Urology Expert Forum
My Doctor thinks it's IC
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My Doctor thinks it's IC

I am a 36 year old female that has been healthy up until 1 year ago.  I have had two babies vaginally, the last of which was born over 5 years ago. My symptoms include urinary leakage during exercising and sneezing and urinary frequency in excess of 20 times per day.  I excercise quite frequently, so this has been very hard (and embarrassing)for me.  I have seen a urologist and done the urodynamics.  His recomendation was physical therapy, which seemed to help a very little bit.  After consulting further with my gynocologist when the symptoms returned, he has recomended a 3 day course of cipro over the last 2 months at two different times.  After taking the Cipro, my symptoms immediately disappear.  Only to return 2-3 weeks later.  My gynocologist's most recent diagnosis is IC and wants to put me on Elmiron.  I have no pain associated with my symptons, and therefore I find it difficult to believe I have this disease.  Furthermore, I am planning to have a minor plastic surgery procedure in one month and I am hesitant to start taking a new medication before the surgery.  Any suggestions?  What should be my next step?  Any and all advice would be greatly appreciated.
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From the symptoms, it sounds like stress incontinence, with the symptoms happening during exercising and sneezing.  If the incontinence is caused by uterine or bladder prolapse, you may want to inquire about the benefit of a pessary.  Alpha adrenergic agonists stimulate urethral smooth muscle contraction and can help in these cases. Imipramine has dual alpha agonist and anticholinergic activity and can be used in women with mixed stress and urge urinary incontinence.

Finally, surgery such as bladder neck suspension, sling procedures or vaginal suspensions are the next step if medications do not work.  You may want to discuss whether imipramine or the surgical options are right for you.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.
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