Urinary Incontinence
Academia of Women’s Health
Urinary Incontinence

Urinary Incontinence

Dear Readers,

Have you experienced occasional or frequent urine loss? It can happen when you laugh, or sneeze, or cough. It can occur when you wait too long to use the lady's room. Urinary incontinence causes anxiety and embarrassment for millions of women.

What causes urinary incontinence? Some women are genetically predisposed to this condition. Others might have medical conditions that can cause the problem. Pregnancy, heavy lifting, incorrect performance of pelvic floor exercises, use of medications that result in higher urinary production, and poor urinary habits are also among the possible causes. On rare occasions, incontinence can be unmasked by surgical correction of adjacent defects.

Can incontinence be corrected without surgery? Absolutely, depending on the cause of the condition. Pelvic floor exercises and medications can be extremely effective either alone or in combination with other forms of treatment. In fact, a relatively new device, called "InTone" can help patients experience exceptional results.

What is "InTone," and how does it work? I discovered InTone for our patients approximately three years ago. InTone is an FDAapproved device that is placed vaginally at home by the patient for 12 minutes a day. We program the devices in the office, setting them precisely for each individual patient, then teach patients how to use them. Within these 12 minutes at home, patients perform biofeedback-guided contractions and experience muscular stimulation by the device, which engages pelvic floor musculature, tones it, and helps patients recognize the correct muscles to contract. Many of our patients see improvement within just two weeks. Out of over 100 patients that have undergone non-surgical pelvic floor rehabilitation with InTone in our practice, surgery for urinary incontinence was needed for only 3 patients. Each of them improved, including women with previous pelvic floor reconstructive surgery. What's more, the device is 100% covered by Medicare and some other insurers, and guaranteed by the manufacturer. Again, no medication or surgery is required in a vast majority of cases.

Is surgery ever needed to correct the problem? Yes, mostly in cases of significant structural problems not correctable by physical therapy with or without InTone. This involves cases with complex pelvic floor defects (pelvic organ prolapse) or persistent urinary incontinence. Surgery can be performed with or without the meshes and are highly individualized depending on the patient's needs.

What can you expect when you visit my office for treatment of urinary incontinence? You can expect loving attention and care, extensive knowledge of gynecologic pathology, diligence, and thorough investigation by examination and other diagnostic techniques. Additional methods of diagnosis may be used as needed, followed by careful selection and implementation of the best strategy to correct the condition.

LOGOWith much love,
Assia Stepanian

P. S. Let us meet in October's Women's Issue to address Holistic and Minimally Invasive Approaches to Gynecologic Surgery and Women's Health.


Dr. Assia Stepanian grew up in Moscow, the daughter of two illustrious physicians. In fact, much of her training was supervised by her mother, Dr. Leila Adamyan, the developer of some of the most advanced techniques used today in the practice of Minimally Invasive Gynecologic Surgery.

Dr. Stepanian has authored and coauthored articles, book chapters and classifications in gynecology. She has presented nationally and internationally. Her devotion to women's health was exemplified by her 2001 creation of the first and the leading media resource with the focus of teaching minimally invasive gynecologic surgery worldwide.

Dr. Stepanian is quite candid about her devotion to her patients. "My focus is always on learning about the total woman," she says. "I spend a great deal of time talking with each patient, and I find that I am both teacher and student. It can be an emotional experience for us both. Our visits invariably end with a warm hug. I am extremely fortunate."


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