Pelvic Health Resources & FAQs

Una Lee, MD, a board-certified urologist with subspecialty board certification in Urogynecology and Reconstructive Surgery (URPS), says women come into her office searching for hope. For years, they suffer not knowing what to do or where to go. The reason: it’s an embarrassing topic for women to talk about, so it is not uncommon for patients to delay care. It’s one of the reasons Dr. Lee wants to break the stigma around urinary incontinence. 

“By the time I see many women in the clinic, they tell me they have been suffering for years,” said Dr. Lee. “The reason they don’t come in sooner is because they think they are the only one it’s happening to, and they don’t know where to turn.” 

Myth: urinary incontinence is rare.
Truth: urinary incontinence is common. 

Urinary incontinence affects millions of people worldwide. It’s estimated that between 24% - 45% of women suffer from some degree of urinary incontinence. Urinary incontinence impairs quality of life. It can not only be embarrassing, it can be debilitating. Studies suggest the prevalence may be understated because of the number of people who do not report urinary incontinence to their health care providers.  

“When it starts to impede your enjoyment of activities. If you don't exercise, travel or leave the house, it’s a problem,” she says. “The good news is, we can help. I’ve always wanted to go into women’s health, and when I found urology I realized there was a huge need to help women with pelvic floor problems.”

Dr. Lee says there are two main types of urinary incontinence, urgency incontinence and stress incontinence. 

Stress incontinence occurs when a pressure from things such as activity puts pressure on the urethra and causes urine to leak. Urgency incontinence is what many refer to as overactive bladder, an inability to stop bladder leakage from occurring. 

Myth: urinary incontinence occurs because of aging.
Fact: there are many contributing factors beyond age.

Risk factors beyond aging include things like:

• Pregnancy
• Vaginal delivery
• Long labor
• Childbirth injury
• Changing hormones
• Perimenopause
• Conditions that increase pressure on your pelvic floor

Myth: there is no treatment for leaking.
Fact: there are effective and safe treatment options for women.

“We offer all types of treatments for urinary incontinence,” said Dr. Lee. “Treatment should be individualized for each woman. Providers work to understand a patient’s symptoms, their experience, their goals, and we work together to make a plan. Specialists in pelvic floor problems validate and acknowledge what patients feel and experience and that makes a big difference in patients feeling comfortable taking the next step.” 

Myth: urinary incontinence is embarrassing.
Truth: many women are affected by bladder leakage problems, and we can normalize it by talking about it.

Dr. Lee says by the time many women see a specialist, they have been struggling with urinary incontinence for months to years. Sometimes, they give up activities, stop playing with their kids, and feel a sense of hopelessness. Dr. Lee says she and others want to empower women and advocate for their needs. Urinary incontinence is common, and she hopes talking about it will reduce the stigma surrounding it – and help women find help faster. 

“It can be a journey for patients, and VMFH specialists are here every step of the way to advocate and support them,” she says.

When to seek help 

Dr. Lee says women should talk to their primary care provider if they leak regularly, or if urinary incontinence starts to affect their normal activities. 

Physical therapy is usually very effective in treating urinary incontinence. Pelvic floor exercises can help, and yet some people require other treatments, possibly procedures or surgery.

At VMFH, a team of experts can help create an individualized treatment plan that aligns with a person’s goals and lifestyle. 

Treatment options

Urethral bulking is a treatment offered at VMFH, and it’s been a game-changer for many patients, says Dr. Lee. 

Dr. Lee says the procedure is effective, safe, and minimally-invasive. An injection helps the urethra become more watertight, and patients experience significant improvement that lasts years. The procedure can be performed in the clinic or under anesthesia. Almost immediately, women see results and can get back to activities. 

Another safe and effective treatment option is Botox of the bladder, which is a powerful treatment that targets overactive bladder and urgency incontinence. Urgency incontinence is the type of bladder leakage that happens when you get the urge to void and leak before you can make it to the bathroom. If fluid, behavioral, and medical treatments do not help patients achieve their goals, then Botox may be an option that can give patients significant improvement in bladder control.

“For patients, we want treatments that are effective, low risk, and improve their quality of life,” said Dr. Lee. “These treatments hit all three.”

First, you should consider the team's experience with treating your condition. If the team has a history of successful outcomes, has done extensive research, conducted clinical trials, and has published their work, that̠s a good indication they̠re leaders in the field and you̠ll be in good hands. A second consideration is the technology used for diagnosis and treatment. Virginia Mason Franciscan Health offers a state-of-the-art video urodynamics lab and a wide range of the latest surgical and nonsurgical treatment options

Our state-of-the-art video urodynamics lab provides us with simultaneous electronic tracings of bladder activity and video imaging of the bladder in motion. Both are important to determine the cause and type of incontinence you may be experiencing. Our specialists all have expertise in interpreting this data.

We are proud of our designation as a Virginia Mason Center of Excellence. This recognition is selectively given to a team of providers who are nationally recognized for patient care and advance medical knowledge by researching and applying state-of-the-art methods and technologies.

You may start to notice that sharing a good laugh with friends, sneezing, coughing, doing jumping jacks or jogging during a workout causes leakage. The fact is any degree of incontinence that bothers you is a reason to discuss it with your primary care doctor. If you aren't finding the solution to your problem, ask your doctor for a referral to the Pelvic Floor Center at Virginia Mason Franciscan Health.

We believe there is appropriate treatment for every patient and that you are a true partner in managing your condition. We dedicate time to discussing all your options and offer suggestions for returning to an active, unrestricted life.

Our highly trained support staff can discuss your particular issue and help you decide the best provider for you to see.

Yes, there are several conservative treatment options, ranging from physical therapy and incontinence aids for stress incontinence to dietary changes, Botox treatments, habit changes, bladder training, and medications for urge incontinence. We also use neuromodulation, a technique that retrains the bladder nerve response using small amounts of direct electrical stimulation to the nerves themselves. Our team of women's health experts considers the least-invasive approaches to treating your pelvic health concerns first. 

Sometimes reducing your fluid intake; avoiding nicotine, caffeine, and carbonated beverages; or regularly practicing pelvic floor exercises will help reduce or eliminate leakage. If these suggestions don’t help, you should consider seeking medical attention. 

Success rates and recovery periods depend on your specific continence problem, but many of our procedures have success rates as high as 80 to 90 percent over the long term. Recovery can range from overnight for most procedures to six weeks for full recovery from bladder augmentation surgery.

Pelvic floor prolapse is a weakening of the pelvic floor, allowing the bladder or the vagina to bulge downward, often causing incontinence. Pelvic prolapse can be the result of childbirth or hormonal changes during menopause. More than 90,000 hysterectomies are performed each year for pelvic prolapse, yet the hysterectomy may not resolve the incontinence. We use innovative techniques and materials for pelvic floor reconstruction, resulting in a 90 to 95 percent success rate.

We use several different innovative types of sling materials and surgical treatments, including a variety of permanent mesh products or fibrous tissue called fascia.

We have experience in choosing the best material for you, as well as the correct surgical approach to place the material for optimal results. The center has performed and published the results of several clinical trials using these techniques and materials at Virginia Mason Franciscan Health. We will thoroughly evaluate your particular symptoms, the results of testing in our incontinence lab, and your personal preferences to help make the best choice for you.