Continence Center

Patient Care – What to Expect

Bladder and bowel function are complex. They often involve many factors including the pelvic organs, muscles and nerves in the pelvic area, and the nervous system. That's why we dedicated an entire center to helping patients achieve the function and comfort they desire.

Patients choose us because of our:

• Advanced evaluations and customized care: We use the latest tests and tools to understand what's causing pain and discomfort. Then we partner with your providers to create a custom treatment plan that helps you regain bladder control.
• Expertise and experience: Our program has helped patients manage and overcome bladder and pelvic conditions for more than 20 years. And we actively participate in cutting-edge research to increase our knowledge and make care even better.
• Neuro-urology specialists: Neuro-urology is a highly specialized field that focuses on bladder issues related to brain and spinal injuries. Not many doctors in the country focus on neuro-urology – but Atrium Health’s neuro-urologists partner closely with the Continence Center to care for patients with those unique needs.

What We Treat

Sometimes bladder and other pelvic issues develop because of problems in your urinary tract or digestive system. They may also result from injury or disease affecting the brain or spine. Whatever the cause, we have the expertise to treat a variety of conditions, including:

• Urine leaks/controlling your bladder
• Leaky bladder when you do things like cough or sneeze
• The need to go too often
• The need to go suddenly
• Frequent nighttime urination
• Slow or weak urinary stream
• Difficulty emptying your bladder
• Urine retention
• Bedwetting
• Overactive bladder
• Pelvic organ prolapse
• Enlarged prostate
• Frequent bladder infections
• Bladder problems caused by pregnancy and childbirth

Continence Center: Tests and Treatments

The Continence Center specializes in urodynamics, which are tests that show us how well your bladder and related organs and muscles work. This helps us recommend the right treatments for your specific condition.

The tests we provide include:

• Cystoscopy: Which shows the inside of your bladder and urethra. This helps us diagnose problems in more detail than you get from urine tests or ultrasound.
• Electromyography (EMG): Which measures your sphincter control to help diagnose bowel problems.
• Videourodynamics: Which assesses your bladder function by showing a video X-ray of the bladder while it’s filling and emptying.

Based on these tests, your provider may recommend further treatment at our center, such as:

• Bladder training: Bladder training helps you reduce leaky episodes and how often you go to the bathroom. Bladder training includes techniques like managing your fluid intake and following a schedule for going to the bathroom.
• Biofeedback: Biofeedback helps you identify and strengthen your internal muscles that support your bladder, so you can regain bladder control.
• Botulinum Toxin injection: These injections relax the muscles of the bladder wall temporarily (3 to 6 months). This can prevent you from leaking urine or feeling a constant need to pee.
• External Collection Device fittings: Our continence care nurses can help men with leaky bladders by fitting them with various devices that collect urine when it leaks. Devices include penile clamps, condom catheters, and one-piece male external urinary collection devices.
• Intermittent Catheterization Teaching: Intermittent self-catheterization (IC) involves inserting a catheter to drain your bladder only when you need it. IC protects your kidneys from infection and damage and lowers the risk of stretching your bladder. Our continence care nurses can teach you how to do it so you can be in charge of your own bladder maintenance.
• Pelvic rehabilitation: Pelvic rehabilitation includes manual therapy, exercises and other treatments to condition the muscles in your pelvic floor. These muscles support your bladder and help it function properly.
• Pessary fittings: These are small rings that are placed in a woman’s vagina to support the bladder and compress the urethra. Pessaries come in various shapes and sizes. Our continence care nurses fit you with the right one for your body.
• Posterior Tibial Nerve Stimulation therapy: This is a treatment for overactive bladder that involves stimulating a nerve near the ankle (the tibial nerve), because it communicates directly with the nerves responsible for bladder control. We perform this therapy in our center using an acupuncture needle hooked up to a temporary electrical stimulator. The treatment lasts for 30 minutes and is repeated once a week for 12 weeks.
• Sacral Neuromodulation Testing: This is a treatment for overactive bladder that involves stimulating nerves near the tailbone that are responsible for bladder control. We start by inserting a thin wire next to your sacral nerve, using a needle and local anesthesia. Then we attach an external device to the wire and have you wear it for about 3-5 days as a test. The device sends electrical impulses into the wire, stimulating your sacral nerve, and you see if it improves your symptoms. If it does, we replace the external device with one you can wear long-term. This is a small battery like a pacemaker, which we implant in the buttock area in a brief outpatient operation.
• Urethral Bulking injection: This therapy involves injecting material called “bulking agents” into the tissues around the urethra. The bulking agents thicken the walls of the urethra so you can close it all the way and avoid leaking urine.

Your Care Team

At the Continence Center, you’re treated by a team of specialists who work together to understand your needs and set the best course for rehabilitation. Your team at the Continence Center may include:

• Urologists and neuro-urologists: Who are doctors that focus on bladder issues and oversee your care.
• Urodynamics and continence care nurses: Who have special training to carry out the tests that diagnose your condition and inform treatments.
• Physical therapists: With training and experience in pelvic rehabilitation, who help you develop skills and physical conditioning for better bladder and bowel control.