Conversations about health issues can be difficult and sometimes, downright embarrassing. That’s how Charlotte resident Connie, who is identified only by first name for privacy reasons, felt about her urinary incontinence. In fact, it led her to silently deal with the issue for years.

“It continued to get worse to the point that it was affecting my life,” Connie said. “I’d have to tell my personal trainer that I couldn’t do certain exercises. It affected my ability to hike with friends and even something as simple as walking my dog. I really had to think about what I was doing and where the bathroom was.”

Urinary incontinence is a general term for the involuntary loss of urine. More than 30 million Americans suffer from some type of urinary incontinence or bladder condition – both men and women – according to the National Association for Continence.

Dr. Joseph Malek, a urogynecologist at Novant Health, is pictured in a white coat.
Dr. Joseph Malek

Urogynecologist Dr. Joseph Malek at Novant Health Urogynecology said women are more prone to experiencing this, mostly due to anatomy. Childbirth, age, genetics, obesity and prior surgeries such as a hysterectomy are among the risk factors for developing incontinence.

“The female urethra, the tube from the bladder to outside of the body that urine passes through, is very short. It’s only about three or four centimeters, which makes it prone to leaking,” Malek said.

‘It’s a quality of life issue’

Malek said the most common form is stress urinary incontinence, which affects about a third of women over 45. It is a loss of urine that occurs at the same time as physical exertion. Activities like sneezing, coughing or exercise increase the pressure or stress on the bladder, pushing urine out of the body. That was Connie’s issue.


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Urgency urinary incontinence occurs when someone has a strong, sudden need to urinate that is difficult to delay. Malek said both types of incontinence can impact a person’s quality of life and in some cases, “patients can get so fearful they don’t want to leave the house.”

But people do not have to live with fear. There are various ways to address incontinence, which involve little to no downtime for the patient – something Connie knows firsthand. Her incontinence only got worse over time, prompting her to meet with Malek at the beginning of the year. He suggested a mid-urethral sling, a safe and successful way to treat stress urinary incontinence and a method that is considered the “gold standard.”

“Success rates with this procedure are high – around 90 percent – especially one year out from surgery,” Malek said.

During the short, outpatient surgery, which Connie underwent in May, Malek made a small incision in the vagina, as well as two small skin incisions in the groin area. Using specially designed needles, he positioned a thin piece of synthetic mesh, known as a sling, under the urethra. Next, Malek pulled the ends of the mesh through the skin incisions and adjusts them to provide the right amount of tension under the urethra – making leaks far less likely to occur. Connie was back at home that evening and even worked the next day.

“The hardest thing about the whole situation was my own feelings of shame and embarrassment,” Connie said. “I wish I had done this sooner.”

After the procedure, the patient’s tissues grow into the mesh which acts as a lattice of support. This typically takes several weeks and helps to secure the sling. Malek said the mid-urethral sling is the most common procedure used to treat stress urinary incontinence, with Novant Health Urogynecology performing more than 300 in the Charlotte area in 2019. Since it is minimally invasive, there is a low risk of infection and a quicker recovery time. It is often covered by insurance, though a deductible or copay may need to be met.

Malek said there is also a device called a sacral nerve modulator, which is an implant that is used to treat urgency urinary incontinence. This is also performed using minimally invasive surgery, eliminating the need for an overnight stay.

“This works under the premise that all muscles are controlled by nerves. The bladder is a muscle and we aim to control the nerve regulation between the bladder and the brain,” Malek said. “It almost works like a pacemaker for the bladder to suppress some of those urges.”

Nonsurgical options are also available

There are also several nonsurgical options for people who suffer from incontinence, including Botox bladder injections. Botox is a drug made from a toxin produced by bacteria, which is called botulinum toxin. Botox relaxes the bladder muscle so the bladder can hold more urine – giving a person more time to make it to the bathroom.

“Just like Botox injections are used for cosmetics or migraines, they can be used to partially paralyze the bladder muscles. We can do these injections in the clinic, without any type of anesthesia, by using a local numbing gel,” Malek said.

Botox bladder injections are not permanent, but will last between six to 12 months, according to Malek. Other options include:

  • Kegel exercises, which can help strengthen the bladder muscle.
  • Limiting fluid consumption to certain times of the day.
  • Avoiding caffeine and artificial sweeteners.
  • Healthy lifestyle changes, such as quitting smoking.

If you or someone you know suffers from urinary incontinence, know there are options. Malek encouraged people to start by scheduling a consultation to have an open conversation and learn more.