John J. Bauer, M.D., brings effective incontinence treatment to the forefront of the practice. He established the Center for Urinary Control to provide specialized comprehensive services for the treatment of all types of bladder control problems, interstitial cystitis for both males and females of all ages.

"Freedom from incontinence begins with
qualified answers from qualified specialists."

Don't Suffer Needlessly . . .

Feeling isolated and embarrassed is not unusual when you suffer from incontinence, or loss of bladder control. You may think you will never lead a normal life; no one can help you or cares. Nevertheless, there is help available from the Center for Urinary Control, a unique group of specialists with years of experience in the treatment of bladder control and incontinence issues. Alternatives are offered that will put you right back to an active way of life.

Loss of bladder control affects at least one of every 10 adults. Half of all women experience urinary incontinence (the accidental loss of urine) at some point in their lives. It is most common in women, however, children and men also experience urinary incontinence. You may feel like you are the only one that suffers from this condition. However, in the U.S., approximately 10 million people suffer from incontinence. This includes older people, women who have had children, anyone who exercises, and men who have had prostate surgery. Incontinence can leave you exhausted, robbed of a good night's sleep, and make travel uncomfortable or even impossible. It can keep you from enjoying a full life. Only 50% of those with some form of incontinence ever tell their physicians. Yet, despite these frustrations, only about one in 12 people seek relief. Most don't realize help is available - and it doesn't always mean surgery.

It is the establishment of this subspecialty center which will expose patients to these successful treatments offered by our practice. It is our genuine feeling that no person in this day and age should have to endure a bladder leakage problem. It is not just a "normal" part of aging.

What is Urinary Incontinence?

Urinary Incontinence is an unplanned loss of urine. Urine loss can be in large amounts or only a few drops. People with urinary incontinence often need to protect themselves with diapers or pads. Urine loss can often be cured or improved. Millions suffer needlessly from embarrassment and discomfort. Understanding the problem is the first step in helping you gain control. The goal of our program is to help you stay drier and reduce the need for protection. For a recent, patient informational, please see Female Urinary Incontinence.

Causes of Urinary Incontinence

Involuntary loss of urine (incontinence) is not a normal part of aging as many patients are condition to think, but it is a symptom of existing medical problems. Incontinence may be the result of pelvic muscles weakened from childbirth, stroke, diabetes, bladder infection, side effects of medication, prior surgery, or radiation treatments. For more information on the many risk factors for bladder control dysfunction follow this link as marked.

Types of Incontinence

There are three main types of incontinence: stress, overflow and urge. You also may have a combination of these called mixed incontinence.

1. Urge Incontinence: "Having a strong desire to urinate and being unable to wait long enough to get to the toilet. Frequency can also be a problem." Urge incontinence is caused by an overly sensitive bladder, which feels full even when it contains a small amount of urine. The bladder contracts unexpectedly, the bladder neck opens, and if the external sphincter is weak, urine in the bladder is expelled. Some symptoms include:
   • wetting if there is a delay in getting to the bathroom.
   • going to the bathroom at least every two hours.
   • getting up frequently during the night.

2. Stress Incontinence: "Leaking urine when you sneeze, cough, laugh, exercise or life heavy objects." This occurs when pelvic organs slip down. As a result, the bladder neck is not in the correct position and activity such as coughing or sneezing increases pressure on the abdominal cavity and bladder. Some symptoms of stress incontinence include:
   • leaking urine during a cough, sneeze or laugh.
   • going to the bathroom more frequently to avoid accidents.
   • avoiding exercise because it may cause leaks.

3. Overflow Incontinence: Dribbling urine throughout the day and never feeling like you have completely emptied your bladder. This form can result when scar tissue or dropped organs make the urethra (urine channel) very narrow, or may arise temporarily after pelvic surgery or childbirth. Overflow can also occur when the bladder stops contracting due to medications, injured nerves, prostate enlargement, or a habitually overstretched bladder. Some symptoms of overflow incontinence are:
   • getting up frequently during the night to urinate.
   • taking a long time to urinate, then urinating small amounts but not feeling empty.
   • dribbling urine throughout the day.

Male Incontinence

Males also have significant problems with all three types of incontinence discussed earlier. The most common male problems that lead to these bladder control issues are:

• Stress Incontinence
  • Post-prostatectomy Incontinence
    • Prostate cancer surgery
      • Perineal prostatectomy
      • Retropubic prostatectomy
    • Prostate enlargement surgery
      • Transurethral Resection of the Prostate (TURP)
• Urge Incontinence
  • Primary bladder instability
  • Prostate enlargement
  • Neurological diseases and conditions
    • Stroke
    • Parkinson's Disease
    • Others
• Overflow Incontinence
  • Prostate enlargement
  • Advanced Prostate Cancer

The male procedures for these problems are located in the surgical services section in the Center for Urinary Control.

What is Interstitial Cystitis (IC)?

Interstitial cystitis is a chronic inflammatory condition of the bladder. IC is a poorly understood disease, and its exact causes have yet to be identified. Although no bacteria, fungi, or viruses have been found in the urine of IC sufferers, some investigators believe that a yet-to-be discovered infectious agent causes IC. Some researchers believe that IC is toxin mediated, due to ischemia or an autoimmune disorder, which is a person's immune system, for unknown reasons, starts to "attack" its own cells. A popular theory, currently, is that the inner layer of the bladder (epithelium) is deficient in glycoaminoglycans, a protective coating on the bladder mucosa. Most investigators believe that the cause of IC has a number of factors and that it is better classified as a syndrome rather than a single disease.

A special IC diet can prevent worsening of your symptoms. Diet recommendations include avoidance of all caffeine products, carbonated drinks (pop, soda, etc.), tomatoes and tomato products, citrus fruits and juices, alcoholic beverages, and spicy foods.

An Interstitial cystitis symptom and problem questionnaire is one diagnostic tool used for IC.

Services

General

We help people manage urine loss, frequency, and urgency. Patients have access to the following range of services as needed.

• Assessment of the problem
• Pelvic floor muscles exercises
  • Kegel exercises: Pelvic floor muscle exercises increase the strength and thickness of these muscles, thereby, improving support of the bladder neck
• Fluid and dietary management
• Biofeedback to help you learn to find and work your pelvic floor muscles
• Relaxation exercises to help control the urgency to void
• Appropriate medication therapy
  • Medicines that relax the bladder
  • Estrogen therapy that increases the bulk, pliability, and tone of the muscles and soft tissues of the vagina
• Collagen injection therapy
  • Collagen treatment is performed on an outpatient basis. Once it has been determined that you are a good candidate for this treatment, your physician will test you to avoid allergic reaction to collagen. (Collagen is a naturally occurring protein in skin and connective tissue of mammals.) Collagen is injected into the connective tissue of the urethra to narrow the area near the urinary sphincter muscle, which controls the release of urine from the bladder.
• Surgical procedures
  • As a last resort, surgery (sling procedures) is performed to reposition the muscles and the connective tissues that support the bladder and the bladder neck. For most patients, no leakage occurs because the bladder neck stays closed, even after a cough or sneeze.

Our physicians in the near future are obtaining specialized training in providing a more advanced electrical stimulation therapy called InterStim (an implantable stimulation device, and lower extremity nerve stimulation for chronic unremitting urgency. Our Center is also going to invest in the newest development by NeoTonus, Inc., which is a chair that treats the pelvic floor laxity with extracorporeal magnetic pulse wave therapy.

Comprehensive diagnostic and therapeutic services are available for bladder control problems, urinary incontinence and interstitial cystitis. Please go to the marked links for more in-depth information.

In-Office Procedure Services

John J. Bauer, M.D., and the Center for Urinary Control offer many procedures in the office at a reduced fee compared to the same procedure in the hospital. For descriptions about these office procedures, use the links below that will take you to the specific section of the In-Office Procedures page of our site. Our practice treats a variety of urological conditions. Included below are the most common procedures that we perform in the office that are involved in the diagnosis and treatment of bladder control problems:

• Rigid Cystoscopy (to examine the inside of the bladder)
• Flexible Cystoscopy (to examine the inside of the bladder)
• Contigen Injections (for urinary incontinence)
• Urodynamic Testing (UDT)/ Cystometrograms (CMG) (for bladder control problem, incontinence)
• Behavior Modification and Biofeedback Therapy (conservative managements for urgency, frequency and incontinence)
• Electrical Stimulation Therapy (for chronic urgency, frequency pelvic pain, prostatitis and prostadynia)
• Intravesical Therapy for Interstitial Cystitis
• Uroflow with Post-Void Residuals (for prostate enlargement and other urinary flow problems)
• Urine Analysis (dip stick/microscopic) (check for blood, infections, etc. in the urine)

Surgical Services

John J. Bauer, M.D., performs many urological services in the local hospitals. The outpatient and inpatient surgeries listed below are performed at these affiliated hospitals or surgery centers.

The procedures listed below are direct links to "Your Surgery Details" which will have everything that you would want to know about you procedure, from after the diagnosis until fully recovered. Please use this section to learn about your upcoming surgery or to contemplate whether you really want a surgical procedure.

Open Surgery:
Open Prostatectomy
Male Sling
Pubovaginal Sling
Cystoceole Repair
Augmentation Cystoplasty
Artificial Urinary Sphincter (AUS-800)
Tension-Free Vaginal Tape (TVT)

Endoscopic Surgery:
Cystoscopy Under Anesthesia (CUA)
Hydrodilation of the Bladder
Transurethral Incision of the Prostate
Transurethral Resection of the Prostate
Transurethral Laser Ablation of the Prostate
Cysto-Bulking Agent Injection
Urolume Stent Placement

Patient Forms

A few questionnaires can be downloaded and printed out before your appointment. Below you will find a list of these forms that link to printer-friendly (PDF) pages. [printable/PDF page help] We request each patient to bring the appropriate forms to the office for their consultation.

• New patient forms - choose one of these two options:
  • Male new patient registration and history form
  • Female new patient registration and history form
• Follow-up patient registration and history form (both male and female)
• Prostate symptom score form (BPH Questionnaire)
• Female Incontinence Questionnaire Form
• Voiding Diary Form
• Interstitial Cystitis Questionnaire

Why Use the Center for Urinary Control?

1. Individualized Care

   The Center for Urinary Control is a comprehensive service for the treatment of all types of urinary incontinence: stress, urge, frequency, overflow, pelvic floor problems and interstitial cystitis. Typical patients that can be helped are:

   • Pre and post-menopausal females experiencing uring leakage.
   • Men who become incontinent after prostate or pelvic surgery.
   • People who may suffer from incontinence due to stroke or other central nervous system disorder.
   • Patients with a presumed diagnosis of interstitial cystitis

2. Professional Medical Staff

   A board-certified urologist monitors the assessment of each patient's problem and supervises the design of the treatment program. Specially trained nurses coordinate the continence treatment program.

Incontinence is frustrating enough without wasting time trying to determine what's wrong. At The Center, we have the expertise to diagnose you accurately and quickly. Dr. Bauer and his staff are genuinely concerned about your health. We feel the future of healthcare is moving toward offering sub-specialty centers of excellence, which will have the most up to date treatment in urology. Our center for excellence, the Center for Urinary Control, offers many options and the solutions for people that suffer from urinary incontinence.