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Bladder health
Leaking urine is common, it is treatable, and it is not something you simply have to live with. The key is figuring out which kind of incontinence you have, because the right treatment for one type does little for another.
Stress incontinence is leakage with coughing, sneezing, laughing, lifting or exercise, when pressure on the bladder overcomes a weakened sphincter or pelvic floor. Urge incontinence comes with a sudden strong need to go, and is part of overactive bladder. Many people have both, which is called mixed incontinence; in that case we usually treat the urge component first, because it often makes the biggest difference. Less commonly, leakage comes from a bladder that never empties properly, and that needs a different approach altogether.
A short bladder diary makes the first appointment far more useful: what you drink, when you urinate and how much, and when leaks happen. A phone app and any measuring cup are enough.
We check a urine sample, measure how fast you empty and how much stays behind with an office ultrasound, and review what triggers the leakage, including childbirth history, chronic cough and prior prostate surgery.
Cystoscopy and urodynamic testing map exactly what the bladder and sphincter are doing, and give a baseline we can compare against over time.
Sometimes the fix is simple. Many "overactive bladders" are really overactive drinking habits; about two liters of fluid a day is plenty for most adults, and adjusting intake and caffeine can transform symptoms.
For stress incontinence we start with supervised pelvic floor rehabilitation with biofeedback, because Kegels done alone at home rarely work as well, and the Emsella chair, which strengthens the pelvic floor while you sit fully clothed. A bulking agent injected in the office near the sphincter helps many patients, and a sling remains an option when leakage is more severe.
For urge incontinence we combine behavioral changes, medication when appropriate, and percutaneous tibial nerve stimulation (Urgent PC), a series of short office sessions that calm the bladder's nerve signals.
After prostate surgery, men with mild leakage often do well with an office bulking injection. For heavier leakage, the artificial urinary sphincter remains the most reliable solution.
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It is common, but it is not normal and it is usually treatable. Most people improve with non-surgical treatment.
They help, but done alone at home they are often done incorrectly. Supervised pelvic floor therapy with biofeedback works considerably better.
Drink enough, not more than enough. Around two liters a day suits most adults; much more than that commonly drives frequency and urgency.
Pelvic floor rehabilitation first, then an office bulking injection for mild leakage, and an artificial urinary sphincter for heavier leakage.
Yes. Incontinence evaluation and treatment are available for both women and men.
Book a men's-health visit at our Manhattan or Forest Hills office — a simple step that's easy to keep putting off.
Manhattan & Queens · All Five Boroughs