Incontinence Care, Bladder Health, and Prolapse

Early Office Evaluation: Stress Incontinence vs. Detrusor Instability

In a typical OB‑GYN visit, your provider will begin by distinguishing two common types of bladder leakage:

• Stress Urinary Incontinence (SUI): leakage that occurs with coughing, sneezing, laughing, or physical exertion, due to weakened pelvic support.
• Detrusor Instability (also called Overactive Bladder or Detrusor Overactivity): sudden, compelling urges to void, often with little warning.

Your provider will take a focused history, ask you to complete a bladder diary, and perform a gentle pelvic exam. Some office tests, like a cough stress test or post‑void residual measurement, can help confirm the diagnosis. From there, you’ll discuss first‑line treatments that can start immediately.

The Role of Pelvic Floor Health in Bladder Control

Let’s start with the foundation. The pelvic floor is a group of muscles, ligaments, and tissues that support your bladder, uterus, and bowels. These muscles work constantly to help you stay in control of when and how your body moves waste. 

Your pelvic floor is involved in everything from lifting to intimacy. Even simple actions like laughing and sneezing call your pelvic floor to action. When these muscles lose strength or coordination, you may notice things like leakage, pressure, or the sudden urge to go. 

Any of the symptoms above is reason enough to consult with your provider. While you may feel intimidated, pelvic floor dysfunction is incredibly normal for women. Childbirth, menopause, chronic constipation, or surgery are just a few of the factors that can shift how these muscles function.

What is a Urogynecologist?

If your symptoms suggest pelvic floor dysfunction or issues tied to incontinence, your provider may refer you to a urogynecologist. Urogynecologists are specialists who focus on the pelvic floor and bladder health, with advanced training in diagnosing and treating conditions that affect this part of the body.

You may benefit from a urogynecology consultation if you’ve been dealing with:

• Sudden or frequent urges to urinate
• Difficulty emptying your bladder fully
• Pelvic pressure or a sensation of heaviness
• Frequent urinary tract infections
• Accidental bowel leakage
• Painful bladder symptoms

These symptoms may be linked to pelvic organ prolapse, overactive bladder, or other conditions that often respond well to focused treatment.

Pelvic Organ Prolapse

Pelvic organ prolapse occurs when one or more pelvic organs (bladder, uterus, rectum) descend from their normal position and press against the vaginal walls. You might feel:

• A bulge or fullness in the vagina
• Pelvic or lower back discomfort
• Difficulty with bowel or bladder emptying

Treatment and management will depend on the degree of prolapse and your personal goals. Your provider may recommend:

• Pelvic Floor Rehabilitation (PFR): Specialized physical therapy to strengthen the pelvic muscles and improve support.
• Pessary Use: A removable vaginal device that props up prolapsed organs to relieve symptoms, often fitted in-office.
• Surgical Management: Minimally invasive procedures can repair and reinforce weakened tissues for more advanced or persistent prolapse.

What Treatment Might Look Like

Care for incontinence and bladder health is highly individualized. Here, your provider will work with you to create a care plan based on your symptoms, your health history, and your preferences. That may include one option, or a thoughtful mix of strategies designed to help you feel better and get back to doing the things you love.

Common treatment approaches include:

• Pelvic floor physical therapy to strengthen or retrain muscle function
• Adjustments in fluid intake or bladder habits
• Medications to ease symptoms like urgency or frequency
• Pessary devices to support pelvic organs
• Bladder Botox and neuromodulation
• Minimally invasive surgical options, if needed

Physical therapy is often a key part of the care plan. Your therapist will introduce simple exercises and techniques to help reduce symptoms and improve bladder control over time, like proper Kegels, breathing coordination, and movement strategies.

In some cases where other treatments haven’t brought enough relief, surgery may be part of your provider’s recommendation. This could involve a procedure to support the bladder, repair weakened tissue, or reduce nerve-related discomfort. 

Pelvic Floor Physical Therapy

Schedule an Appointment for Bladder Health, Incontinence, or Prolapse Care

UWH of The Carolinas offers a judgment-free space to talk openly about your symptoms. If you’re ready to feel more confident and in control, schedule a visit to one of our providers. We’ll listen, we’ll guide, and we’ll help you take the next step toward better bladder health.

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