HJBR May/Jun 2026

HEALTHCARE JOURNAL OF BATON ROUGE I  MAY / JUN 2026 27 night to urinate. For individuals under the age of 60, urination of no more than once a night is generally considered the norm. It is important to note that other medical con- ditions can also contribute to frequent uri- nation and nocturia. Some of these include urinary tract infections, diabetes, enlarged prostate, and certain medications. Overflow urinary incontinence is a third type in which the involuntary loss of urine occurs when the bladder is overdistended. This is usually the result of either a weak bladder contraction or pelvic organ pro- lapse. Prolapse occurs when one of the pelvic organs (bladder, uterus, or rectum) descends into the vagina. This may present as an obvious bulge or a more subtle heavi- ness or discomfort in the vaginal area. Pro- lapse can contribute to incontinence symp- toms and incomplete bladder emptying. Why Incontinence Conversations Are Not Happening With such a high prevalence, it is shock- ing that patients and providers are not hav- ing conversations about urinary inconti- nence on a regular basis. Often, neither the patient nor the provider wants to be the person who brings it up. One study that surveyed over 94,000 women found that only about 34% had discussed their symp- toms with a healthcare provider. Some of the barriers to discussing incontinence include embarrassment about broaching such a personal and sensitive topic; lack of awareness of how common incontinence is; and lack of knowledge about incontinence symptoms and available treatments. Many women simply do not know that help is available because the topic does not come up regularly at annual checkups. For providers, adding a simple question, such as, “Do you experience any bowel or bladder issues?” to the health history could open the door to a much-needed conversation. I have found in practice that simply asking results in a productive and very informative discussion that helps my patients feel validated and heard. Using a brief questionnaire can also help to gather more detailed information. One example is the Incontinence Impact Questionnaire (IIQ-7). The information gathered can help to identify the type of incontinence, deter- mine severity of symptoms, and assist in monitoring response to treatment. Beyond the Conversation Examining someone with complaints of incontinence or frequency often starts with ruling out a urinary tract infection since this can be the culprit, particularly in new onset incontinence. With female patients, completing a physical exam should include assessing the vulva for signs of atrophy, which often accompany loss of estrogen in those post-menopause. Visually inspecting the urethra and assessing for pelvic organ prolapse may also be indicated. Having the patient perform a cough stress test to assess for urine leakage is also helpful when assessing for presence of SUI and UUI. For providers with training in intravagi- nal assessment, checking the strength and endurance of the pelvic floor muscles can also provide some valuable information and help to direct treatment. Some individuals may require further assessment which can include urodynamic testing, cystoscopy, or ultrasound to measure postvoid residual volumes. These tests are typically performed when trying to discern the specific cause for urinary symptoms or when patients fail to respond tomore conservative interventions. Treatment Options for Urinary Incontinence Almost everyone has heard about Kegel exercises to strengthen pelvic floor mus- cles, but not everyone knows how to do them, and not everyone needs to do them. For patients with SUI, the International Continence Society recommends pelvic floor physical therapy (PFPT) as a first course of treatment. PFPT provides a low risk, affordable option for many patients. One of the primary interventions is pel- vic floor muscle training which focuses on improving the strength and endurance of the pelvic floor and may also incorporate muscle relaxation when indicated. Pelvic floor muscle training also works to help patients coordinate muscle activation with activities of daily living. It may include train- ing patients on how to perform activities such as moving from lying down to sitting without putting excessive strain on the pel- vic organs while simultaneously contracting the pelvic floor muscles for support. Some patients may require additional interven- tions such as electrical stimulation or bio- feedback to assist with pelvic floor muscle training. Patients dealing with UUI are often treated with a combination of pelvic floor muscle training and bladder retraining. Education on bladder irritants and tracking fluid intake and incontinence episodes on a bladder diary are components of bladder retraining. Urge deferral techniques com- bined with pelvic floor strengthening can also help to reduce incontinent episodes. For patients with pelvic organ prolapse, a pessary may be indicated. This is a small device inserted into the vagina to support the pelvic organs. Incontinence pessaries can be used for patients with SUI to help support the bladder neck and urethra. Pes- saries are a good option for patients who may not be appropriate for surgery or who want to postpone surgery. For more advanced cases of prolapse, surgical repair may be necessary and is typically performed by a specialist such as a urogynecologist, urologist, or gynecologist. Pharmacological interventions may be indicated in some cases of incontinence. Individuals experiencing overactive bladder