Women's Health

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women's health in johnson city, tn

Comprehensive Women's Health

At The Caudle Center, we provide comprehensive women’s health services while making you feel at ease and comfortable with your body and any health concerns you may have.

Women’s health treats conditions that mainly affect women. These conditions could be related to the female sex hormones, female reproductive organs, and conditions that primarily affect women.

  • Hair Loss
  • Hormones
  • O-Shot®
  • Urinary Incontinence
  • Vaginal Rejuvenation
Hair Loss
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Hair Loss

For many of us, our hair is a huge part of our identity. It's one of the first things people notice about us, and it can be a big source of confidence. So when hair loss happens, it can be devastating.

We know how important it is for our patients to feel confident and attractive, so we offer the latest in hair loss technology and procedures.

Lifecycle of a Hair Follicle

Anagen – This is the active growth phase of the hair follicle and may last 2-6 years.

Catagen – This is the transition where the hair follicle and bulb begin to separate from the hair papilla and start the migration up to the skin before shedding. This phase usually lasts 1-2 weeks.

Telogen This is the resting phase where the hair follicle has fully separated from the dermal papilla and usually lasts 6 weeks to 3 months.

Return to Anagen Phase Dermal papilla and hair matrix forms a new hair follicle.

Causes of Hair Loss

Female Pattern Hair Loss (androgenetic alopecia)

This is the most common hair loss pattern in women and is characterized as nonscarring diffuse hair loss evolving from progressive miniaturization of hair follicles and, consequently, progressive reduction of total hair count and thickness primarily involving the frontal and central scalp areas and extending laterally. Hair loss in women tends to be less severe and rarely leads to total baldness.

Women tend to maintain their frontal hairline, which is more diffuse. Male pattern hair loss can occur in women but is uncommon. Hair loss in women is more complex involving more genetic influences, and is multifactorial, including the additional influence of environmental factors. Various possible hormonal influences include androgens, estradiol, progesterone, thyroid hormone, and hormonal changes during pregnancy or menopause.

Other Causes of Hair Loss

  • Thyroid dysfunction.
  • Post-partum.
  • Nutritional deficiencies such as Iron, Zinc, protein, or Vitamin D deficiency.
  • Rapid weight loss.
  • High-stress levels or major life events causing emotional and hormonal changes.
  • Inflammatory conditions causing scarring of the hair, such as folliculitis, infection, lichen-type changes, and lupus.
  • Secondary scarring from traumatic scalp injuries, surgery on or through the scalp, keloids, burns.
  • Medications such as beta-blockers, ACE inhibitors, high doses of Vitamin A, low molecular weight heparins (enoxaparin, dalteparin), warfarin (rare), lithium, SSRIs (e.g., fluoxetine/Prozac), Retinoids (Acetretin, Isotretinoin, Vitamin A supplements), antimicrobials (Isoniazid, Antiretrovirals like Indinavir).
  • Chemotherapy.
  • Autoimmune causes.
  • Traction on hair roots such as tight braids, glued hairpieces, or anything where the hair is pulled tight.
  • Trichotillomania (obsessive-compulsive behavior) caused by excessive pulling on their hair (usually by children or teens).
  • Excessive pressure to an area of the scalp, such as a type of pressure sore.
  • Radiation-induced.
  • Infections such as Syphilis, bacteria, fungus (tinea capitis), or untreated ringworm of the scalp.
  • Scalp conditions causing itchy scalp, hair loss, and flaking repeated scratching such as dandruff or seborrheic dermatitis.

Hair Loss Treatments

Male or Female pattern hair loss can mimic and often runs concurrently with other health problems that may affect hair loss. A detailed medical history and physical examination are necessary.

It is easier to treat hair loss early, when the process is starting and hair structures are still present but dormant, than when the hair structures are absent and dead. The earlier treatment leads to better results. Both male and female pattern hair loss is not cured in a “one and done” treatment. It requires lifelong treatment. Any break in treatment will begin the hair loss process.

Current treatment options include
  • Hair replacement / transplantation
  • Cosmetics
  • Micropigmentation (tattoo) to resemble shaven scalp
  • Hairpieces
  • Minoxidil solution
  • Finasteride tablets (type II 5-alpha-reductase inhibitor)
  • Dutasteride
  • Platelet-rich plasma
  • Microneedling
  • Low-level light therapy
  • Stem cell therapy

The medications listed (Minoxidil, Finasteride, & Dutasteride) have the potential to cause fetal abnormalities and are thus contraindicated in pregnant women or women trying to become pregnant. Those three medications affect androgen metabolism or its effects. The use of medications is the cornerstone of male or female hair loss treatment. These are FDA-approved medications.

Platelet Rich Plasma (PRP)

Platelets are rich in numerous growth factors that are released upon platelet activation (injection into the scalp). The growth factors activate stem cells in the bulge area of follicles, encourage the growth of existing hair, as well as encourage the formation of microvascular networks improving circulation and eventually providing the nutrients required for hair growth. Clinical studies have proven the effectiveness of PRP therapy in hair loss.

Typically 3 to 5 sessions are performed in the desired area within 4- 6 months. Injections can range from every two weeks to once monthly. Then booster treatments are performed every three to six months to one year after that. Studies have shown that the hair regrown from PRP can last for up to 18 months after treatment. I recommend once-yearly boosters to keep the regrowth.


Microneedling is a minimally invasive dermatologic procedure in which fine needles are rolled over the skin to puncture the top layer of the skin (stratum corneum). The physical trauma from needle penetration induces a wound-healing cascade with minimal damage to the epidermis that induces collagen formation, neovascularization, and growth factor production in the treated areas. Microneedling has shown promising results as an adjuvant treatment with existing techniques.

Low-Level Light Therapy

Low-level light therapy (LLLT) is a relatively new technique for hair loss treatment. The biochemical mechanisms are not completely understood, but the cellular respiratory chain of mitochondria probably absorbs the light energy, which results in increased electron transport and the promotion of cellular signaling and, in turn, allows for hair regrowth. LLLT efficacy is still being studied. It seems that LLLT in the 650 to 900 nm wavelength at 5mW may be a therapeutic option for patients with male or female pattern hair loss.

Regenerative (Stem cell) Medicine

Adipose-derived stem cells show much promise in hair loss treatment. Adipose-derived stem cells are multipotent cells that have shown potential for regenerative medicine. Adipose-derived stem cells not only differentiate into mesenchymal lineage cells but also secrete various growth factors. Recent studies have reported that adipose-derived stem cells promote hair growth via growth factor secretion. We have already used adipose-derived stem cell-conditioned medium to treat alopecia and reported good results.

FAQ's About Hair Loss

How is hair loss (Baldness) defined?

All normal men and women lose scalp hair every day, which averages between 25 to 100 hairs per day. Some individuals can normally shed up to 150 hairs per day. When hair loss is increased compared to daily baseline hair loss, or when it occurs in patches, then it is abnormal. Abnormal hair shedding or bald areas on the scalp constitute a hair loss disorder known as alopecia. Hair usually becomes thin and weak (miniaturization) before there is a complete loss.

Why is hair loss important?

Hair loss isn’t only just cosmetic. Hair loss can have detrimental psychological effects. Studies have shown that hair loss can be associated with low self-esteem, depression, introversion, and feelings of unattractiveness. This is particularly true in Western societies and increasingly true in Eastern societies. Generally, economically developed countries place great value on youthful appearance and attractiveness.

Some studies have shown that based on appearance alone, men with hair loss (as well as other features) are seen as less attractive, less assertive, less likable, and less successful than men without hair loss.

How prevalent is hair loss?
  • Studies have shown that more than 50% of all men over the age of 50, and up to 80% of men aged 70, will be affected by male pattern baldness to some extent.
  • Studies have shown that about 25% of all women at the age of 50, and up to 42% of women by age 70, will be affected by female pattern baldness to some extent.
  • Hair loss in Caucasians is more prevalent than in blacks or Asians.
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Optimal hormone levels are of vital importance to all men and women. Declines in these levels can cause many symptoms that negatively affect your quality of life and longevity. Declines are naturally occurring as we age; however, many other factors can play a role in declining hormone levels, such as genetics and other disease processes.

Identifying and replacing these hormones can greatly reduce the symptoms of their decline and mitigate the long-term effects of their absence.

Declining Hormone Levels Symptoms

Declining hormone levels may cause unfavorable symptoms such as low libido or sexual interest, vaginal dryness, discomfort with intercourse, fatigue, mood swings, excessive sweating, decreased libido, etc.

About Bioidentical Hormone Therapy

Bioidentical Hormone Replacement Therapy (BHRT) is the science of returning your body’s hormones to optimal levels. It can help avoid and minimize unfavorable symptoms such as fatigue, mood swings, excessive sweating, decreased libido, and many more.

BHRT providers address these symptoms with medications that closely mimic or are identical to your body’s own naturally occurring hormones. Our providers specialize in using the most current knowledge, medication, and testing to manage your imbalance.

Success is achieved by careful analysis of your current hormone levels, symptoms, careful evaluation of your personal medical history, risk mitigation by analysis of family history, and close attention to your personal goals.

After evaluation, appropriate medication(s) can be prescribed and closely monitored for necessary changes to improve symptom relief and avoid unwanted side effects.

Recent medical research has proven that prudent use of these medications can improve your quality of life by relieving undesired symptoms and potentially reversing diseases that feed off the imbalance of your hormones.

FAQ's About Bioidentical Hormone Therapy

What is Bioidentical Hormone Therapy?

The use of medications that are identical or closely mimic your body’s naturally occurring hormones to optimize your health. Your natural hormones will decline due to genetics, age, or disease processes.

What are the benefits of Bioidentical Hormone Therapy?

• Although they should be used in specific situations and under the careful watch of your provider, their benefits have been proven in numerous studies.

• Not just for sweats and vasomotor symptoms of menopause.

• Bio-identical hormones are molecularly identical to the same hormones in your body.

• Signs and symptoms, as well as lab analysis, are used to guide your treatment.

• Although some symptoms and problems are relieved quickly with the replacement of needed hormones, the hormones continue over time to provide protection from other diseases, such as heart disease, strokes, and osteoporosis, that arise, in part, from hormonal imbalance.

• There are many options for the delivery of hormones, including patches, creams, pills, and injections.

• Hormones are critical messengers used in your body for daily organ function and metabolism.

• Optimal hormone balance is a major factor in our quality of life.

Who needs Bioidentical Hormone Therapy?

Anyone suffering from the decline of their natural hormones, based on exam, diagnostic testing, and symptoms.

What is the difference between Bioidentical Hormones and other prescriptive medications?

Although both are made in laboratories that have to meet stringent quality standards, Bioidentical Hormones are identical or closely mimic your body’s hormones and are as identical to your hormones as current medical science can achieve.

How long will it take to tell the benefits of Bioidentical Hormones?

Some symptoms will be relieved quickly; however other symptoms will require adjusting the doses of medication that you will take based on symptoms and diagnostic testing.

Could my decreased sex drive be related to hormones?

There are many reasons for a low sex drive or erectile dysfunction. A normal libido is mediated by a balance of hormones. Any change in this balance can have detrimental effects on your sex drive.

What are my treatment options?

Should you be found to need hormone replacement, there are several options. Prescriptions could be issued for an FDA-approved medication with patented doses that you can pick up at your pharmacy. Other options include the use of a compounding pharmacy to allow more dosing options, injectable forms, or pellet therapy.

Do you evaluate more than my hormone levels?

Yes, our providers may offer to monitor other aspects of your overall health with diagnostics, exams, and symptom monitoring, depending on your situation and needs. Options will be given to you should there be other needs outside of hormones, such as vitamins, supplements, or other lifestyle changes required to maximize your health.

Will I need these hormones forever?

This will be individually determined from patient to patient. Some patients will certainly need longer treatment than others. This will be based on your symptoms, health, and need for long-term management.

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At Caudle Center, we believe that sexual health is an important part of overall health. That’s why we offer a variety of services to help you reach your sexual potential.

The O-shot is an injection of platelet-rich plasma (PRP) that is injected into the tissue of the clitoris and upper vagina. PRP is derived from your own blood, so it is completely natural and safe.

FAQ's About O-Shot®

What benefits can a woman have from the O-Shot®?
  • Decreased or completely resolved pain during sex (known as dyspareunia).
  • Increased ability to have vaginal orgasms.
  • Greater arousal from clitoral stimulation.
  • A tighter vaginal canal (if felt to be too loose prior).
  • A more elastic vaginal canal (if felt to be too tight prior, usually after menopause).
  • Younger, smoother skin externally (lips of the vagina).
  • Decreased or resolved overactive bladder and/or urinary incontinence.
  • Stronger and more frequent orgasms.
  • Increased vaginal lubrication.
How does the O-Shot® work?

The growth factors & proteins released by the high concentration of platelets in PRP activate stem cells and stimulate cellular repair and regeneration wherever they are applied in the body. In addition, collagen production and the formation of new blood vessels occur and further aid in tissue repair.

How is the PRP for the O-Shot® acquired?

A small amount of blood is drawn in the office at the time of the procedure. Your blood is then spun in a specially designed centrifuge which separates the platelets and plasma from the rest of the blood. The platelets are isolated and then injected back into the body wherever their benefits are needed. Since a numbing cream is applied to the skin long before the injection, there is no pain during the procedure.

How long does the O-Shot® procedure take to perform?

The O-Shot® is performed in our office. It should take about 60 minutes from start to finish, but we do usually allow a little extra time. You may drive yourself home after the procedure.

Is there anything else that I will need to do after the O-Shot®?

Yes. Using an Apex M or Intensity pelvic floor muscle stimulation device is vital for achieving optimal success from the procedure. This is usually done twice daily. It requires only a few minutes of your time, and without it, success rates are usually lower. We will walk you through it the first time.

When can I resume sexual activity after the O-Shot®?

You may resume sexual activity about 4 hours after the procedure on the same day. An increase in sexual response can be seen within days of the procedure.

What are the potential side effects of the O-Shot®?

Since PRP is extracted from your own blood, there are few and only minor potential side effects. These include minor bleeding or bruising, swelling, and, very rarely, infection.

Urinary Incontinence
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Urinary Incontinence

Millions of women experience involuntary loss of urine called urinary incontinence (UI). Some women may lose a few drops of urine while running or coughing. Others may feel a strong, sudden urge to urinate just before losing a large amount of urine. Many women experience both symptoms.

UI can be slightly bothersome or totally debilitating. For some women, the risk of public embarrassment keeps them from enjoying many activities with their family and friends. Urine loss can also occur during sexual activity and cause tremendous emotional distress.

Women experience UI twice as often as men. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference. But both women and men can become incontinent from neurologic injury, birth defects, stroke, multiple sclerosis, and physical problems associated with aging.

Older women experience UI more often than younger women. But incontinence is not inevitable with age. UI is a medical problem. Your doctor or nurse can help you find a solution. No single treatment works for everyone, but many women can find improvement without surgery.

Types of Urinary Incontinence

Urge Incontinence

If you lose urine for no apparent reason after suddenly feeling the need or urge to urinate, you may have urge incontinence. A common cause of urge incontinence is inappropriate bladder contractions. Abnormal nerve signals might be the cause of these bladder spasms.

Urge incontinence can mean that your bladder empties during sleep, after drinking a small amount of water, or when you touch water or hear it running (as when washing dishes or hearing someone else taking a shower). Certain fluids and medications, such as diuretics, or emotional states, such as anxiety, can worsen this condition. Some medical conditions, such as hyperthyroidism and uncontrolled diabetes, can also lead to or worsen urge incontinence.

Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to the muscles themselves. Multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke, and injury — including injury that occurs during surgery — all can harm bladder nerves or muscles.

Overactive Bladder

An overactive bladder occurs when abnormal nerves send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. Voiding up to seven times a day is normal for many women, but women with overactive bladder may find that they must urinate even more frequently.

Specifically, the symptoms of an overactive bladder include:

• Urinary frequency — bothersome urination eight or more times a day or two or more times at night.

• Urinary urgency — the sudden, strong need to urinate immediately.

• Urge incontinence — leakage or gushing of urine that follows a sudden, strong urge.

• Nocturia — waking at night to urinate.

Functional Incontinence

People with medical problems that interfere with thinking, moving, or communicating may have trouble reaching a toilet. A person with Alzheimer’s disease, for example, may not think well enough to plan a timely trip to a restroom. A person in a wheelchair may have a hard time getting to a toilet in time. Functional incontinence is the result of these physical and medical conditions. Conditions such as arthritis often develop with age and account for some of the incontinence of elderly women in nursing homes.

Overflow Incontinence

Overflow incontinence happens when the bladder doesn’t empty properly, causing it to spill over. Your doctor can check for this problem. Weak bladder muscles or a blocked urethra can cause this type of incontinence. Nerve damage from diabetes or other diseases can lead to weak bladder muscles; tumors and urinary stones can block the urethra. Overflow incontinence is rare in women.

Other Types of Incontinence

Stress and urge incontinence often occur together in women. Combinations of incontinence — and this combination in particular — are sometimes referred to as mixed incontinence. Most women don’t have pure stress or urge incontinence, and many studies show that mixed incontinence is the most common type of urine loss in women.

Transient incontinence is a temporary version of incontinence. Medications, urinary tract infections, mental impairment, and restricted mobility can all trigger transient incontinence. Severe constipation can cause transient incontinence when the impacted stool pushes against the urinary tract and obstructs outflow. A cold can trigger incontinence, which resolves once the coughing spells cease.

Treatments for Urinary Incontinence

Behavioral Remedies: Bladder Retraining and Kegel Exercises

By looking at your bladder diary, the doctor may see a pattern and suggest making it a point to use the bathroom at regular timed intervals, a habit called timed voiding. As you gain control, you can extend the time between scheduled trips to the bathroom. Behavioral treatment also includes Kegel exercises to strengthen the muscles that help hold in urine.

How do you do Kegel exercises?

The first step is to find the right muscles. One way to find them is to imagine that you are sitting on a marble and want to pick up the marble with your vagina. Imagine sucking or drawing the marble into your vagina.

Try not to squeeze other muscles at the same time. Be careful not to tighten your stomach, legs, or buttocks. Squeezing the wrong muscles can put more pressure on your bladder control muscles. Just squeeze the pelvic muscles. Don’t hold your breath. Do not practice while urinating.

Repeat, but don’t overdo it. First, find a quiet spot to practice — your bathroom or bedroom — so you can concentrate. Pull in the pelvic muscles and hold for a count of three. Then relax for a count of three. Work up to three sets of 10 repeats. Start doing your pelvic muscle exercises lying down. This is the easiest position to do them in because the muscles do not need to work against gravity. When your muscles get stronger, do your exercises sitting or standing. Working against gravity is like adding more weight.

Be patient. Don’t give up. It takes just 5 minutes a day. You may not feel your bladder control improve for 3 to 6 weeks. Still, most people do notice an improvement after a few weeks.

Some people with nerve damage cannot tell whether they are doing Kegel exercises correctly. If you are not sure, ask your doctor or nurse to examine you while you try to do them. If it turns out that you are not squeezing the right muscles, you may still be able to learn proper Kegel exercises by doing special training with biofeedback, electrical stimulation, or both.

Medicines for Overactive Bladder

If you have an overactive bladder, your doctor may prescribe a medicine to block the nerve signals that cause frequent urination and urgency.

Several medicines from a class of drugs called anticholinergics can help relax bladder muscles and prevent bladder spasms. Their most common side effect is dry mouth, although larger doses may cause blurred vision, constipation, a faster heartbeat, and flushing. Other side effects include drowsiness, confusion, or memory loss. If you have glaucoma, ask your ophthalmologist if these drugs are safe for you.

Some medicines can affect the nerves and muscles of the urinary tract in different ways. Pills to treat swelling (edema) or high blood pressure may increase your urine output and contribute to bladder control problems. Talk with your doctor; you may find that taking an alternative to a medicine you already take may solve the problem without adding another prescription.

Scientists are studying other drugs and injections that have not yet received U.S. Food and Drug Administration (FDA) approval for incontinence to see if they are effective treatments for people who were unsuccessful with behavioral therapy or pills.


Biofeedback uses measuring devices to help you become aware of your body’s functioning. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles. Biofeedback can supplement pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.


For urge incontinence not responding to behavioral treatments or drugs, stimulation of nerves to the bladder leaving the spine can be effective in some patients. Neuromodulation is the name of this therapy. The FDA has approved a device called InterStim for this purpose. Your doctor will need to test to determine if this device would be helpful to you.

The doctor applies an external stimulator to determine if neuromodulation works in you. If you have a 50 percent reduction in symptoms, a surgeon will implant the device. Although neuromodulation can be effective, it is not for everyone. The therapy is expensive, involving surgery with possible surgical revisions and replacement.

Vaginal Devices for Stress Incontinence

One of the reasons for stress incontinence may be weak pelvic muscles, the muscles that hold the bladder in place and hold urine inside. A pessary is a stiff ring that a doctor or nurse inserts into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps reposition the urethra, leading to less stress leakage. If you use a pessary, you should watch for possible vaginal and urinary tract infections and see your doctor regularly.

Injections for Stress Incontinence

A variety of bulking agents, such as collagen and carbon spheres, are available for injection near the urinary sphincter. The doctor injects the bulking agent into tissues around the bladder neck and urethra to make the tissues thicker and close the bladder opening to reduce stress incontinence. After using local anesthesia or sedation, a doctor can inject the material in about half an hour. Over time, the body may slowly eliminate certain bulking agents, so you will need repeat injections.

Before you receive an injection, a doctor may perform a skin test to determine whether you could have an allergic reaction to the material. Scientists are testing newer agents, including your own muscle cells, to see if they are effective in treating stress incontinence. Your doctor will discuss which bulking agent may be best for you.

Surgery for Stress Incontinence

In some women, the bladder can move out of its normal position, especially following childbirth. Surgeons have developed different techniques for supporting the bladder back to its normal position. The three main types of surgery are retropubic suspension and two types of sling procedures.

Retropubic suspension

Retropubic suspension uses surgical threads called sutures to support the bladder neck. The most common retropubic suspension procedure is called the Burch procedure. In this operation, the surgeon makes an incision in the abdomen a few inches below the navel and then secures the threads to strong ligaments within the pelvis to support the urethral sphincter. This common procedure is often done at the time of an abdominal procedure, such as a hysterectomy.

Sling procedures

Sling procedures are performed through a vaginal incision. The traditional sling procedure uses a strip of your own tissue called fascia to cradle the bladder neck. Some slings may consist of natural tissue or man-made material. The surgeon attaches both ends of the sling to the pubic bone or ties them in front of the abdomen just above the pubic bone.

Midurethral slings are newer procedures that you can have on an outpatient basis. These procedures use synthetic mesh materials that the surgeon places midway along the urethra. The two general types of midurethral slings are retropubic slings, such as transvaginal tapes (TVT), and transobturator slings (TOT). The surgeon makes small incisions behind the pubic bone or just by the sides of the vaginal opening, as well as a small incision in the vagina. The surgeon uses specially designed needles to position a synthetic tape under the urethra.

If you have pelvic prolapse, your surgeon may recommend an anti-incontinence procedure with a prolapse repair and possibly a hysterectomy.

Recent women’s health studies performed with the Urinary Incontinence Treatment Network (UITN) compared the suspension and sling procedures and found that two years after surgery, about two-thirds of women with a sling and about half of women with a suspension were cured of stress incontinence. Women with a sling, however, had more urinary tract infections, voiding problems, and urge incontinence than women with a suspension. Overall, 86 percent of women with a sling, and 78 percent of women with a suspension said they were satisfied with their results. Women who are interested in joining a study for urinary incontinence can go to www.ClinicalTrials.gov for a list of current studies recruiting patients.

Talk with your doctor about whether surgery will help your condition and what type of surgery is best for you. The procedure you choose may depend on your own preferences or on your surgeon’s experience. Ask what you should expect after the procedure. You may also wish to talk with someone who has recently had the procedure. Surgeons have described more than 200 procedures for stress incontinence, so no single surgery stands out as best.


If you are incontinent because your bladder never empties completely — overflow incontinence — or your bladder cannot empty because of poor muscle tone, past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube that you can learn to insert through the urethra into the bladder to drain urine. You may use a catheter once in a while or on a constant basis, in which case the tube connects to a bag that you can attach to your leg. If you use an indwelling — long-term — catheter, you should watch for possible urinary tract infections.

Other Helpful Hints

Many women manage urinary incontinence with menstrual pads that catch slight leakage during activities such as exercising. Also, many people find they can reduce incontinence by restricting certain liquids, such as coffee, tea, and alcohol.

Finally, many women are afraid to mention their problem. They may have urinary incontinence that can improve with treatment but remain silent sufferers and resort to wearing absorbent undergarments or diapers. This practice is unfortunate because diapering can lead to diminished self-esteem, as well as skin irritation and sores. If you are relying on diapers to manage your incontinence, you and your family should discuss with your doctor the possible effectiveness of treatments such as timed voiding and pelvic muscle exercises.

FAQ's About Urinary Incontinence

Why does urinary incontinence occur?

Incontinence occurs because of problems with muscles and nerves that help to hold or release urine. The body stores urine — water and wastes removed by the kidneys — in the bladder, a balloon-like organ. The bladder connects to the urethra, the tube through which urine leaves the body.

During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if your bladder muscles suddenly contract or the sphincter muscles are not strong enough to hold back urine. Urine may escape with less pressure than usual if the muscles are damaged, causing a change in the position of the bladder. Obesity, which is associated with increased abdominal pressure, can worsen incontinence. Fortunately, weight loss can reduce its severity.

How is incontinence evaluated?

The first step toward relief is to see a doctor who has experience treating incontinence to learn what type you have. A urologist specializes in the urinary tract, and some urologists further specialize in the female urinary tract. Gynecologists and obstetricians specialize in the female reproductive tract and childbirth. A urogynecologist focuses on urinary and associated pelvic problems in women. Family practitioners and internists see patients for all kinds of health conditions. Any of these doctors may be able to help you. In addition, some nurses and other health care providers often provide rehabilitation services and teach behavioral therapies such as fluid management and pelvic floor strengthening.

To diagnose the problem, your doctor will first ask about symptoms and medical history. Your pattern of voiding and urine leakage may suggest the type of incontinence you have. Thus, many specialists begin with having you fill out a bladder diary over several days. These diaries can reveal obvious factors that can help define the problem — including straining and discomfort, fluid intake, use of drugs, recent surgery, and illness. Often you can begin treatment at the first medical visit.

Your doctor may instruct you to keep a diary for a day or more — sometimes up to a week — to record when you void. This diary should note the times you urinate and the amounts of urine you produce. To measure your urine, you can use a special pan that fits over the toilet rim. You can also use the bladder diary to record your fluid intake, episodes of urine leakage, and estimated amounts of leakage.

If your diary and medical history do not define the problem, they will at least suggest which tests you need.

Your doctor will physically examine you for signs of medical conditions causing incontinence, including treatable blockages from bowel or pelvic growths. In addition, weakness of the pelvic floor leading to incontinence may cause a condition called prolapse, where the vagina or bladder begins to protrude out of your body. This condition is also important to diagnose at the time of evaluation.

Your doctor may measure your bladder capacity. The doctor may also measure the residual urine for evidence of poorly functioning bladder muscles. To do this, you will urinate into a measuring pan, after which the nurse or doctor will measure any urine remaining in the bladder. Your doctor may also recommend other tests:

Bladder stress test — You cough vigorously as the doctor watches for loss of urine from the urinary opening.

Urinalysis and urine culture — Laboratory technicians test your urine for evidence of infection, urinary stones, or other contributing causes.

Ultrasound — This test uses sound waves to create an image of the kidneys, ureters, bladder, and urethra.

Cystoscopy — The doctor inserts a thin tube with a tiny camera in the urethra to see inside the urethra and bladder.

Urodynamics — Various techniques measure pressure in the bladder and the flow of urine.

Vaginal Rejuvenation
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Vaginal / Labial Rejuvenation

The growth in options for feminine health solutions has increased awareness of many health issues that were previously not addressed.

Votiva is a vaginal rejuvenation treatment for both internal & external vaginal issues without surgery. It can help with elasticity, blood flow, and sensitivity.

It is a safe, effective treatment for feminine health concerns that offers immediate results with continued improvements over time.

Components of Your Feminine Rejuvenation

  • Vaginal (internal): to tighten loose tissue and reinforce vaginal skin structure and elasticity to improve sensation along with less dryness. This is performed with radiofrequency Votiva-V.
  • Labial (external): improve the appearance of the labia and vulva.

A. Tighten & recontour the labia and vulva

B. Volume enhancement with fat transfer to labia and vulva

FAQ's About Labial / Vaginal Rejuvenation

What is Votiva?

Votiva is a safe, effective treatment for feminine health that offers immediate results with continued improvements over time.

What can I expect?

Patients can expect to feel a heating sensation during treatment. Results can be felt and seen immediately, with continued results over the following weeks or multiple treatments.

What is the down time?

Depending on the intensity of the treatment, there is little to no downtime. Most patients may have slight discomfort during and immediately after treatment. Some patients will experience no discomfort at all.

How many sessions are required?

Your physician will determine the best treatment plan for you. The majority of patients have 2-3 sessions. However, most notice a difference after only 1 treatment. The number of sessions depends on your treatment concerns, your personal goals, and if you plan to use a combination treatment or a single treatment approach.