For Chelsea, motherhood brought unexpected challenges. After having her second child, she found herself dealing with an embarrassing problem that started affecting her quality of life and confidence.
Her journey with Dr. Rusnack at Tower Urology represents how even long-standing patients can discover new, life-changing solutions to problems they thought they’d have to manage forever.
“Overall, I was leaking anytime I would run, jump, or overexert myself,” Chelsea recalls of her struggle with stress urinary incontinence (SUI). “It was also an issue when I was horseback riding. I would completely empty my bladder, but 30 seconds later could get on a treadmill and would still leak urine even though I knew I didn’t have a full bladder, that it was completely empty.”
The constant urine leakage wasn’t just uncomfortable; it was impacting her daily activities and her peace of mind.
The need to solve the issue became apparent when Chelsea realized just how much it was affecting her routine. “I used to have to bring two pairs of pants when I went to the gym so that after I went on the treadmill and leaked, I could change my pants before weight lifting,” she explains. The need to plan around potential accidents had become a part of her life, and she knew something had to change.
Understanding stress urinary incontinence and urethral bulking
Stress urinary incontinence occurs when physical activities, such as running, jumping, sneezing, laughing, or heavy lifting, put pressure on the bladder and cause urine leakage. Other symptoms of stress incontinence include dampness in the underwear, dribbling, and frequent urination. SUI is particularly common after vaginal delivery, as pregnancy and childbirth can weaken the pelvic floor muscles and the urethral sphincter muscle that normally controls urine flow.
Urge incontinence is different from stress incontinence. This type of urinary incontinence involves a sudden, urgent need to urinate that’s difficult to control. It is related to bladder filling and involves an overactive bladder. In some cases, the bladder muscles contract too often. In others, the bladder cannot empty fully. Sometimes, people have mixed incontinence which is a combination of both stress and urge incontinence.
While both are types of urinary incontinence, they require different treatment approaches. Your healthcare provider can perform a stress test during a physical exam, order urinalysis or urodynamics testing, perform a cystoscopy, and have you keep a bladder diary to determine your specific type of incontinence.
Chelsea had already tried traditional pelvic floor therapy. “I saw a pelvic floor therapist and wasn’t getting results,” she says. “The therapists actually weren’t confident it would work because they said my pelvic floor muscles looked good, so they suspected my pelvic floor wasn’t the issue.” This observation pointed to a different problem. Not weak pelvic muscles or even an issue with her bladder muscle, but a loose urethra itself, which is why Dr. Rusnack proposed a different treatment.
A conversation that led to solutions
Chelsea had been a patient of Dr. Rusnack’s for about 10 years, so when she casually mentioned her leakage problem during an office visit, Dr. Rusnack was ready with a solution. “I just mentioned it to Dr. Rusnack, talked about my symptoms, and asked what she could do,” Chelsea explains. “I noted how I wanted immediate results because I had been seeing a pelvic floor therapist, and I was still leaking. And I was over it.”
What made the difference was Dr. Rusnack’s clear explanation of the problem and the solution — urethral bulking.
Urethral bulking is a minimally invasive procedure where bulking agents like collagen or other FDA-approved materials are injected directly into the tissue surrounding the urethral sphincter. This bulks up the urethra, creating better closure and preventing urine leakage during physical activity. Unlike surgical options like a sling procedure or artificial urinary sphincter, urethral bulking is an outpatient procedure that offers immediate results with minimal downtime.
“The way it was explained, it made so much sense,” Chelsea says. “She explained it in a way that I could picture the problem and what was happening, and I was confident in the procedure she suggested.” Dr. Rusnack described how urethral bulking would address Chelsea’s specific issue. “She said it was a new-ish procedure that she was using, and that it was relatively simple. That I could get right back to my life (I only stopped working out for about 24 hours), and that the results would be practically immediate.”
A simple procedure and immediate relief
Chelsea appreciated that Dr. Rusnack offered her comfort options for the procedure. “She did it in the office, and I would say it was really easy,” Chelsea recalls. “She offered me laughing gas to make the procedure more comfortable, which is something that isn’t required, but I appreciated that she wanted to make me as comfortable as possible.” “She also used imaging the entire time, on a screen, so I could see what was going on, and that just gave me extra peace of mind.” The use of mild sedation, combined with the minimally invasive nature of the treatment, meant Chelsea experienced less worry and discomfort during the procedure.
The results were everything Chelsea hoped for. “I didn’t want a year and a half of physical therapy,” she explains. “I just wanted the leaking gone as soon as possible.” Unlike the long recovery or extended treatment periods associated with other surgical options or having to attend multiple therapy sessions weekly, which Chelsea noted didn’t fit into her life, urethral bulking delivered what she needed: immediate improvement and the ability to return to her normal activities right away.
Two years and counting of lasting results
Now, more than two years after her urethral bulking procedure, Chelsea’s results continue to hold strong. “I’ve had it for over two years and it’s holding great,” she reports. “I would consider the procedure cost-effective because it’s still making me more confident and there’s no leakage years later.” For Chelsea, the procedure wasn’t just about physical improvement; it was about reclaiming her confidence and her active lifestyle.
“I no longer have to pack two pairs of pants when I go to the gym, and it’s great,” Chelsea says with evident relief. The ability to exercise without worry, to participate in physical activity without planning for accidents, represents a return to normalcy that many women with stress urinary incontinence take for granted.
Chelsea’s recommendation to others
Chelsea has become an advocate for the procedure among friends and family. “I’ve told a ton of people about it. I would highly recommend it,” she says enthusiastically. For Chelsea, the value extends beyond just the physical solution. “I know everyone’s budget is different. However, I thought the procedure was relatively affordable, even out of pocket, especially for the peace of mind of not peeing yourself in public.”
She’s also vocal about why this treatment worked better for her than traditional physical therapy in the case of a urethral issue and not a pelvic floor concern. “I honestly didn’t have time to do pelvic floor therapy all the time for an hour and a half each day, I didn’t have time in my life for that, so I am relieved Dr. Rusnack offered this solution,” she says candidly. While pelvic floor exercises and biofeedback-assisted training can be helpful for some women with stress incontinence, Chelsea’s experience illustrates that not every patient has the time or motivation for long-term physical therapy, nor does every case respond to it.
Dr. Rusnack’s exceptional approach to care
What stood out to Chelsea during her treatment experience went beyond just the procedure itself.
Dr. Rusnack’s bedside manner was impressive. “She was super knowledgeable, very informative, patient, and with a great bedside manner. She has a sense of humor and is just really easy to talk to, giving me no reason to feel uncomfortable or worried,” Chelsea describes. “Basically Dr. Rusnack had nothing but confidence about the procedure, but not in an egotistical way, just like I was in good hands.”
Even small touches made a difference. “She offered the gas as extra comfort during the procedure, and it’s not required, but I love how she offered it for comfort as an extra layer of comfort for me,” Chelsea notes. These kinds of gestures, where a healthcare provider anticipates patient anxiety and offers solutions, reflect the difference between adequate care and exceptional care.
The Tower Urology advantage
Chelsea’s experience highlights why Tower Urology stands out in treating urological conditions that affect quality of life. Dr. Rusnack’s combination of technical expertise, knowledge of the latest minimally invasive treatment options, and genuine compassion creates an environment where patients feel heard, understood, and empowered to address health concerns they might otherwise silently suffer with.
For women dealing with stress urinary incontinence, whether from childbirth, aging, obesity, chronic cough, or other risk factors, knowing that effective, minimally invasive options exist can be life-changing.
If you’re experiencing stress urinary incontinence or other bladder control concerns affecting your quality of life, we invite you to establish care with Tower Urology.
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.
FAQs stress urinary incontinence and treatment options
Yes, pelvic floor exercises (Kegel exercises), biofeedback training, lifestyle changes like reducing caffeine and managing constipation, and bladder training can help some women, though results vary. A physical therapist specializing in pelvic floor rehabilitation can evaluate whether physical therapy is appropriate for your situation, or your gynecologist or urogynecologic specialist can discuss which treatment options align with your needs.
Urethral bulking is a minimally invasive outpatient procedure using FDA-approved bulking agents. A sling procedure involves creating support under the urethra, while an artificial urinary sphincter is a mechanical device more commonly used in men. These procedures typically require more incisions and recovery time. Your healthcare provider can discuss which surgical option best fits your anatomy, symptom severity, and lifestyle preferences.
Risk factors include vaginal delivery, pregnancy-related changes to the pelvic floor muscles, aging and menopause, obesity, chronic cough, pelvic organ prolapse, and conditions affecting the urethral sphincter muscle or bladder neck. Understanding your specific risk factors and the causes of your symptoms through a comprehensive physical exam and appropriate testing helps determine the most effective treatment for your situation.
The short answer is yes. There are incontinence products such as a vaginal pessary which may help. However, while incontinence products provide temporary management, they don’t address the underlying problem causing urine leakage and can limit your physical activity and quality of life. Many women find that treating the root cause with options like urethral bulking or other minimally invasive procedures allows them to return to full physical activity without worrying about leakage or needing protective products.
Sources
Urethral Bulking
https://pubmed.ncbi.nlm.nih.gov/39051928/
Urethral bulking agents versus other surgical procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis https://pubmed.ncbi.nlm.nih.gov/25855326/
Stress Urinary Incontinence
https://www.ncbi.nlm.nih.gov/books/NBK539769/
Urinary incontinence after uncomplicated spontaneous vaginal birth in primiparous women during the first year after birth https://pmc.ncbi.nlm.nih.gov/articles/PMC7306031/
