Addressing Incontinence in Women – Insights by Quynh-Dao Tonnu, PA-C

Key Takeaways:

  1. Incontinence in women can have different causes and diagnosis and requires tailored treatment options.
  2. Breaking the stigma and silence around incontinence is essential to encourage women to seek help.
  3. Advanced Urology Institute in Orange City, FL offers top-tier medical support and personalized treatment options to help women regain control over their lives.

Quynh-Dao Tonnu, a leading physician assistant at Advanced Urology Institute, offers expert insights into a topic that is often whispered about, but seldom openly discussed — female incontinence. Hidden behind hushed tones and uneasy glances, incontinence in women is a common but rarely explored issue.

Overactive Bladder and Female Incontinence

Tonnu attributes female incontinence to two common reasons. The first could be a narrowed urethra, which might require medical procedures or dilation. The second possibility is an overactive bladder where, as Tonnu explains, “The bladder contracts inappropriately, making them go more frequently.”

What’s important to note here is that both situations can have profoundly different approaches for diagnosis and treatment. Incontinence, and especially overactive bladders, can disrupt the rhythm of life, making it essential to “assess the underlying cause.”

Breaking the Silence

For many women, speaking about their incontinence can feel invasive and embarrassing. However, Tonnu’s empathetic and understanding approach encourages open conversations about this condition. As a physician assistant, and more importantly, a woman herself, Tonnu establishes a comforting sense of intimacy that encourages patients to share their experiences.

“I personally don’t find it particularly difficult to have that conversation with patients,” says Tonnu. “Perhaps because I’m female there’s already a sense of intimacy that they can share with me.”

Recognizing the Need for Help

Undoubtedly, opening up about incontinence is a bold step, signifying the point where the condition has become bothersome enough for the individual to seek help. Tonnu remarks, “Once they’ve consciously made the decision to make an appointment and come in, they’re usually willing to talk about it.”

This willingness to seek help and discuss their issues is a testament to the motivational environment created by Tonnu and her colleagues at Advanced Urology Institute. When a woman is ready to address her concerns, it means that she has acknowledged the problem and is prepared to take the necessary steps towards her treatment.

Choosing the Right Support in Orange City, FL

Tonnu’s dedicated approach to handling female incontinence provides hope for many women silently coping with the condition. By encouraging open conversations and providing personalized treatment options, she helps these women regain control over their lives. Located in Orange City, FL, Tonnu and the team at Advanced Urology Institute offer top-tier medical support to anyone facing urological concerns.

As the largest urology practice in Florida, the Advanced Urology Institute stands at the forefront of urinary health issues like overactive bladder and female incontinence. Their team of experts, led by individuals like Quynh-Dao Tonnu, PA-C, work tirelessly to ensure that each patient receives the best possible care. Because at the end of the day, it’s not just about treating a condition – it’s about reclaiming your life from the shadows of incontinence.


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  2. Advanced Urology Institute. (2023, May 19). What is Urinary Incontinence in Women and how can Dr. Amar Raval help? | Advanced Urology Institute. Advanced Urology Institute. \
  3. Advanced Urology Institute. (2023, April 24). How does Dr. Rishi Modh treat female urinary incontinence? | Advanced Urology Institute. Advanced Urology Institute.
  4. Hartmann, K. E., McPheeters, M. L., Biller, D. H., Ward, R. M., McKoy, J. N., Jerome, R. N., Micucci, S. R., Meints, L., Fisher, J. A., Scott, T. A., Slaughter, J. C., & Blume, J. D. (2009). Treatment of overactive bladder in women. Evidence Report/Technology Assessment, 187, 1–120, v.
  5. NHS Choices. (2023). Overview – Urinary incontinence.
  6. Elad Leron, Weintraub, A. Y., Salvatore Andrea Mastrolia, & Schwarzman, P. (2018). Overactive Bladder Syndrome: Evaluation and Management. Current Urology, 11(3), 117–125.
  7. Urinary incontinence | Office on Women’s Health. (2014).


My name is Quynh-Dao Tonnu, I’m a physician assistant at Advanced Urology. So it could be two things, they could have like a narrowed urethra or maybe they need to be dilated or have a procedure or it could be they have overactive bladder and they’re bladders kind of contracting inappropriately and making them go more frequently so we kind of have to assess the underlying cause. I personally don’t find it particularly difficult to have that conversation because maybe because I’m female and so there’s also there’s already like a sense of intimacy that they can share with me but also if once they’ve consciously made decision to make an appointment and come in then they’re usually willing to talk about it because it’s gotten to that point where it’s bothersome to them.

BPH Enlarged Prostate Symptoms & Treatment

Benign prostatic hyperplasia (BPH) is a non-cancerous increase in the size of the prostate gland and surrounding tissue. As the gland enlarges, it squeezes the urethra and causes the bladder wall to become thicker. Over time, the bladder muscles weaken and the bladder loses the ability to empty fully, resulting in urinary symptoms.

The most common complaints in people with BPH include:

  1. Difficulty starting urination
  2. Having to strain or push in order to pass urine
  3. Weak stream due to a weak urine flow
  4. Dribbling at the end of urination
  5. Urgent or frequent need to urinate
  6. Nocturia—increased urinary frequency at night
  7. Intermittency—the need to stop and start many times when passing urine

In some men, rare symptoms may occur, including:

  1. Inability to urinate
  2. Blood in urine
  3. Urinary tract infections

The size of the enlarged prostate gland does not determine the severity of the symptoms. Actually, some men with only a slightly enlarged prostate have significant symptoms while others with a massive enlargement have only minor urinary symptoms. Plus, in some men, symptoms tend to stabilize and even improve with time.

Besides, an enlarged prostate shares urinary symptoms with a number of conditions, including:

  1. Inflammation of the prostate (prostatitis)
  2. Narrowing of the urethra (urethral stricture)
  3. Urinary tract infection
  4. Kidney or bladder stones
  5. Problems with nerves controlling the bladder
  6. Scarred bladder neck after surgery
  7. Bladder or prostate cancer

Therefore, it is advisable that you see a urologist as soon as possible if you are having persistent urinary symptoms. Regardless of whether the urinary symptoms are bothersome or not, seeing a doctor will help to identify or rule out any underlying causes. 

How is benign prostatic hyperplasia treated?

When your urologist is certain that you have benign prostatic hyperplasia, you’re typically started on an alpha blocker—a medication that relaxes your bladder neck muscles and the muscle fibers in the prostate, making urination easier.  

Commonly prescribed alpha blockers include alfuzosin (Uroxatral), tamsulosin (Flomax), doxazosin (Cardura), and silodosin (Rapaflo).  For men with only slightly enlarged prostates, alpha blockers work really quickly and relieve urinary symptoms effectively.

Another option is to prescribe medication that can shrink the prostate by preventing hormonal changes behind prostate enlargement. The medications, called 5-alpha reductase inhibitors, such as Finasteride (Proscar) and Dutasteride (Avodart), can shrink the prostate by as much as 50-percent over a period of six months. You can rely on these drugs to relieve urinary symptoms within a few weeks of usage.

In some cases, your doctor may opt for a combined therapy using an alpha blocker together with a 5-alpha reductase inhibitor. This is done if either medication isn’t effective when used alone.

If your symptoms fail to respond to these medications, your doctor may recommend a minimally invasive surgical procedure. Such a procedure may also be necessary if your symptoms are severe or if you have a urinary obstruction, bladder stones or kidney problem.

Some procedures your doctor may consider include:

  1. Transurethral resection of the prostate (TURP)

This is a minimally invasive procedure that involves inserting a lighted scope into the urethra and using it to guide the removal of all but the outer part of the prostate.

  1. Transurethral incision of the prostate (TUIP)

Just like TURP, this procedure involves inserting a lighted scope into the prostate. The difference is that during TUIP, the surgeon makes 1-2 small incisions in the prostate gland, which enable urine to pass through the urethra.

  1. Transurethral microwave thermotherapy (TUMT)

As opposed to using a lighted scope, this procedure uses a special electrode inserted through the urethra into the prostate. The electrode provides microwave energy that is directed to the inner portion of the enlarged prostate. As a result, the prostate shrinks and urine flow improves.

  1. Transurethral needle ablation (TUNA)

This is another minimally invasive procedure that involves passing a scope into the urethra to allow the surgeon to place needles into the prostate gland. Radio waves are directed through the needles, which help to heat up and destroy excess prostate tissue.

  1. Laser therapy

During this procedure, high-energy laser is used to remove or destroy overgrown prostate tissue. It is preferred in men who are taking blood-thinning medications and who shouldn’t undergo the other minimally-invasive prostate procedures stated above.

  1. Prostate urethral lift (PUL)

This is a minimally invasive procedure that involves using special tags to compress the sides of the prostate in order to enhance urine flow. It is recommended in men who are wary about the impact of treatment on erectile and ejaculatory function. Prostate urethral lift causes minimal adverse effects on ejaculation and sexual function compared with TURP, TUIP, TUMT, and TUNA.

  1. Robot assisted prostatectomy

As a last resort or in cases where the prostate is too much enlarged, the bladder is damaged or there are other complicating factors, the surgeon may opt for da Vinci robot-assisted prostatectomy. The procedure involves making an incision in the lower abdomen to reach the prostate gland, which is then removed.

Reliable, unbeatable care

Are you 50 years or above and are having a frequent urge to urinate, a weak urine stream, leakage or dribbling of urine, or trouble beginning urination? You may be having benign prostatic hyperplasia.

At Advanced Urology Institute, we offer safe, timely and reliable diagnosis and treatment of BPH. Our urologists are skilled in doing physical examination, patient history, symptom evaluation, and ordering tests that form the basis for diagnosing the condition and ruling out other problems, including prostate cancer.

We also make sure that our patients understand the full range of treatment options available to them, and guide them on making an informed decision and on pursuing the treatment that is best for their individual medical situation. For more information on benign prostatic hyperplasia diagnosis and treatment, visit the site “Advanced Urology Institute.”

Ways to Pass Kidney Stones

Kidney stones can be a painful and difficult experience for the many men and women who get them. These stones are hard deposits of minerals that build up in the body and cause blockages in the urinary tract. The blockages can make it very painful and difficult to urinate. In addition to difficulty urinating, the stones can cause nausea as well as pain in the groin and abdomen. Luckily, there are many ways that urologists can help speed up the process.

Quynh-Dao Tonnu, PA-C: Physician Assistant in DeLand, FLFinding the best way to help a patient to pass a kidney stone depends on several factors. Not all patients are the same, and the size and difficulty of their kidney stones vary as well. If the stones are smaller than 5 millimeters, the urologist will want the patient to try and pass them naturally. This is the least invasive way to pass kidney stones, although it may not always be possible. Drinking lots of liquids for frequent urination is the key for this method. Urologists may also recommend movement like bicycling and jumping jacks to help dislodge the stones naturally.

If passing naturally is not an option, then medication may be the next step. Urologists will use some of the same medications that are used to treat an enlarged prostate. Medication like Flomax helps relieve pressure on the urinary tract by relaxing the muscles in the prostate. This allows for easier urine flow and can help the patient pass the stones.

Another treatment option that makes passing stones easier is called shock wave lithotripsy. This treatment uses a machine pressed up against the patient’s body that targets water waves directly at the kidney stones. With as many as 2,500 waves per treatment, these waves break the kidney stones into small, sand-like particles. The sandy remnant is then easily passed during urination.

In some cases, a more invasive treatment may be needed to remove the stones from the body. A surgeon may use a scope fitted with a medical laser to enter the patient’s urinary tract through the penis. They can then use the laser to break the stones up into smaller fragments for easier passing. This method is sure to help pass the stones, but a urologist may prefer to try more natural methods first.

There is no single method to passing kidney stones. What matters most is making the process as fast, safe and pain-free as possible. For more information about kidney stones, visit the Advance Urology Institute website.

Surgical Options for Overactive Bladder

If you feel frequent, sudden urges to urinate that you cannot control, you might be suffering from overactive bladder. This condition can lead to feelings of embarrassment or shame, but it’s a common problem and can be treated in a variety of ways. For many people, overactive bladder can be treated with lifestyle changes such as special diet, weight loss, regularly timed trips to the bathroom, and exercises to strengthen the pelvic floor. Dealing with symptoms by using absorbent pads is also an option.

However, for some people, these methods are not enough to ensure they can live a healthy, fulfilling life. In these situations, surgical intervention is an option to correct overactive bladder problems.

Augmentation Cytoplasty

One of the options for treating overactive bladder is called augmentation cytoplasty. This procedure increases the size of the bladder. The surgeon accomplishes this by removing a small part of the intestine and using it to replace parts of the bladder in order to increase its capacity. For some people, this procedure allows them to resume normal bladder function. For others, the use of a catheter may be necessary for the rest of their life.

Urinary Diversion Surgery

Another surgical treatment option for overactive bladder is urinary diversion surgery. This procedure involves diverting urine from the bladder. One option for bypassing the bladder involves linking the ureters, which normally connect the kidneys to the bladder, to an ostomy bag outside of the body. Another option involves the creation of a new bladder inside of the patient’s body, which means they will be able to continue normal urinary function.

Bladder Removal

Bladder removal surgery, or a cystectomy, is the last resort option for patients with overactive bladder for whom no other treatment has been successful. For men, bladder removal surgery also involves the removal of part of the prostate; for women, it involves removal of the uterus, ovaries and part of the vagina. Because this is a risky procedure that involves multiple organs, it is usually only used for more serious urological conditions such as bladder cancer or birth defects. Removal of the bladder necessitates the use of a urinary diversion such as an ostomy bag or a stoma.

An overactive bladder can be a debilitating condition, but there are many options for treatment. If you are dealing with this issue, the physicians at Advanced Urology Institute are here to help you reach a diagnosis and find a treatment to restore your quality of life.

Treatments for Bladder Control Problems in Women

Urinary incontinence happens when the bladder becomes weak and urination happens by accident. Although they seldom want to talk about it, urinary incontinence affects women twice as often as men. The cause may be related to childbirth or menopause, and the structure of the female urinary tract plays a role as well.

If you suffer from this problem, it’s important to realize you are not alone. More than 33 million Americans deal with urinary incontinence or a bladder condition. Unwanted urinary activity occurs in both men and women and increasing age can be a partial cause. Is is estimated that one out of three women in the United States has a bladder problem.

Quynh-Dao Tonnu, PA-C of Daytona Beach, FLBladder control problems can vary, from occasional urine leakage that happens when you cough or sneeze, to having sudden urges to urinate so strong you do not make it to the toilet in time. There are several basic forms of incontinence and you can have more than one condition. There is urge incontinence, where you will feel a need to urinate all of a sudden as the bladder involuntarily contracts, compelling you to urinate immediately. Another form is stress incontinence. This is caused when physical stress from coughing or sneezing, or athletic activity, puts pressure on the bladder and causes leakage.

Some women experience overflow incontinence, which happens when you leak urine because your bladder does not empty all the way.

Assessing Causes of Urinary Leakage

When you make an appointment, your doctor or a physician assistant will ask for a thorough history of the problem, followed by a physical exam. Some simple and painless tests may be taken. Urinalysis is a test in which a urine sample is checked for traces of blood, signs of infection, nitrates, or other indications of a medical problem. You may be asked to create a bladder diary, keeping a record for a few days to track the amount of fluids you drink and the frequency and amount of urine, as well as details of urgency or leakage.

Another test may be a post-void residual measurement. You will urinate into a container, and then your doctor uses ultrasound to measure the amount of urine left in your bladder.

Treating Bladder Control Problems

  • Changing your diet and performing Kegel exercises may help with both urge and stress incontinence. Additional treatments may be recommended ranging from medications to surgery.
  • Medications can be prescribed, including anticholinergics (used to block neurotransmitters), antidepressants, estrogens, or nerve-stimulating drugs.
  • Injection therapy involves the injection of collagen and other compounds to bulk up the urethra.
  • Botox injection is another possibility. Injecting Botox into the bladder partially paralyzes muscles to help reduce overactivity.
  • Surgical options are available for treating bladder control issues. They include urethral slings or mesh tape inserted to support a sagging urethra, or sacral nerve stimulation through an implanted device that calms nerves of the bladder.

It is best to make an appointment with a urologist if you are experiencing bladder control problems. Our doctors at Advanced Urology Institute have years of experience with treating bladder problems and working with patients to find the best solutions. For more information, visit the Advanced Urology Institute website.

Becoming a Physician Assistant with Quynh-Dao Tonnu, PA-C

While certified physician assistants (PA-C) are not the same as American Medical Association board-certified medical doctors, they are competent medical professionals. Physician assistants often go into medicine later in life, having already worked in other occupations.

Quynh-Dao Tonnu, PA-CCertified physician assistants go through a rigorous graduate-level training program that takes more than two years to complete. The degree program must be accredited by both the Committee on Allied Health, Education and Accreditation, and the Accreditation Review Commission on Education for the Physician Assistant. After successful completion of the academic portions, the graduates must pass the national Physician Assistant National Certifying Exam. The final stages include formal application with the Florida Board of Medicine and completion of 2,000 hours (about one year) of supervised clinical practice.

Physician assistants are important within medical practices because they relieve the physicians of much of the routine workload. They take medical histories and, because of their medical training and experience, they are able to notice when a patient has a special issue the primary physician should be aware of. They can understand medical histories written by other medical professionals and understand their patients’ backgrounds. For example, some fad diets can seriously affect a person’s digestive system, kidneys, urinary tract and bladder. An experienced PA knows when to ask patients if they have been on such diets.

With a solid understanding of pharmaceutical medicine, physician assistants can prescribe medications or recommend that the physician prescribe certain types of medications. PAs also approve prescription refills according to the physician’s practice and standard medical guidelines. If a patient has questions about how and when to take medications, PAs can give that information.

Quynh-Dao Tonnu, PA-C started her post-secondary education at the University of Florida, where she received her BA in Economics in 2005. Later in 2007, she completed a master’s degree at the University of South Florida in Library and Information Science. After that, she worked in hedge fund accounting, which she found interesting but not very personally fulfilling. In 2014, she changed occupations to become a medical assistant. She realized her most fulfilling job experiences involved working with people, so she went back to school and obtained her Physician Assistant degree in 2017. She has been working in urology for three years and is now fully certified. You can meet this talented PA at the Advanced Urology Institute Oxford office. For more information, visit the Advanced Urology Institute website.