Urinary incontinence care in Fort Worth
Leaking urine — a little with a cough or sneeze, or a sudden urgent rush you can’t hold back — is one of the most common reasons women come to see us. It is not something you simply have to accept.
If you’ve started mapping out every bathroom before you leave the house, or quietly given up activities you love, you are far from alone — and there is a great deal we can do to help.
What is urinary incontinence?
Urinary incontinence means the accidental loss of urine. It ranges from a few drops when you cough to a complete inability to reach the bathroom in time. It affects women of every age — not only older women — and becomes more common after childbirth and around menopause. However common it is, it is never simply “part of getting older” that has to be tolerated, and it is not a sign that something is seriously wrong.
Understanding which type you have is the key that unlocks the right treatment, because the three main patterns are driven by different problems and respond to different care.
Stress incontinence
Leaking when physical pressure is placed on the bladder — coughing, sneezing, laughing, lifting, jumping, or exercising. It happens because the support and closing pressure beneath the bladder and urethra have weakened, so a sudden increase in abdominal pressure pushes a little urine out. This is the most common type in younger and active women.
Urge incontinence
A sudden, powerful need to urinate that’s followed by leakage before you can get to a toilet. Here the problem is an overactive bladder muscle that contracts when it shouldn’t. Many women with urge incontinence also notice they’re going very frequently and waking at night.
Mixed incontinence
A combination of stress and urge symptoms in the same person, which is extremely common. We treat mixed incontinence by identifying which component bothers you most and addressing each part in turn.
How common is it?
Urinary incontinence is one of the most common conditions in women’s health — studies suggest that roughly one in three to one in two women experience some degree of it during their lifetime, and the likelihood rises with age and with the number of children a woman has delivered. Despite how common it is, most women wait years before mentioning it to a doctor, often because they assume nothing can be done or feel embarrassed to bring it up. Neither is true. If you are dealing with this, you are in very good company, and you’ve come to exactly the right kind of specialist.
Signs you might have urinary incontinence
- Leaking with a cough, sneeze, laugh, or during exercise
- A sudden, strong urge to urinate that’s difficult to control
- Not always reaching the bathroom in time
- Wearing pads or liners “just in case”
- Getting up more than once at night to urinate
- Avoiding activities, travel, or social plans because of your bladder
Why it happens
Continence depends on a coordinated system: the bladder muscle, the urethra and its closing pressure, the pelvic floor muscles that support everything, and the nerves that tie them together. When one or more of these weakens, leakage can follow. Common contributors include:
- Pregnancy and childbirth — both vaginal and cesarean delivery stretch and can injure the pelvic floor and its nerves
- Menopause — the natural drop in estrogen thins and weakens the tissues of the bladder and urethra
- Aging — the pelvic floor and connective tissue gradually lose strength and elasticity
- Chronic straining — from a long-standing cough, constipation, or repeated heavy lifting
- Prior pelvic surgery — which can alter support and nerve supply
- Excess weight, certain medications, and some medical conditions that increase pressure on the bladder or affect the nerves
Very often it’s not a single cause but a combination, built up gradually over years. The good news is that most of these factors can be worked with, and improvement rarely depends on reversing any one of them.
When should you see a specialist?
It’s worth being evaluated whenever leakage is affecting how you live — changing what you wear, where you go, or what you’re willing to do. You don’t need to wait until it’s severe. In particular, we’d encourage you to be seen sooner if you notice blood in your urine, pain or burning with urination, a feeling of incomplete emptying, or a sudden change in your pattern, since those deserve a prompt look. There is no threshold of “bad enough” you have to reach first; if it bothers you, that’s reason enough.
How we evaluate it
Your first visit is an unhurried conversation about what you’re experiencing and how it affects your day, followed by a focused, gentle pelvic exam. We’ll check a urine sample to rule out infection and perform a quick, painless in-office measurement of how completely your bladder empties. We may ask you to keep a short “bladder diary” for a few days — simply noting what you drink and when you go — which is often the single most revealing tool we have.
In some cases, particularly before surgery or when the picture is mixed, we recommend urodynamic testing: a painless study that measures how your bladder fills, stores, and empties, so we can tailor treatment precisely. Nothing is done without first explaining what it is and why it helps.
How we treat it
Our approach moves from the least invasive option that’s likely to help toward more involved treatment only if it’s needed. Most women improve significantly without surgery, and you’re always part of deciding how far to go.
- Pelvic floor physical therapy. Targeted, guided strengthening of the muscles that support the bladder and urethra. Often remarkably effective for stress symptoms, and a first-line option many women wish they’d tried sooner.
- Behavioral & bladder training. Practical techniques such as timed voiding, urge-suppression strategies, and simple adjustments to fluids and bladder irritants. These retrain the bladder and can meaningfully reduce urgency and leakage.
- Medications. For urge-type leakage, medications can calm an overactive bladder muscle and reduce accidents. We match the option to your symptoms and health, and monitor how it works.
- A pessary or support device. A soft, removable insert fitted in the office can support the urethra and reduce stress leakage — an effective, entirely non-surgical choice, and a good option if you’d prefer to avoid or delay surgery.
- Urethral bulking. A minimally invasive, in-office option for stress incontinence in which a bulking agent is injected around the urethra to improve its seal. It involves no incisions and can be a good choice if you’d prefer to avoid surgery or aren’t a candidate for a sling.
- Bladder Botox & nerve therapies. For urge incontinence that hasn’t responded to other measures, options include bladder Botox injections, PTNS — a gentle, in-office nerve therapy using a fine electrode near the ankle — and sacral neuromodulation, an implanted therapy that regulates the nerve signals behind urgency and leakage. How sacral neuromodulation works, step by step →
- Sling surgery. A well-established, minimally invasive outpatient procedure for stress incontinence that provides a durable fix when that’s the right choice for you. Most women go home the same day.
Facing more than one of these at once? Prolapse, leaking and urgency often travel together, and treating one can affect the others. How we decide on a plan together →
Trusted resources
For further physician-reviewed patient education, we recommend Voices for PFD, from the American Urogynecologic Society (AUGS), and Your Pelvic Floor, from the International Urogynecological Association (IUGA) — the leading professional societies in our field. As always, the guidance most relevant to you is what we can offer after seeing you in person.
Most women get real, lasting relief.
Whether the answer is a few weeks of pelvic floor therapy, a simple device, or a short outpatient procedure, the great majority of patients see meaningful improvement. The hardest part is often just deciding to be seen — and you’ve already thought about it enough to be reading this.
About bladder leakage.
Stress incontinence is leaking when pressure is placed on the bladder — coughing, laughing, exercising. Urge incontinence is a sudden, strong need to go that’s hard to control. Many women have both, called mixed incontinence, and each part can be treated separately.
Usually not. Most patients improve with pelvic floor therapy, behavioral changes, a support device, or medication. Surgery is one option among many, offered when it’s the best fit for you — and always your choice.
It becomes more common with age and after childbirth, but common is not the same as normal or untreatable. There is almost always something that can be done to improve it, at any age.
For many women with stress incontinence, guided pelvic floor therapy makes a substantial difference — more so than exercises done on your own, because technique matters a great deal. For others it’s one part of a larger plan. An evaluation helps set realistic expectations.
Yes. In fact the hormonal changes of menopause are a frequent contributor, and there are effective treatments — including options specifically suited to postmenopausal women, such as local estrogen therapy alongside other measures.
You don’t have to plan your life around the bathroom.
Give us a call and let’s talk about what’s really going on — discreetly, and without judgment.