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Internal Medicine Doctors of
Mill Basin & Bergen Beach, Brooklyn

6301 Mill Lane (Corner of East 63rd) in Mill Basin (11234)


Dr. Bella Zimilevich

Dr. Bella Zimilevich, MD
Primary Care Doctor

Dr. Bella Zimilevich

Dr. Anatoly Pisman, M.D
Physical Medicine & Rehabilitation

Dr. Bella Zimilevich

Dr. Alexander Shapsis, M.D

Urology Care


Treatment for Urinary Incontinence (Frequent Urination, Stress Incontinence)

Posted by on July 8th, 2013

Dr. Bella Zimilevich, MD

“Urinary incontinence and frequent urination are common issues that many people are embarrassed to discuss. Incontinence is more common in women and older individuals, but it is not an inevitable consequence of aging. If you suffer from incontinence, there are self-help strategies that can help. Medications are also available. In severe cases, surgery may cure the problem. Don’t suffer in silence- incontinence is nothing to be embarrassed about. I can help you improve your symptoms, but not unless you come in and discuss them with me”.

-Dr. Zimilevich, MD

 What is urinary incontinence?

Urinary incontinence is the involuntary loss of urine. People who have urinary incontinence may be unable to control their bladder some or all of the time.

Is there more than one type of urinary incontinence?

Yes, there are several types of urinary incontinence:

  • Stress incontinence- in this type of incontinence, loss of urine occurs when stress is placed on the bladder. You may experience loss of urine when you cough, sneeze, lift a heavy object or even laugh- all of these activities increase abdominal pressure. Pregnancy, childbirth and hormonal changes associated with menopause are common factors in this type of incontinence.
  • Urge incontinence- people with urge incontinence experience a sudden and impossible-to-ignore urge to urinate and may leak urine before they are able to make it to the bathroom. They may also void very frequently, including at night. The bladder spasms associated with this type of incontinence can be quite uncomfortable.
  • Mixed incontinence– some people have symptoms of both stress and urge incontinence; this is known as mixed incontinence.
  • Overflow incontinence- in overflow incontinence, the bladder retains urine, causing urine to leak out in small amounts on an almost continuous basis. This type of incontinence is usually related to blockage somewhere in the urinary tract (such as a stone) or to conditions that cause damage to the nerves supplying the bladder (i.e., stroke or Multiple Sclerosis).
  • Functional incontinence- people with functional incontinence have a normal urinary tract system, but are incontinent simply because they are physically incapable of getting to the bathroom in time. For example, someone suffering from severe arthritis may take too long to get to the bathroom and remove their clothing on time, resulting in involuntary loss of urine.

Types of Incontinence

What causes urinary incontinence?

Several factors may increase your risk of incontinence, including:

  • pregnancy and childbirth– the weight of the growing fetus places a lot of pressure on the abdomen, which can lead to loss of urine during pregnancy. Childbirth can damage pelvic floor muscles, which help us to hold urine in. Having a large baby, a prolonged labor and the use of instruments such as forceps can damage these delicate muscles, leading to incontinence which may not occur for several years after childbirth.
  • menopause- estrogen levels decline during menopause, which can have an effect on pelvic floor muscles and the bladder.
  • obesity– being overweight or obese can place added pressure on the bladder; being obese can also make it more difficult to get to the bathroom quickly.
  • cigarette smoking– the frequent cough that occurs after years of smoking can aggravate stress incontinence- you may leak urine when you cough.
  • constipation– constipation can cause incontinence when hard stool in the lower bowel puts pressure on the urethra.
  • prostate problems– in men, the prostate gland often enlarges with age. The enlarged prostate located at the base (neck) of the bladder can apply pressure to the urethral sphincter, which controls the release of urine from the body. This may cause urge incontinence and may also cause overflow incontinence if the prostate becomes so large that it obstructs the flow of urine. Men who undergo prostate surgery for cancer often experience urinary incontinence after surgery.
  • neurological problems– conditions affecting the brain and the nerves can cause incontinence, such as diabetes, stroke, Multiple Sclerosis (MS), spinal cord injuries and Parkinson’s disease.
  • dementia– individuals with dementia may suffer from incontinence because they are cognitively unaware of the need to urinate or can’t remember  where the bathroom is located.
  • medications– some medications may cause or worsen urinary incontinence, such as diuretics and certain blood pressure medications.
  • lifestyle factors– drinking alcoholic and/or caffeinated beverages can worsen incontinence, as can drinking water and acidic juices to excess. Ignoring the urge to urinate may also lead to episodes of incontinence if you have weak pelvic floor muscles.

How does urinary incontinence affect people?

Individuals who are incontinent may be more prone to urinary tract infections, depending on the underlying cause of their incontinence. Skin breakdown can also be an issue for people with severe incontinence. Although these physical issues are important, the stigma associated with incontinence can be devastating. People who are incontinent often feel embarrassed and ashamed. Incontinence can affect functioning at work, social relationships and personal relationships, especially when the affected person is reluctant to talk about the problem. If you are incontinent, you may feel depressed and isolated. That’s why it is so important to seek help.

What can I expect when I come in to see you?

If you have been experiencing incontinence, we’ll start by discussing your symptoms- when they started, how often they occur, how they impact your life and what makes them better or worse. We’ll discuss any lifestyle factors that may be contributing to your incontinence episodes. I’ll ask you about your medical history and any medications you are taking. If you are a woman, I’ll ask about pregnancies, childbirth and menopause (if applicable). If you are a man I will ask about any symptoms of prostate disease. I may ask for a urine sample to check for infection, blood in the urine or other abnormalities that may be contributing to incontinence. I might also order blood work if needed. When I have gathered all of the information I need, we can talk about treatment options.

What is the treatment for urinary incontinence?

Treatment options often begin with lifestyle remedies, such as quitting smoking, losing weight, avoiding constipation and cutting back on alcohol and caffeine intake. If your medication is contributing to incontinence, a change in medication may be helpful. Sometimes lifestyle changes are all that is needed for mild incontinence.

  • Bladder retraining– bladder and sphincter muscles can be strengthened by bladder retraining. In this technique, you attempt to hold your bladder for a set number of hours, slowly increasing the time between trips to the bathroom. You can try starting with two hours and increase the time between trips to the bathroom by half an hour until you can hold your urine without leaking for 4 hours. At the same time, be mindful of what you are drinking. It may be helpful to keep a bladder diary so that you become more aware of your symptoms, when you are incontinent and what factors may be making the problem worse. For example, if you are often incontinent at night, you may find restricting fluids before bedtime to be helpful. Bladder retraining can be helpful if you void too frequently.
  • Kegel exercises– these exercises help to strengthen weak pelvic floor muscles, which are the muscles that help you to control urination. Kegel exercises should be performed by anyone who is experiencing incontinence. When you come in to the clinic to see me, I can instruct you in the proper performance of these simple yet effective exercises.
  • Medications– there are several medications available that can help to reduce urinary frequency and urgency. Many people suffering from incontinence find that their symptoms are vastly improved with these medications.
  • Surgery– surgery for urinary incontinence is sometimes necessary for severe incontinence that does not respond to lifestyle changes and/or medication. If you are a candidate for surgery, I can refer you to a urologist.

Urinary incontinence can be very distressing and embarrassing. Whether you are male or female, treatment options are available. Don’t let your life be ruled by incontinence- make an appointment to see me today.

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Urination Problems: Urinary Tract Infection, Painful Urination, Inability to Urinate, etc.

Posted by on June 12th, 2013

Dr. Bella Zimilevich, MDIf you are suffering from a problem involving the urinary  or reproductive tract, I can help. I have experience treating patients with issues ranging from urinating too often to not urinating at all. Whatever your urology care need, whether it involves painful urination, blood in the urine, or a frequent and/or urgent need to urinate, chances are I have seen and treated it before. Feeling embarrassed? There’s no need- your problem can be solved, but first you need to see me.”

-Dr. Zimilevich, MD

What is urology?

Urology is the branch of medicine that focuses on care of the female and male urinary tract.

What are common symptoms caused by urological conditions?

Generally, if there is something wrong within your urinary tract, you will know about it! Few disorders of the urinary tract are completely asymptomatic (without symptoms). The following are some symptoms you might experience if you have a urinary tract issue:

  • blood in the urine (hematuria)
  • urinating frequently at night (nocturia)
  • painful urination or difficulty voiding (dysuria)
  • urinary frequency (“going all the time”)
  • urinary urgency (urgent and painful need to urinate)
  • urinary incontinence (loss of control over urination)
  • inability to urinate
  • flank pain (pain in your back just below your ribs)
  • foul-smelling urine

What to expect during your visit

First of all, I will need to know what brought you to see me. Many people find it embarrassing to talk about their urinary habits. Let me assure you, whether you are a male or female, I have likely seen and heard it all, and there is nothing that you can tell me that I haven’t heard before! I promise discretion and respect and I prize patient confidentiality above all else.

There’s a good reason for you to tell me all of your symptoms: symptoms will often point to a diagnosis, so try not to leave anything out, no matter how embarrassing. For example, if you tell me that you have been having difficulty holding your urine and that you lose control when you sneeze or cough, that information tells me that you are probably experiencing stress incontinence, a type of incontinence that often affects women who have been pregnant or given birth due to relaxation of the pelvic floor muscles. As another example, if you tell me that you have symptoms that are compatible with a sexually transmitted infection but you have never been sexually active, my list of possible diagnoses diminishes. You can see why it is important not to leave anything out- the more information I have, the more accurately I can treat you.

Once I have learned about your symptoms and we have discussed your past medical history, I may need to examine you. Examination may not be necessary for some conditions, such as a urinary tract infection, but other conditions may warrant an exam. If an exam is necessary I will ask you to change into a gown. I will carefully explain what I am going to do before I do it so that you don’t feel anxious.

If necessary, I may order tests, depending on what I feel may be causing the problem. I may order urine or blood tests (most commonly) or other tests (such as an x-ray or ultrasound) if I feel they are necessary. Some diagnostic tests can be performed right here in the clinic.

Most of the time, after discussing signs and symptoms, performing a physical exam and ordering any diagnostic tests that might be necessary, your care will start and end with me. I may ask you to follow up with me after treatment, depending on what I find.

If you are experiencing urinary tract  or reproductive tract issues, a delay in treatment may lead to complications. The sooner you are seen, the sooner you can be treated. Don’t delay-make an appointment today.

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