Urinary Incontinence


Millions of women experience some sort of urinary incontinence sometime in their life, whether it is a few drops of urine while running or coughing or the strong, sudden urge to urinate just before losing a large amount of urine. Many women experience both symptoms. This involuntary loss of urine can be totally debilitating. The fear of “peeing in one’s pants” outside of the home environment and the associated public embarrassment keeps some women from enjoying many activities with their family and friends. Urine loss can also occur during sexual activity and cause tremendous emotional distress.

Women are twice as prone to urinary incontinence than men for several reasons. Pregnancy and childbirth weaken the muscles, menopause, and the structure of the female urinary tract account for this difference. But both women and men can become incontinent from neurologic injury, birth defects, stroke, multiple sclerosis and physical problems associated with aging.

Older women experience urinary incontinence more often than younger women, but incontinence is not inevitable with age. Urinary incontinence is a medical problem that we can help find a solution for. No single treatment works for everyone, but many women can find improvement without surgery.

Incontinence occurs because of problems with muscles and nerves that help to hold or release urine. The body stores urine – water and wastes removed by the kidneys – in the bladder, a balloon-like organ. The bladder connects to the urethra, the tube through which urine leaves the body.

The types of urinary incontinence

  • Stress: Leakage of small amounts of urine during physical movement (coughing, sneezing, exercising).
  • Urge: Leakage of large amounts of urine at unexpected times, including during sleep.
  • Overactive bladder: Urinary frequency and urgency, with or without urge incontinence.
  • Functional: Untimely urination because of physical disability, external obstacles or problems in thinking or communicating that prevent a person from reaching a toilet.
  • Overflow: Unexpected leakage of small amounts of urine because of a full bladder.
  • Mixed: Usually the occurrence of stress and urge incontinence together.
  • Transient: Leakage that occurs temporarily because of a situation that will pass (infection, taking a new medication, colds with coughing).

How is incontinence treated?

Kegel exercises

  • The first step is to find the right muscles. One way to find them is to imagine that you are sitting on a marble and want to pick up the marble with your vagina. Imagine sucking or drawing the marble into your vagina.
  • Try not to squeeze other muscles at the same time. Be careful not to tighten your stomach, legs or buttocks. Squeezing the wrong muscles can put more pressure on your bladder control muscles. Just squeeze the pelvic muscles. Don’t hold your breath. Do not practice while urinating.
  • Repeat, but don’t overdo it. At first, find a quiet spot to practice – your bathroom or bedroom – so you can concentrate. Pull in the pelvic muscles and hold for a count of three. Then relax for a count of three. Work up to three sets of 10 repeats. Start doing your pelvic muscle exercises lying down. This is the easiest position to do them in because the muscles do not need to work against gravity. When your muscles get stronger, do your exercises sitting or standing. Working against gravity is like adding more weight.
  • Be patient. Don’t give up. It takes just 5 minutes a day. You may not feel your bladder control improve for 3 to 6 weeks. Still, most people do notice an improvement after a few weeks.
  • Medicines for overactive bladder
  • Biofeedback
  • Neuromodulation
  • Vaginal devices for stress incontinence
  • Injections for stress incontinence
  • Incontinence surgery for stress incontinence

Two minimally invasive surgeries


The MiniArc system is a procedure for female stress urinary incontinence that uses a single-incision approach designed to reduce invasiveness and enhance patient recovery. MiniArc requires only a single, 1.5 cm vaginal incision designed to reduce dissection and may minimize the risk of bladder, bowel and major vessel perforation. Since it is a minimally invasive procedure, it can be performed with local, spinal or general anesthesia.

The MiniArc provides many benefits:

  • Easy to use and implant
  • Uses a slim needle
  • Smooth and easy engagement and disengagement of mesh to needle
  • Mesh features midline mark for accurate placement under the urethra
  • Optional redocking feature promotes proper intra-operative tightening
  • Self-fixating tips along with AMS proven mesh provide strong holding force
  • Permanent tips reduce potential for mesh movement during tissue integration
  • Minimally invasive for enhanced patient recovery
  • Most patients can resume normal activities within 1-2 weeks of the procedure

The MonarcTM

The MonarcTM Subfascial Hammock treats female stress urinary incontinence by placing a narrow strip of mesh in your body to support the urethra. The Monarc uses a transobturator approach to place the supportive mesh. The transobturator approach avoids the retropubic space, the area of loose connective tissue between the bladder, pubic bone and abdominal wall. With this approach, narrow mesh carriers are passed through an area near the groin at the obturator of the pubic bone. The mesh is then attached and pulled into place under the urethra. Once placed, the hammock cradles your urethra and gives it a point of support. Most patients are continent immediately following the procedure and can resume normal, non-strenuous activities within a few days.

The Monarc provides several benefits:

  • Almost all patients recover quickly and experience immediate continence.
  • Minimally invasive and suitable for a wide variety of patients.
  • Incisions small.
  • The hammock may be loosened or tightened during and immediately after the procedure.

The MonarcTM Subfascial Hammock is used to treat stress urinary incontinence in women. To determine if it may be a good choice for you, take the incontinence quiz below and share your answers with your doctor.

  1. Do you ever experience unplanned, sudden urine loss either while sleeping or during the day?
  2. Do you experience leakage while laughing, sneezing, jumping or performing other movements that put pressure on the bladder?
  3. Do you have trouble holding your urine as you hurry to the bathroom?
  4. Do you frequently experience a sudden and immediate urge to urinate?
  5. Have you noticed a change in your frequency of urination?
  6. Do you visit the bathroom to urinate more than eight times per day?
  7. Do you currently wear pads or liners to protect against unplanned leaks?
  8. When planning a trip, outing or event, does the availability or location of restroom facilities affect your decision?

To learn more about our urinary incontinence services or to schedule an appointment, please call our main office at (404) 255-3633. You can also use our online Request an Appointment form. Our urinary incontinence patients come to us from the area of Buckhead in Atlanta, Cumming, North Atlanta, Sandy Springs, Alpharetta, Dunwoody, Roswell and Forsyth in Fulton County, GA.

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