,” says Jeffrey Goldberg, MD, Head of Reproductive Endocrinology and Infertility at Cleveland Clinic. Dr. Goldberg treats patients at various Cleveland Clinic locations including Akron General Health and Wellness Center in Bath.

In women, causes of infertility can include endometriosis, uterine fibroids, blocked fallopian tubes and menstrual problems such as polycystic ovary syndrome. Men may have abnormal sperm count and/or function due to hormonal or genetic problems or blocked ducts. In many cases, the cause of infertility is unexplained.

“Although many people associate fertility treatment with in vitro fertilization (IVF), our fertility center provides the full range of services including medical treatment, artificial insemination and minimally invasive surgery,” says Dr. Goldberg. “For those who do require IVF, our program is one of the largest in the state and is equipped with the most advanced reproductive technologies available. In addition, our IVF lab director has over 30 years of experience. For these reasons, our IVF success rates are among the highest in the nation.”

Temporary or short-term causes of incontinence include:

Urinary tract infections (UTIs): An infection inside your urinary tract (urethra, ureters, bladder and kidneys) can cause pain and increase your need to pee more often. Once treated, the urge to urinate frequently usually goes away.
Pregnancy: During pregnancy, your uterus places extra pressure on the bladder as it expands. Most women who experience incontinence during pregnancy notice that it goes away in the weeks after delivery.
Medications: Incontinence can be a side effect of certain medications, including diuretics and antidepressants.
Beverages: There are certain drinks — like coffee and alcohol — that can make you need to urinate much more often. If you stop drinking these beverages, your need to urinate frequently typically goes down.
Constipation: Chronic constipation (stool that’s hard and dry) can cause you to have bladder control issues.

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Chronic or long-term causes of incontinence can include:

Pelvic floor disorders: When you have an issue with your pelvic floor muscles, it can impact the way your organs function, including your bladder.
Stroke: A stroke can cause you to experience issues with muscle control. This can include the muscles that control your urinary system.
Diabetes: When you have diabetes, your body produces more urine. This increase in the amount of urine can cause leakage issues. In addition, peripheral neuropathy can affect the bladder’s function.
Menopause: Menopause is another time of change in a woman’s body when hormone levels change rapidly and pelvic floor muscles can also become weaker — something that also can happen as you get older.
Multiple sclerosis (MS): If you have MS, you may experience a loss of control with your bladder, leading to leakage issues.

Types of incontinence

Of the 1 in 3 women who experience incontinence, some may lose a few drops of urine while running or when they cough, sneeze or lift — stress incontinence caused by pressure. Others may feel a strong, sudden urge to urinate — urinary urgency or urge incontinence. Some women experience both.

Your body is just like a car or home heating system — it needs routine maintenance. Routine checkups are necessary to ensure that your body is working as it should be.

Neel Parekh, MD

Don’t ignore the symptoms

Even minor symptoms that you only notice once can be the sign of something serious. If a simple visit to the bathroom has you seeing red, don’t ignore it.

“Blood in the urine — whether it’s slightly pink, brown or bright red — is a signal that something is wrong,” says Jayram Krishnan, DO, MBA, a urological surgeon at Medina Medical Office Building. “It’s important to find and treat the root cause of the discoloration.”

Though blood in the urine most often comes from a benign condition like kidney stones, enlarged prostate or a urinary tract infection, it also can signal bladder or kidney cancer.

Prostate cancer is the most common cancer in men and is silent in its early stages. For most, the cancer grows very slowly. Dr. Krishnan says you can live with early prostate cancer for years without developing symptoms. Symptoms — such as trouble urinating or feeling like you always need to urinate, particularly at night — start later.

While not as common, testicular cancer also is one of the top cancers in men. The earlier you get care, the better. Testicular cancer is curable in 95% of cases — 98% if treated early.

Shannon Wallace, MD

When to Seek Treatment

If you find that incontinence is disturbing your daily activities and causing you to miss out on things you typically enjoy, you should have a conversation with your primary care or Ob/Gyn physician or a urologist about your medical history and bladder control issues.

“Most people usually mention it to their primary care physician, and will come to a urologist when things aren’t improving or they have bigger symptoms,” says Shannon Wallace, MD, a urogynecologist with Cleveland Clinic’s Ob/Gyn & Women’s Health Institute. Dr. Wallace specializes in pelvic floor disorders and the minimally invasive treatment of stress urinary incontinence, overactive bladder and pelvic organ prolapse. She treats patients at Cleveland Clinic Medina Medical Office Building and main campus.

“Issues like an overactive bladder can be treated with medications, while pelvic floor therapy can address that as well as leakage and mild prolapse.”

Treatment options
There are three main types of treatment for incontinence – medications, lifestyle changes and surgery. Each has pros and cons you should discuss with your provider.

Medications
“Some medications reduce leakage by helping to stabilize muscle contractions that lead to an overactive bladder. Others help relax the bladder to help it empty completely. And hormone replacement therapies — including replacing decreased estrogen during menopause — can help restore bladder function,” says Dr. Wallace.

Lifestyle changes
Lifestyle changes can help improve incontinence. These behaviors include:

Go to the bathroom on a regular schedule rather than waiting until you feel the urge to go.
Empty your bladder before physical activity.
Avoid drinks with caffeine.
Avoid drinking a lot of fluids before starting an activity or before bedtime.
Maintain a healthy body weight.

Kegel exercises and pelvic floor therapy, along with use of a vaginal support deceive like a pessary can help strengthen the muscles that you use for holding your urine.

Surgery
“If non-invasive treatment options don’t help, there are surgical options available. For urge incontinence, neuromodulation or interstim therapy consists of a pacemaker-like unit that sends a constant signal to the nerves of the bladder to help it settle down,” says Dr. Bologna. “And for stress incontinence, a small vaginal incision is made to place a sling under the urethra to provide support to stop leakage.”

Therapy
If you’ve been told that you could benefit from pelvic floor therapy, Cleveland Clinic Brunswick Family Health Center has physical therapists who specialize in this treatment.

The safety of our patients and caregivers remains our top priority. We want to assure our patients that our Cleveland Clinic facilities are safe for them to receive care. We have taken several steps to increase safety including limiting visitors to our facilities and screening everyone for potential COVID-19 symptoms.