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Could My Painful Periods Be Endometriosis?

Updated on Jun 30, 2022 | OB/GYN, Women's Health, Your Health

Menstruation can be uncomfortable. But, for some, “that time of the month” is also a period of extreme pain accompanied with heavy bleeding and pelvic discomfort. Affecting 2 to 10 percent of premenopausal women, endometriosis is often difficult to diagnose and can hamper the day-to-day living of those with the condition.

In this Q & A, endometriosis specialist Susan S. Khalil, MD, Assistant Professor of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, explains the condition, its symptoms, and why early diagnosis and treatment is important.

What is endometriosis?

Endometriosis is a condition in which there is an ectopic implantation of the endometrium. In layman’s terms, the lining of the uterus is implanted in sites outside of the uterus. Implantation can be in the fallopian tubes, the ovaries, or inside the belly. It can also be in areas of the body very distant from the reproductive organs, such as the lungs or even the brain. The condition typically effects women who are still having their period.

What causes the condition, and can it be prevented?

The cause of endometriosis is largely unknown, but there are a few different theories. One is that, in some women, blood from menstruation flows backward into the belly instead of flowing downward, causing incorrect implantation. Another is “de novo” formation, meaning that it just happens on its own. Yet another theory is that local cell changes can lead to endometriosis.

There is no cure for endometriosis, but there are treatments. And early diagnosis leads to less invasive methods of managing the condition.

I think I have endometriosis. What are the symptoms?

The most common symptoms of endometriosis are pelvic pain and painful periods.

If you are wondering how much period pain is too much, remember that your period should not routinely interfere with your ability to go to work or school, or to go about the activities of daily living. If you are missing out on these activities due to your period, please see a gynecologist.

Patients with endometriosis may also experience unexplained painful urination, painful bowel movements, and painful intercourse. Occasionally, women will get evaluated for the condition if they are having difficulty getting pregnant. Based on your symptoms, endometriosis can be suspected, but the condition is confirmed through laparoscopy.

I was diagnosed with endometriosis. Can I still get pregnant?

Yes, you can get pregnant. However, you may require some assistance. For instance, some people with the condition may need to undergo minimally invasive surgery to remove endometrial tissue.

There is a wide spectrum of severity with endometriosis. While many women actively pursue treatment or diagnosis because they are having difficulty conceiving, there are also pregnant women whose diagnosis is only discovered during routine examination.

What are the treatment options for the condition? Will I need surgery?

Generally, the treatment for endometriosis includes medication and, for some, a surgical option.

Common medications prescribed for the condition depend on the patient’s primary goals, which may include pain control or suppression, or pain control while trying to conceive. The medications include hormonal agents with progesterone only, a combination of estrogen and progesterone, and gonadotropin-releasing hormone (GNRH) agonists or antagonists. The treatments are tailored to the patient when they are evaluated.

If patients need surgical intervention, laparoscopy is one option. It can be used to diagnose endometriosis and to remove growths and scar tissue from the reproductive area. The procedure is often regarded as a fertility-sparing operation that also helps to reduce the pain associated with endometriosis and improve quality of life.

How important is early treatment, and diagnosis, of endometriosis?

Early treatment and diagnosis is important to maintain fertility and manage pain symptoms. It also helps with identifying patients who have endometriosis, and patterns in their family history.

At Mount Sinai, we offer a team-based approach that includes various services, such as pelvic floor therapy, acupuncture, dietary management, and pain management. All of these services are intended to make endometriosis a more livable condition for patients as well as to provide them with a good framework for support.

Make an appointment with Dr. Khalil

Learn about OB/GYN Services at Mount Sinai

What Is the Delta Variant and Why Is It a Concern for Those Who Are Not Vaccinated

Updated on Jun 30, 2022 | COVID-19, Featured, Vaccines, Your Health

One of the latest terms to emerge from the pandemic is the Delta variant. This variant appears to be more contagious than previous variants and has become more common in the United States.

In this Q&A, Sean Liu, MD, PhD, an Assistant Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine, says the spread of this variant is concerning because of the number of people who remain unvaccinated. Those who become infected with this variant pose an elevated risk to household members who are not vaccinated and to others they come in contact with, such as those with compromised immune systems—which includes those with chronic medical conditions and the elderly—who are not able to fight infections as easily as most. Dr. Liu is part of the team of experts at Mount Sinai who are at the forefront of research into vaccines and who are also on the front lines treating patients and helping to limit the spread of the virus in the New York metropolitan area.

Sean Liu, MD, PhD

What is the Delta variant?

All viruses, including the SARS-CoV-2 virus that causes COVID-19, will evolve over time. It is normal for a virus to change a little bit when it makes copies of itself, or replicates. These changes are called mutations. The virus with one or more new mutations is referred to as a variant. Genetic variants of SARS-CoV-2 have been emerging and circulating around the world throughout the COVID 19 pandemic. There are six variants of concern circulating in the United States; the Delta variant is one of these circulating variants. The Delta variant was first detected in December 2020, and recently this variant has been detected in more than 80 countries, and in all 50 states.

Why is there a concern over this variant?

The variants of concern show evidence of at least one of the following five properties:

The variant may spread more easily from person to person.
The variant may lead to more severe disease, including increased hospitalizations or deaths.
The variant may be significantly harder to combat by antibodies generated during a previous infection or vaccination.
Treatments or vaccines may show reduced effectiveness against the variant.
The variant may evade diagnostic detection.

The Delta variant, specifically, has three of these properties, one being increased transmissibility. There is a 1.6-fold increase in the odds of household transmissions for the Delta variant compared with the Alpha variant, also known as the UK variant.

Why is the issue of transmissibility so important?

The fact that this strain can spread so quickly means is that you have a higher likelihood of spreading the Delta variant if infected. As clinicians, we see a lot of COVID-19 spread throughout families. It’s very devastating among households, and this variant specifically has this increased transmissibility within a household. People who are unvaccinated are really putting their family members, or those in their household, at increased risk for severe disease, especially if they too are unvaccinated.

For those who are fully vaccinated, does the Delta variant pose a risk?

It is important to remember that the goal of the COVID-19 vaccines is to prevent severe infections, hospitalizations, and deaths. The mRNA-based vaccines are about 95 percent effective against hospitalization for COVID-19, with either one or two doses. Studies suggest that the Pfizer-BioNTech vaccine reduced the odds of symptomatic disease from the Delta variant, which means getting mildly sick, by 36 percent after one dose and 88 percent after two doses. There is, however, no available data about asymptomatic or mild infections with the Delta variant in fully vaccinated people, which means that people can get infected but not show any symptoms. Also, we know that people with underlying medical conditions have died from COVID-19, even after being fully vaccinated. As a result, the Delta variant creates a major concern if there are fully vaccinated people who are in close contact with family or household members or with people who are immunocompromised or have not been vaccinated, including children.

What about those who are not vaccinated?

If you have not been vaccinated yet, you should seriously consider doing so now. People who have not been vaccinated have a much greater risk of getting seriously ill or dying from COVID-19, especially the Delta variant. Meanwhile, people who are not vaccinated, or who are immunocompromised, should continue to use masks, socially distance to avoid infection especially if you don’t know the status of the individuals around you. If you’re unsure of getting vaccinated, I would encourage you to have discussions with medical professionals who may provide reliable information about the benefits of vaccination. Currently, 44 percent of New York City residents of all ages have not been vaccinated and 34 percent of adults have not been vaccinated in New York City. The distribution of people getting vaccinated is not even. Check out the New York City Department of Health website for the latest information about vaccine availability and vaccination rates.

Why are vaccines important?

The COVID 19 pandemic is a global problem. While vaccines are becoming readily available in the United States, the majority of the world remains unvaccinated. And the pandemic will persist for months, and likely years. Vaccination is our primary means of ending the pandemic. Vaccines are safe and effective. Please consider getting vaccinated, if you are eligible.

Visit our website for COVID-19 vaccination information, appointments and resources

Can the COVID-19 Vaccines Affect My Fertility?

Updated on Jun 30, 2022 | COVID-19, Featured, Men's Health, Vaccines, Women's Health, Your Health

Worried young woman holding pregnancy test

Some men and women may be reluctant to get the COVID-19 vaccination because of concerns about fertility. You may be wondering if any of the vaccines used in the United States can have an effect on your sperm count, or on your eggs, embryo, or the pregnancy itself.

In this Q&A, Alan Copperman, MD, Director of the Division of Reproductive Endocrinology and Infertility and Vice Chair of the Department of Obstetrics, Gynecology, and Reproductive Science at the Mount Sinai Health System, says the evidence shows that the vaccines do not pose a concern.

Update: The Centers for Disease Control and Prevention on September 29, 2021, strongly recommended COVID-19 vaccination either before or during pregnancy because the benefits of vaccination outweigh known or potential risks. Read more from the CDC

Does the COVID-19 vaccine affect my sperm count?

None of the COVID-19 vaccines in use in the United States affect sperm count or the sperm’s ability to move toward an egg (motility). It is true that contracting a severe case of COVID-19 can lower sperm count for a time. But studies show that the vaccine itself does not affect sperm. In fact, we recently completed a study looking at sperm donors around the country before and after getting the vaccine. We saw no change in count or motility.

Can the vaccine affect my ability to get pregnant and have a baby?

We have found that the COVID-19 vaccinations do not affect a woman’s fertility. Pregnancy involves a number of steps:

Your ovaries release an egg.
The egg travels through the fallopian tube to the womb (uterus).
Sperm fertilizes the egg as it travels.
The fertilized egg attaches to the inside of the uterus (implantation) and grows.

A problem at any one of these steps can lead to infertility. We’ve been studying women who have gone through several fertility cycles to see if any of the COVID-19 vaccines used in the United States affects any of these steps. We have found that:

The vaccine does not decrease egg production.
It doesn’t affect the ability to make an embryo.
It doesn’t affect a chromosomally normal embryo’s ability to grow in the uterus.

Will the COVID-19 vaccine have any effect on my pregnancy?

This is a good question because we’ve found that pregnant women who get COVID-19 tend to become very ill. That’s why we recommend taking the vaccine. As of now, three billion COVID-19 vaccinations have been administered, have of them to women, and we haven’t heard any reports of them affecting a woman’s pregnancy. We have also seen women getting the vaccine while undergoing in vitro fertilization—and it has had no effect on their outcomes. In fact, we have found that the vaccine not only protects the pregnant woman, but it keeps them safe at vulnerable times, such as when they deliver—and the fetus gets some immunity as well. We hypothesize that the vaccine prevents severe illness in these babies.

Should I get the COVID-19 vaccine if I’m planning a pregnancy in the near future?

The best time to get the vaccine is as soon as it becomes available to you. You may feel tired after the shot, and you may have short-term symptoms like fever. Some people have an allergic reaction to the vaccine, but that is very rare. We definitely recommend getting the COVID-19 vaccine to protect you, your pregnancy, and your infant.

If I’m already pregnant should I get the vaccine?

Safety data from around the world shows that women taking the vaccine during pregnancy have seen no effect on their pregnancy. The vaccine has shown itself to be safe and effective. As a result, all the major organizations involved with women’s health care—including the Society for Maternal-Fetal Medicine and the Centers for Disease Control and Prevention—are strongly advocating that people who are pregnant get the vaccine.

Which vaccine is best for a pregnant woman?

There’s no data suggesting that any one of the vaccines is better than any of the others for pregnant women. We know that the effectiveness against preventing disease seems a little bit higher in the mRNA vaccines (Pfizer-BioNTech and Moderna), but all the vaccines that have been authorized by the Food and Drug Administration (FDA) are up to 99 percent effective in preventing severe disease and death. Get whatever vaccine is most readily available to you.

What should I do if I have questions about the vaccine and my fertility?

If you have any questions, ask your health care provider. You can also check the online guidelines from organizations like the World Health Organization and the FDA. There is a lot of great information out there to help us fight back against this pandemic.

Get more COVID-19 vaccine information from Mount Sinai

What Can I Do About My Post-COVID Ear, Nose, and Throat Symptoms?

Updated on Jun 30, 2022 | COVID-19, Ear Nose Throat, Your Health

Loss of taste and smell. Persistent cough. Nagging throat clearing. Hearing loss. These are just some of the symptoms experienced by those who were infected with and have since recovered from COVID-19. Researchers estimate that nearly 10 percent of all patients who have recovered from COVID-19 suffer from prolonged symptoms. Often called post-COVID-19 syndrome, this condition can cause a range of health problems including fatigue, headache, shortness of breath, confusion, forgetfulness, and cardiac complications.

Every day, Sam Huh, MD, Chair of Otolaryngology-Head and Neck Surgery at Mount Sinai Brooklyn, sees at least two of these patients with long COVID for persistent ear, nose, and throat symptoms.

“There are many of these patients suffering from a variety of symptoms that last approximately three months or longer after infection,” explains Dr. Huh. “They can be quite debilitating and have a significant impact on their quality of life and ability to return to normal.”

While some of Dr. Huh’s patients had severe COVID-19 infection, others were asymptomatic. “Many patients who come to me were never officially diagnosed with the virus but have symptoms of post-COVID syndrome. However, when I run an antibody test, it often comes back positive for a prior infection,” he says.

Fortunately, many of the ear, nose, and throat symptoms experienced by those with long COVID are reversible.

Loss of smell and taste may return organically, or with training

One of the most common post-COVID symptoms is the loss of smell and taste, also known as anosmia and ageusia. Additionally, on their way to recovery, some patients develop an altered sense of smell and taste called parosmia and dysgeusia. For these patients, nothing smells or tastes like what it should. It is not clear why this happens, but it can cause much distress among the sufferers.

“Smell and taste are linked together,” says Dr. Huh. “If you lose smell, taste often goes with it. Most of these patients get better on their own in a month or so, but others may have issues for up to eight months.”

There are two potential culprits for these altered senses. In some patients, post-infection inflammation and swelling in the nasal tissues prevents odor from reaching the olfactory nerve, which is instrumental for the sense of smell. For others, the COVID-19 virus has damaged the area surrounding the nerve, affecting their sense of smell and taste.

To address this problem, it is important to identify anything in the patient’s medical history that is contributing to the problem, such as abnormal nasal anatomy or allergies. When inflammation is the contributing factor, Dr. Huh recommends using saline rinses to irrigate the nasal passageways, topical or oral steroids, and antihistamines. If the problem is damage around the nerve, Dr. Huh advises olfactory smell training. Research shows that patients can retrain the nose by smelling five strong scents—such as cinnamon, citrus, garlic, rose, or lavender—three times a day.

Your post-COVID cough might be post-nasal drip

Many people who have long COVID struggle with a prolonged cough that lasts for months.

Lung damage is one of the more serious causes of this symptom. Patients experiencing shortness of breath or who are becoming winded when walking up the stairs should seek medical attention immediately. Consult a lung specialist if your symptoms are mild and, if they are severe, head to the emergency room.

The majority of post-COVID patients with chronic cough do not have shortness of breath. Instead, they experience an irritating, nagging tickle in their throat from post-nasal drip caused by post-viral inflammation of the nasal passages. This causes them to cough incessantly. For these patients, Dr. Huh usually prescribes saline rinses, topical or oral steroids, and antihistamines.

A dietary change may help with chronic throat clearing

Post-COVID patients often describe that they feel as though something is stuck in their throat. This feeling causes them to repeatedly try to open their airway by coughing and throat clearing.

“These individuals typically had an awful cough during the symptomatic period when they had COVID-19,” explains Dr. Huh. “The constant coughing caused pressure to rise in their stomach, acid to build up, and reflux to occur.”

Known as laryngopharyngeal reflux, this condition occurs when stomach acid and an enzyme called pepsin travel up to the throat. Thankfully, once the reflux is addressed, patients tend to feel better.

Unlike with the more common gastroesophageal reflux disease, antacids typically do not alleviate these symptoms. However, Dr. Huh has had success with low-protein, plant-based diets, which reduce stomach acid. He also advises that patients drink at least eight cups of water a day.

Extreme post-COVID pain is rare, but treatable

An uncommon post-COVID complication is neuralgia, a severe stabbing pain that can develop after being infected with a virus. This debilitating condition is caused by an inflamed or damaged nerve. Dr. Huh has seen a handful of patients with neuralgia in the throat who experience extreme pain or even incontinence when they cough. These patients are typically treated with neuroleptics, a class of medication normally used to treat psychosis, which research has shown to be beneficial in the treatment of nerve pain.

Post-COVID hearing loss is an unusual side effect that is not fully understood

Another unusual ear, nose, and throat complication is post-viral hearing loss. Dr. Huh estimates seeing one of these patients approximately every month. Physicians are not entirely sure what causes this symptom to develop. They suspect the virus triggers an immune response that may be damaging the tiny vessels inside the ear. Since COVID-19 is associated with blood clots, it is also possible that these vessels become clogged. These patients are typically treated with steroids. However, Dr. Huh says the medication is not always effective in restoring hearing loss. But, some patients can recover their hearing spontaneously.

“Most people recover fairly well when we give them these supportive treatments,” says Dr. Huh. “So, if you are suffering, please know there is hope. I encourage anyone with symptoms to make an appointment because there is probably something we can do to make you feel better.”

Dr. Huh and his colleagues evaluate and treat patients who have symptoms related to the ear, nose, and throat at Mount Sinai Brooklyn. For complications that affect vital organs including the lung, heart, or brain, he advises patients to visit the Center for Post-COVID Care at Mount Sinai.

Make an appointment with Dr. Huh at the following locations:

Mount Sinai Brooklyn
125 St. Nicholas Avenue
Brooklyn, NY 11237

718-756-9025
9 am to 5 pm

Mount Sinai Otolaryngology Faculty Practice
3131 Kings Highway
Suite C1
Brooklyn, NY 11234

718-756-9025

9 am to 5 pm (Wednesdays only)

Mount Sinai Doctors Manhasset
1155 Northern Boulevard
Manhasset, NY 11030

516-370-3434
9 am to 1 pm

Get more COVID-19 information from Mount Sinai

How Can You Tell if Someone You Know May Have PTSD?

Updated on Jun 30, 2022 | Featured, Mental Health, Psychiatry, Your Health

Many people think post-traumatic stress disorder (PTSD) is something that occurs mostly in soldiers returning home from war. Not so. In fact, PTSD affects millions of people throughout the United States, and the numbers are no doubt rising due to the pandemic.

In this Q&A, Jonathan DePierro, PhD, Assistant Professor, Psychiatry, and Clinical and Research Director, Center for Stress, Resilience and Personal Growth at the Icahn School of Medicine at Mount Sinai, explains how PTSD develops, what some of the warning signs are, and why having symptoms of PTSD is not a sign of weakness.

What is PTSD?

PTSD is a mental health condition that can develop after someone goes through a life-threatening event, like a car accident, combat, or a serious illness; or when sudden life-threatening events happen to a loved one. Seeing and hearing about human suffering and death at work over and over, like medics, nurses, and 911 dispatchers do, can also contribute to PTSD.

Jonathan DePierro, PhD

What are the symptoms of PTSD?

PTSD involves four types of symptoms that happen at the same time.

Intrusions – reliving the event with upsetting memories, nightmares, or flashbacks where it truly feels as if the event is happening all over again
Avoidance – trying very hard to avoid any reminders of the trauma, including talking about what happened
Negative thoughts and emotions – feeling depressed, angry, numb, mistrustful, guilty, or ashamed
Hyperarousal – feeling on edge, irritable, having difficulty concentrating, being easily startled, and having poor sleep

These symptoms also need to last for more than a month, be distressing, and/or cause problems for you in your life. Some people may notice changes in their mood, behavior, or relationships right after a trauma; but for others who develop PTSD, symptoms might not develop for many months.

What causes PTSD?

One of the important things to keep in mind about PTSD is that it is the result of a person being exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in one or more of the following ways:

Experiencing it yourself
Witnessing the event(s) firsthand
Learning it happened to a loved one
Indirect exposure to aversive details of the trauma, usually by nature of one’s job

The American Psychiatric Association estimates that about 7 percent of adults in the United States will develop PTSD during their lives. People who do develop PTSD are not “weak.” They have experienced an event that they struggle to understand, and their bodies and brains are “stuck” replaying the event and all the upsetting emotions that come along with it.

How can you recognize the signs of PTSD in someone you know?

People with PTSD struggle to make sense of what happened to them or what they witnessed. They might have upsetting images or memories of the most upsetting parts of the trauma, even though they spend a lot of time trying to avoid anything that might remind them of what happened. The events feel too overwhelming to think or talk about. Spending time with others feels like a lot of work and more stressful, so people with PTSD might withdraw and spent a lot more time alone. Sleep and attention problems are common, because the body is so “on edge” and still reacting as if the trauma is still happening in the present moment.

We also know that people with PTSD tend to see themselves, the future, and other people in their lives through certain “mental filters.” One example is that people with PTSD often blame themselves for things that happened during the trauma, even though that does not make sense. Some of our health care workers experience “moral injury” – blaming themselves all the time for something they did or did not do during the worst of the pandemic.

How is PTSD diagnosed and treated?

If you are concerned that you may be experiencing symptoms of PTSD, speak with your health care provider. They may refer you to a mental health clinician, who can review your symptoms and make a treatment plan. You should also know that depression and PTSD often co-occur, so mention any symptoms of depression you may be experiencing to your providers so they can better understand your needs. If you are concerned about a friend or loved one, speak to them and encourage them to seek help.

Treatment for PTSD directly address avoidance, fear, and negative thoughts. Catching negative thoughts and trying to change them, to make them more realistic and helpful, is a key part of many treatments. Treatment also involves rebuilding a sense of safety that often feels so absent in people with PTSD. Some people with PTSD also find antidepressant medications to be helpful.

Get more information from Mount Sinai about PTSD

Learn more about PTSD from the National Institute for Mental Health

Find additional resources at the National Center for PTSD

Female Incontinence: What You Can Do About It

Updated on Jun 30, 2022 | Urogynecology, Women's Health, Your Health

If you’ve ever had a sudden urge or leakage of urine, you’re not alone. Lisa Dabney, MD, a specialist in urogynecology for the Mount Sinai Health System, notes that 30 percent of women aged 60 years and older will experience episodes of incontinence that interfere with their quality of life. In this Q&A, she explains some treatment options and lifestyle changes that could help.

What causes female urinary incontinence?

Female urinary incontinence has two main causes. One is called stress incontinence. This does not mean emotional stress, but rather stress on the bladder in the form of increased pressure from running, jumping, laughing, coughing, or sneezing that causes a loss of bladder control. The other is called urge incontinence. This occurs when you have a strong desire to void and the urge is so sudden you may not have time to get to the bathroom. The condition called overactive bladder encompasses urge incontinence, but can also include simple urinary frequency and urgency without incontinence.

What are the symptoms?

The symptoms are generally leakage of urine or involuntary passage of urine when you’re not sitting on the toilet. Obviously, it can be a very embarrassing situation. These symptoms increase as women get older.

What causes stress incontinence?

Stress incontinence usually starts to appear in younger women after they give birth. During delivery the passage of the fetal head through the vagina can weaken the delicate supports of the urethra, and that’s when women start to develop stress incontinence. When women are young—in their 30s and 40s—they may not experience symptoms of stress incontinence because their musculature will still be quite strong. Strong pelvic floor muscles can compensate for the weakened support of the urethra.

What causes urge incontinence?

As women get older, urge incontinence becomes more and more common. In 80 year olds, approximately 50 percent of women have some degree of urge incontinence. In this case, the muscle that surrounds the bladder, called the detrusor muscle, contracts when we sit on the toilet. There’s a lot of complicated communication that goes on between our brains and our bladder. When we are toilet-trained, our brains maintain control over the detrusor muscle. It tells the muscle not to empty until one is sitting on the toilet. As we get older, some of those connections are lost and the detrusor muscle may start to contract when randomly. It’s not under as firm control from the brain anymore and so patients start to leak urine when they’re not on the toilet. So as you get older, you can’t hold your bladder as long, and that leads to urge incontinence.

How can women manage urinary incontinence and improve their quality of life?

There are a variety of ways to manage incontinence, from lifestyle changes to surgery. Many of these solutions work for both stress incontinence and urge incontinence. In fact, many women have a mixture of both types. Doing Kegel exercises and pelvic floor exercises are the first-line treatment for either type. They also help prevent the condition and prevent it from getting worse. These exercises strengthen the pelvic floor and help compensate for the weakened support of the urethra that causes stress incontinence.

What changes in lifestyle may help?

Dietary changes can help quite a bit with urge incontinence. For example, one lifestyle change is to limit the consumption of coffee, alcohol, and citrus drinks. These types of drinks are very irritating to the bladder, so patients who have urge incontinence should try to cut back on these types of liquids. It’s also important to understanding that as you get older you can’t hold your bladder for as long, and you simply have to go to the bathroom a little more frequently.

What are some treatment options?

There are a variety of treatments depending on the severity of the symptoms and what’s been tried before.

For stress incontinence, there are small devices called pessaries which can be placed in the vagina. They look like a little ring with a knob on it. When they are placed in the vagina the little knob will sit under the urethra and support it. When a woman coughs or sneezes, the urethra pushes against the knob and this helps with stress incontinence. There are also surgical options such as placing a sling underneath the urethra which replaces the urethral support which has been lost. This is a minimally invasive option that’s 90 percent effective for stress incontinence. Patients are in and out of the hospital the same day.

What about treatment options for urge incontinence?

For women who have gone through menopause, the tissues in the bladder and vagina get irritable, and that can make urge incontinence worse. Vaginal estrogen treatments can help as they reverse the effects of menopause on the bladder. There are also medications that relax the bladder. There is an acupuncture procedure called posterior tibial nerve stimulation. The nerve near the ankle is very similar to the nerve roots that enervate the bladder. Stimulating these nerves in the ankle has been shown to help with urinary frequency and urgency, and it’s very safe and effective.

Finally, there are Botox injections into the bladder wall. Botox is a substance that paralyzes muscles. The injection is given after giving some anesthetic to the bladder to decrease discomfort.

What is your overall approach to treating this condition?

As a practitioner, I spend a lot of time discussing the patient’s lifestyle with them and figuring out how incontinence is impacting their life. That way, we can come up with options that work for them. Treating incontinence is all about improving quality of life. As a doctor and clinician, I always work the patient to outline her objectives—and that means that there is a lot of flexibility and choices for each patient’s treatment.

Make an appointment with Dr. Dabney

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