Stress urinary incontinence (SUI)

“I leak when I laugh, cough, sneeze, lift, or exercise.”

Leakage triggered by pressure or movement. Common in women after childbirth, aging, or pelvic floor changes. Often improves with urethral bulking (Bulkamid) or pelvic floor therapy.

Overactive bladder (OAB) & urgency

“When I have to go, I have to go now.”

Sudden, hard-to-control urgency, frequent bathroom trips, and sometimes leakage before you reach the toilet. Treatable with Bladder Botox, PTNS nerve stimulation, or sacral neuromodulation.

Urge incontinence

“I leak before I make it to the bathroom.”

A specific OAB pattern where urgency leads to involuntary leakage. Often responds well to nerve-based therapies including sacral neuromodulation (InterStim) and PTNS.

Mixed incontinence

“It’s a little of both.”

Leakage with activity plus urgency and frequency. We map which component is dominant and build a layered plan that addresses both.

Nocturia (waking to urinate)

“I wake up multiple times a night to go.”

Repeated nighttime bathroom trips that disrupt sleep, mood, and daytime energy. Often part of an OAB pattern that may respond to nerve modulation or medication.

Urinary frequency & retention

“I’m always in the bathroom, or I can’t fully empty.”

Going more than 8 times a day, or feeling like your bladder doesn’t fully empty. Both ends of the spectrum can respond to sacral neuromodulation.

Post-childbirth bladder changes

“It started after my kids were born.”

Pregnancy and delivery can change pelvic floor support, leading to leaks with activity or urgency. A female provider is available to discuss options in a comfortable setting.

Menopausal & aging-related bladder changes

“It’s been getting worse for years.”

Hormonal and tissue changes after menopause often affect bladder control. Many patients are surprised how much improvement is possible at any age.

Aligned with the AUA/SUFU guideline. The American Urological Association and Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction recommend an individualized, layered approach to overactive bladder, not a rigid sequence forced on every patient. That’s the model we follow.

A Private, Judgment-Free Consultation

We treat bladder symptoms as a routine medical condition. Consultations are unrushed, confidential, and built around your comfort, with the time and respect this topic deserves.

Female Provider Available on Request

For women who prefer to discuss bladder leakage or pelvic concerns with a female provider, we can schedule your evaluation accordingly. Just ask when you book.

Full Range of Modern Therapies

Conservative care, Bladder Botox, PTNS, sacral neuromodulation (InterStim), and Bulkamid urethral bulking, all under one practice. We match the therapy to your pattern, not the other way around.

Board-Certified Specialists

SEVA’s incontinence service line is delivered in partnership with MM Urology, bringing fellowship-level urologic and pelvic expertise to Lewisville and Rowlett.

Evidence-Based, Guideline-Aligned

Our care follows the AUA/SUFU OAB guideline and FDA labeling for each therapy, including Medtronic InterStim and Bulkamid. No exaggerated promises, just the right tool for the right patient.

Conservative First, Always

We don’t default to surgery or implants. Many patients improve with pelvic floor therapy, bladder training, or office-based procedures long before an implant is ever considered.

A private, unrushed conversation

We start by listening. When does leakage happen? How many times a day or night are you going? What have you already tried? You set the pace.

Identifying your pattern

Stress incontinence, urgency / OAB, mixed, or another cause. A focused exam and (if needed) a simple bladder diary or in-office testing clarifies which pattern fits.

A plan that matches you

Conservative care first when reasonable. If you’ve already tried first-line treatments, we discuss whether Bladder Botox, PTNS, sacral neuromodulation, or Bulkamid may be appropriate.

Trial before commitment

For sacral neuromodulation, patients trial the therapy externally for several days before any permanent implant decision. PTNS is non-implant. Bladder Botox is repeatable rather than permanent.

Follow-up and adjustment

We track your symptoms over time and adjust the plan. Many patients combine therapies (for example, pelvic floor therapy alongside medication or nerve stimulation) for the best result.

All major plans: BCBS of Texas, UnitedHealthcare, Aetna, Cigna, Humana, and most regional carriers.

Medicare & Texas Medicaid, including Medicare Advantage and Texas Medicaid managed-care plans.

Coverage confirmed in advance for Botox, InterStim, Bulkamid, and PTNS, so there are no billing surprises.

Transparent cash pricing, with payment plans available for advanced procedures.

Is bladder leakage really treatable, or do I just have to live with it?

Urinary incontinence is a medical condition, not just a normal part of aging or a permanent consequence of childbirth. In many cases, there are treatment options (conservative, medical, or procedural) that can help improve bladder control. The right step is a private consultation to find the cause.

What is the difference between stress and urge incontinence?

Stress urinary incontinence (SUI) is leakage triggered by pressure or movement: coughing, laughing, sneezing, lifting, exercising. Urge incontinence is leakage triggered by sudden, hard-to-control urgency. Many patients have a mix of both. Treatments differ for each, so identifying the pattern matters.

What is sacral neuromodulation (InterStim)?

Sacral neuromodulation is an FDA-cleared therapy that uses a small implanted device to deliver mild electrical impulses to the sacral nerves, which help regulate the bladder. It is indicated for urinary urgency, urgency-frequency, urge incontinence, and non-obstructive urinary retention in selected patients who haven’t responded to or can’t tolerate conservative treatments. Patients trial the therapy externally before any permanent implant.

How does PTNS (tibial nerve stimulation) work?

PTNS is an office-based therapy that uses a fine needle near the ankle to gently stimulate the tibial nerve, which shares a neural pathway with the bladder. A typical course is 30-minute weekly sessions over 12 weeks. There is no implant, and it can be a useful option for urgency, frequency, and urge incontinence in appropriate patients.

Does Bladder Botox really help overactive bladder?

According to the Urology Care Foundation and Mayo Clinic, Botox injections into the bladder muscle may help relax the overactive bladder and reduce urinary urgency and urge incontinence in appropriate patients, commonly after first-line treatments haven’t worked well enough. Effects typically last several months and the treatment can be repeated.

What is Bulkamid, and is it for me?

Bulkamid is an FDA-approved urethral bulking agent for adult women with stress urinary incontinence due to intrinsic sphincter deficiency, including stress-predominant mixed incontinence. It’s a minimally invasive office procedure designed to support closure of the urethra to reduce leakage with cough, laugh, sneeze, or activity. Your provider will help determine if you’re a candidate.

Can I see a female provider?

Yes. A female provider is available for incontinence and pelvic concerns on request. Just let us know when you book your appointment. Our goal is to make sure you feel comfortable, heard, and never rushed.

I leak when I laugh, cough, or exercise. Which treatment fits me?

That pattern usually points to stress urinary incontinence (SUI). First-line care often includes pelvic floor therapy. If symptoms persist, urethral bulking (Bulkamid) is a minimally invasive office option for women with SUI who haven’t responded to conservative care. A consultation can help confirm which option may be right for you.

I wake up multiple times a night to urinate. Is that treatable?

Nighttime urination (nocturia) is often part of an overactive bladder pattern and can sometimes be improved with the same therapies used for daytime urgency, including nerve modulation and bladder-relaxing therapies. Identifying the cause is the first step.

Does insurance cover these treatments?

Most major commercial insurance plans, Medicare, and Texas Medicaid cover medically necessary incontinence evaluation and treatment, including Bladder Botox, PTNS, sacral neuromodulation, and Bulkamid when criteria are met. We verify your specific benefits before scheduling any procedure.

How long until I see improvement?

It depends on the cause and the treatment. Conservative care and PTNS unfold over weeks; Bladder Botox typically takes a few weeks to reach full effect; sacral neuromodulation results are first evaluated during the trial phase. Your provider will set realistic expectations specific to your plan.

Are these procedures done in the office or at a surgical center?

PTNS, Bladder Botox, and Bulkamid are typically office-based procedures. Sacral neuromodulation involves an external trial phase, and the implant procedure (if you choose to proceed) is performed at an accredited surgical facility.