Urinary incontinence — a common problem
“I was vaguely aware that some older ladies can sometimes have urine leakage problems, but when I noticed it myself, I became concerned,” Annie recalls. What began as an occasional small amount of urine that she managed using a single pad a day gradually worsened. “First, one pad would get me through a day, but as time went on, I found I had to replace it two or three times a day.”
Annie’s experience highlights a frustrating reality about bladder control problems in older adults. “It’s not a subject women talk about easily, which I understand because it can be embarrassing,” she admits.
Many women deal with the issue in silence: an estimated 50% of adult women face incontinence issues, but as few as 25% of those discuss their concerns and treatment options with their doctor.
When Annie began discussing her problem openly among her friends, she discovered many of them shared her concerns. “When I talked to other women, they said, ‘Oh yeah, I had that,’ but up until then I wasn’t aware it was a common issue that others had had to deal with too.”
However, Annie was more determined than most. “I became annoyed and wondered what I could do,” she says. “Before talking to my friends, I’d never heard anyone mention this problem before — never!” she insists. “Now I know that it’s a common issue, I feel very strongly that people — women — should know that they’re not alone in this, and that more information should be readily available,” she continues.
For Annie, an elegant 85-year-old woman who divides her time between Los Angeles and her Paris apartment, maintaining an active, fashion-conscious lifestyle has always been important. “I don’t always feel good physically, but I try to ignore any little aches and pains and just get on with my life,” she says. But one issue became impossible to ignore — urinary incontinence that progressively worsened and threatened both her quality of life and independence.
Finding Dr. Kuhlmann through a trusted recommendation
About a year and a half ago, Annie needed a colonoscopy for an unrelated intestinal issue. When she attended that appointment, she seized the opportunity to ask about her urinary concerns. “At that time, I discussed with my doctor the leakage of urine I was experiencing and whether I could fix it,” she explains.
That doctor gave her a glowing referral to Dr. Kuhlmann. “He couldn’t recommend Dr. Kuhlmann highly enough,” explains Annie. “He told me, ‘Everyone’s in love with her — she’s so wonderful.’”
Annie’s first meeting with Dr. Kuhlmann set the tone for their relationship at the outset. “The fact that she was a woman made it easier to explain my condition,” Annie recalls. “She understood the embarrassment that one feels, and I felt that she got it right away.”
Beyond her professional competence, Dr. Kuhlmann’s approachability made all the difference. “Dr. Kuhlmann is sweet, down-to-earth, absolutely drop-dead gorgeous, and so friendly straight from the get-go,” Annie says. “She’s not pretentious at all, and she listens — she really hears what you say.”
Comprehensive diagnosis and treatment planning
Dr. Kuhlmann suspected Annie had mixed incontinence, a combination of both stress incontinence and urge incontinence associated with an overactive bladder.
The symptoms of stress incontinence include leakage (ranging from a small amount of urine or dribbling to a more significant urine flow) during the following activities:
- Couging
- Sneezing
- Physical activity (such as exercise and heavy lifting)
Symptoms of urge incontinence associated with an overactive bladder include:
- Sudden, intense, and uncontrollable urge to urinate
- Frequent urination
- Nocturia (waking up more than twice in the night to visit the bathroom)
Different types of urinary incontinence require different approaches, and Annie needed a comprehensive treatment plan addressing both issues.
“Dr. Kuhlmann was terrific,” Annie remembers. “She said, ‘This is what you have, but let me do a test. I first underwent urinalysis just to rule out a simple urinary tract infection.'”
During the diagnostic process, Annie admits that she encountered some discomfort. “I had to see someone else to do the test, and they did it with an instrument, which I didn’t like at all, and it was a little painful.”
But even then, Dr. Kuhlmann demonstrated her commitment to patient care. “She happened to be in the office at the time,” Annie recalls. “She noticed that I was uncomfortable, and she came over and said, ‘Let me do it.’ I became much more relaxed and it didn’t hurt as much,” Annie recalls.
The efforts that Dr. Kuhlmann made to minimize discomfort, whether during urodynamic testing or physical examination, made a big impression. “It was very encouraging as I considered the next steps,” Annie says.
Dr. Kuhlmann’s treatment plan involved medication to calm the bladder muscle and reduce urge incontinence, combined with Bulkamid (urethral bulking agents) to address the stress incontinence component.
“Dr. Kuhlmann explained about the bulking surgery and what would happen. She said it was straightforward and that I wouldn’t have a problem. I felt completely reassured.” But before the Bulkamid procedure, Annie needed medical clearance. “I had to get some bloodwork carried out and other tests, and then I got the go-ahead to undergo surgery,” she explains.
A smooth procedure with attentive follow-up
“Dr. Kuhlmann met me at Cedars-Sinai and performed the operation — everything was great, no problem,” Annie reports. The procedure itself went exactly as promised. “But before I could leave, I had to urinate, so I tried, but not enough to their satisfaction,” explained Annie. “I had to leave with a catheter for the night and remove it in the morning.”
Rather than viewing this as a setback, Annie handled it with grace. “I left the hospital with a catheter, but otherwise, I was comfortable,” she explains.
Dr. Kuhlmann made sure to check up on Annie once she arrived home, and again the following day. “She called me right away when I got home and again the next morning to make sure everything was okay and that I had emptied the bag and followed the post-op instructions,” Annie recalls. “Everything just went as she had described. It was all very easy.”
Dr. Kuhlmann restored Annie’s confidence and comfort
The results exceeded Annie’s hopes. The treatment for her mixed incontinence, combining medication for her overactive bladder and Bulkamid for stress urinary incontinence, allowed her to achieve complete dryness: no more pads, no more planning activities around bathroom access, no more embarrassment.
For someone who travels internationally and maintains an active social life, this transformation is profound. The bladder control problems and loss of urine that once required changing pads multiple times daily have been eliminated, restoring Annie’s confidence and quality of life.
An unqualified endorsement for Dr. Kuhlmann
Annie’s assessment of Dr. Kuhlmann is simple yet profound: “Dr. Kuhlmann is top-notch. There’s really nothing more I can say — she’s wonderful in every way.”
Annie’s story carries an important message for other women suffering in silence with bladder control problems. Urinary incontinence, whether stress incontinence from weakened pelvic floor muscles, urge incontinence from an overactive bladder, or mixed incontinence, is treatable. Modern treatment options, ranging from lifestyle changes and medications to minimally invasive procedures, can dramatically improve daily life.
The embarrassment and isolation women can feel around leaking urine is unnecessary. With compassionate healthcare providers like Dr. Kuhlmann who understand the emotional and physical impact of incontinence, women can reclaim their confidence, comfort, and freedom, whether that means traveling to Paris, enjoying time with friends, or simply sleeping through the night without waking up multiple times to visit the bathroom.
Why choose Tower Urology for urinary incontinence and bladder control?
At Tower Urology, our specialists understand that urinary incontinence significantly impacts quality of life and emotional well-being. Dr. Kuhlmann and our team provide compassionate, comprehensive care for all types of urinary incontinence, including stress incontinence, urge incontinence, mixed incontinence, overflow incontinence, and functional incontinence. We offer personalized treatment plans that may include lifestyle modifications, medications, minimally invasive procedures, Botox, or surgical options. Our goal is to restore bladder function and help patients return to confident, active living.
We invite you to establish a care plan with Tower Urology. Please make an appointment online or call us at (310) 854-9898.
Tower Urology is a proud affiliate of Cedars-Sinai Medical Center, ranked #1 in California and #2 nationwide by U.S. News & World Report. This partnership reflects our dedication to delivering the highest standard of urologic care alongside the best urologists in Los Angeles. Our years of experience and access to Cedars-Sinai’s world-class facilities ensure that our exceptional and innovative urological care positions Tower Urology as a leader in Southern California.
Tower Urology is conveniently located for patients throughout Southern California and Los Angeles, including Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Burbank, Glendale, and Downtown Los Angeles.
If you’re experiencing urinary incontinence, frequent urination, or bladder control problems, Tower Urology offers expert, compassionate care. Contact us to schedule a consultation.
Frequently asked questions about mixed incontinence and treatment
Mixed incontinence is a combination of stress incontinence (leaking with physical activity, sneezing, or coughing) and urge incontinence (sudden, intense urge to urinate associated with an overactive bladder). It requires treating both components, often with a combination of medications to improve bladder muscle control and procedures such as bulking agents for the urethral sphincter.
While urinary incontinence becomes more common with age due to risk factors like menopause, weakened pelvic floor muscles, and medical conditions (such as multiple sclerosis, Parkinson’s disease, spinal cord injury, or pelvic organ prolapse), it’s not something you must simply accept. Effective treatment options exist for older adults to restore bladder control, ranging from conservative procedures, such as bladder training or pelvic floor exercises (Kegel exercises), to surgical procedures, such as sling procedures to support the urethra and bladder neck.
Bulkamid is a urethral bulking agent injected around the urethra during a brief outpatient procedure to help the urethral sphincter close more effectively. This reduces or eliminates urine leakage with minimal side effects and no downtime, allowing an immediate return to daily life.
Recovery depends on the treatment type. Medications work gradually over weeks; however, Bulkamid injections have minimal recovery time, and most patients can resume normal activities almost immediately, while some need a temporary catheter overnight. Most procedures for stress urinary incontinence or overactive bladder are performed as outpatient treatments with quick recovery and excellent success rates for improved bladder function.
Sources:
Is urine incontinence normal for women?
https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/is-urine-incontinence-normal-for-women
Up-to-Date Procedures in Female Stress Urinary Incontinence Surgery: A Concise Review on Bulking Agents Procedures https://pmc.ncbi.nlm.nih.gov/articles/PMC9227870/
