What Does Dr. Nicole Szell Say About Women’s Urinary Incontinence?


  • Urinary incontinence in women can be classified into different types, such as stress or urge incontinence, which require different treatment approaches.
  • Treatment for urinary incontinence can involve lifestyle changes, pelvic floor exercises, medications, and in some cases, surgery.
  • It’s essential to consult a urologist for appropriate diagnosis and treatment for urinary incontinence to improve symptoms and quality of life.

When you complain to us about urinary incontinence, we will take quick vital steps to help you. For instance, if you are able to immediately provide a clean-catch urine sample, we will do a urinalysis to rule out urinary tract infection. We also will ask you to keep a three-day voiding diary to enable us to classify and identify the cause and severity of your incontinence. Then we will schedule a follow-up visit before we begin treatment to review the timing, quantity, severity and circumstances of your typical episodes of urine leakage, particularly those that you find most troubling.

Types of Urinary Incontinence

The treatment approach we adopt for each case depends on the type of incontinence and severity of symptoms. In women, the most common types are stress or urge incontinence, but some women may have mixed incontinence, where urge and stress incontinence occur simultaneously. When episodes of urine leakage occur following a physical act like sneezing, coughing, heavy lifting or bending over, that is stress incontinence. On the other hand, urine loss associated with a strong uncontrollable need to void is urge incontinence. So we will use the three-day voiding diary, medical history, physical exam and any necessary tests to determine what type of incontinence you have in order to administer the right treatment.

Lifestyle Changes

Once the type of incontinence is determined, we will embark on appropriate treatment for your condition. For example, if we find that you have early-stage incontinence with rare or less troubling symptoms, we will reassure you that your condition is not that bad and recommend a number of lifestyle changes to improve your situation. We are good at building close and abiding relationships with our patients, so we will explain the diagnosis caringly and instruct you compassionately on what lifestyle changes we want you to make. For instance, since timed voiding is quite helpful with nocturnal urge incontinence, we may instruct that you set an alarm every night an hour before the usual time you wake up with a deep sense of urgency and empty your bladder before it gets full to the point of leakage. We also may advise that you reduce your overall fluid intake, avoid caffeine, spicy foods or carbonated drinks.

Pelvic Floor Exercises

We often recommend Kegel (pelvic floor) exercises for women with stress incontinence. Well-timed, regular Kegel and bladder retraining exercises help to relieve symptoms and treat the condition. We will instruct you on the right technique for these exercises and work with you on a plan to help you practice them until they become second nature. We recommend that you begin by exercising the pelvic floor muscles 4 times a day and gradually increase this to 8 times a day, making sure also to use bladder retraining exercises to increase the interval of time you take between your bathroom visits. We will guide you all the way, checking on you to find out if there is any relief from the symptoms as you implement the exercise regimen.

Anticholinergic Medications

In case of a severe, debilitating urinary incontinence with very bothersome and embarrassing symptoms, we may give anticholinergic (anti-muscarinic) medications to eliminate bladder spasms and relieve the symptoms of incontinence. Some common medications we may recommend include Detrol, Vesicare, Ditropan XL, Enablex, Urispas and Oxytrol, with Oxytrol being available even without prescription. Apart from medications, we may advise you to use absorbent pads, panty liners or similar products, to prevent urine leakage or possible embarrassment from a potential leakage. A good example is the pessary, a plastic insert into the vagina, which we may recommend for supporting your bladder’s neck and preventing urine leakage associated with stress incontinence.


If these treatments fail to give enough relief, we may opt for surgery. For instance, we may surgically implant small nerve stimulators just beneath your skin to stimulate the nerves controlling the pelvic floor area and manipulate the contraction of the muscles within your pelvic floor. Or we may opt for the sling procedure, a surgical intervention in which a strap of natural tissue or synthetic mesh is added to support the urethra. We also may conduct procedures to restore your bladder to its original position.

Are you worried about urine loss when you sneeze or cough? Do you always have to stop what you are doing and rush to the bathroom whenever your bladder is full? Or do you fear going out with your friends because of a possible urine leakage? Do not suffer in silence. At Advanced Urology Institute, we have been treating urinary incontinence in women for many years and have the tools and personnel to solve your problem. Whether you just started having urine leaks recently or have had the problem for so long that you have decided to avoid the social activities you used to love, we will give you the right treatment to help you recover. For more information on treating urinary incontinence in women, visit the “Advanced Urology Institute” site.


Hi, I’m Dr. Nicole Szell, I’m a board certified urologist with Advanced Urology Institute.

I think the first thing that’s really important to understand when a patient comes in with these issues is how debilitating is it for them?

Are they in the early stages, it doesn’t bother them that much, they just need to be reassured that it’s something that happens to a lot of women, it could get worse, or it could remain the same, or is it become so debilitating to them that they are willing to have surgery or other invasive maneuvers in order to help prevent it.


How Did Nicole Szell Become a Urologist?


  • Dr. Nicole Szell’s journey to becoming a urologist was driven by her passion for women’s health and her educational background in biology, chemistry, and osteopathic medicine.
  • Urology as a profession is intellectually challenging and rewarding, allowing practitioners to build trust-based relationships with patients and improve their quality of life.
  • Advanced Urology Institute is an ideal place for urologists like Dr. Szell to practice, as it offers a supportive environment with skilled professionals and a patient-centered approach to care.

To be able to dedicate your life to preventing, detecting and intervening in painful and embarrassing situations is an attractive and gratifying undertaking. It may not be for everyone, but for those of us in this profession it just brings incredible joy. As a urologist, you are able to direct your energy and enthusiasm to helping people. You are allowed into the lives of people facing painful conditions and are trusted to inject hope and bring back the joy to living. And as you are diagnosing, treating and educating patients, you make long-term connections and enjoy the thrill of being able to make other people well and happy again. It is a wonderful experience.

My Journey to Urology

Women’s health interested me from a very young age, driving me into many years of service as a volunteer and researcher in various women’s health programs and organizations. So when I went to college, my mind was already made up. I just wanted to pursue female urology and pelvic floor medicine. Being a native of the Midwest and Cleveland, Ohio, I went to Radford University in Radford for my bachelor of science in biology and chemistry. Upon graduation, I joined the College of Osteopathic Medicine, East Lansing, MI, for my medical school degree. Then I went to St. John’s Providence Health System, Detroit, for my urology residency program. I specialized in voiding dysfunction, pelvic floor disorders, sexual dysfunction, urologic reconstruction and pelvic organ prolapse, though I also handle general urology disorders such as kidney stones and bladder cancer.

Job Satisfaction

Urology is a field that challenges the intellect daily. It also inculcates the capacity to develop relationships based on trust. But most importantly, it offers the opportunity to solve women’s health problems, something I have been committed to since I was a young girl. As a urologist, I am able to engage with women in different situations and suffering from various conditions. It is a great privilege to listen to them, help them relax and find hope even in the face of a devastating diagnosis. I love my job because each day offers the chance to relieve discomfort, solve embarrassing conditions and improve the quality of life.

Why Advanced Urology Institute

Advanced Urology Institute is a great place to practice. I call it the urologist’s paradise. You are surrounded by passionate, skilled and talented professionals who are dedicated to a greater purpose. Each member of the pool has an unwavering drive to deliver the best possible care. As a team, we collaborate a lot when handling our patients. Since all administrative work has been centralized, we are left to focus on how to address the issues of our patients. So when patients come, they find us energetic and enthusiastic to serve them. And with our multidisciplinary, compassionate and patient-friendly approach, every patient can be sure of the best possible care. Want to know more about our services? Visit the “Advanced Urology Institute” site.


Hi, I’m Dr. Nicole Szell. I’m a board certified urologist with Advanced Urology Institute.

I grew up in Cleveland. I am an only child. I moved to Michigan. I did my training at Michigan State for medical school. I did my residency in Detroit, Michigan, and then I went down to Miami for my fellowship in female pelvic medicine and urethral reconstruction. I also did specialized training in chronic pelvic pain, which was in Detroit, and I also did specialized training in female sexual function and dysfunction in San Diego, California, before coming here.