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Better Bladder and Bowel Control

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Bladder Control and Incontinence Report
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Urinary Incontinence & Bladder Control

Urinary incontinence is surprisingly common. Surgery, medications, childbirth, or injury can interfere with the muscles, nerves and other tissues that work together for bladder control and urinary and rectal function. Middle aged and older people are particularly susceptible to these conditions. But there are a variety of treatments available including exercise programs, medications and surgery. This Special Health Report, Better Bladder and Bowel Control, describes the causes of urinary and bowel or fecal incontinence and treatments tailored to the specific cause.

Better Bladder and Bowel Control  was prepared by the editors of the Harvard Health Publications in consultation with May M. Wakamatsu, M.D., assistant professor of obstetrics gynecology and reproductive biology at Harvard Medical School and Massachusetts General Hospital and Joseph A. Grocela, M.D., Instructor in surgery, Harvard Medical school and Massachusetts General Hospital. 47 pages. (updated: 2007)

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Table of Contents:

  • Urinary incontinence
    • Anatomy of urinary continence
    • Types of urinary incontinence
    • Evaluating urinary incontinence
  • Treating urinary incontinence
    • Lifestyle changes
    • Medication to treat urinary incontinence
    • Neurological strategies
    • Surgery
  • Managing urinary incontinence
    • Containment options
    • Collection devices
    • Leakage barriers
    • Catheterization
    • Vaginal support devices
    • Skin care
    • Odor control
    • Emotional concerns
  • Fecal incontinence
    • Anatomy of fecal continence
    • What can go wrong?
    • Evaluating fecal incontinence
    • Physical exam
    • Testing
  • Treating fecal incontinence
    • Diet and medication
    • Pelvic muscle exercises and biofeedback
    • Surgical treatments
  • Managing fecal incontinence
    • Containment and collection options
    • Enemas and suppositories
    • Skin care
    • Reducing odor
    • Emotional concerns
  • Glossary
  • Resources
    • Organizations
    • Books

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Here's an Excerpt from this Incontinence Special Health Report

Most people take bladder and bowel control for granted—until something goes wrong. Then, you may find yourself worrying about getting to a bathroom on time, avoiding certain situations for fear of leakage, or relying on absorbent pads for protection. If so, you are not alone.

An estimated 25 million adults have incontinence, the unintended loss of urine or feces that is significant enough to make it difficult for them to maintain good hygiene and carry on ordinary social and work lives. What’s the cause? For women, it’s a rarely discussed but common result of childbirth. For men, it’s most often the result of treatment for prostate problems. Sometimes incontinence is minor, and all you need is an occasional absorbent pad to keep enjoying your normal activities. But when you begin organizing your life around easy access to a bathroom or start giving up the activities that are important to you—your daily walk, travel, career, or sex—because you can’t control leakage, it may be time to take action.

Besides disrupting daily activities and nighttime sleep, incontinence can also chip away at your health. If you have stopped exercising, for example, you are giving up one of the most effective strategies for maintaining health. Getting up several times a night can lead to sleep deprivation and raises the risk of injury from falls. And incontinence that causes withdrawal from social interactions can contribute to result in depression. Older women who frequently must rush to the bathroom are 26% more likely to fall and 34% more likely to break a bone. Incontinence is also a leading cause of nursing home placement, and that prospect drives some people to try to hide their condition rather than seek help.

While it engenders fear and embarrassment, rest assured that incontinence is not a psychological problem or a personal failure. Incontinence is a medical symptom, and it deserves the same attention you would give to any other medical problem. This report describes the common causes of urinary and fecal incontinence for men and women and the treatments for these conditions. No matter how serious or longstanding the problem, there is assistance available—you may not find a total cure, but you can get help. Even if you have not had success in the past, advances in medical care provide a good reason to try again. For example, easier-to-take medications are now available for urinary incontinence. Exercises can help strengthen the muscles of the pelvic floor, shoring up the muscles that control both bladder and bowel. Surgical options now include outpatient procedures that work as well as major surgery. There are even treatments for the most severe cases of fecal incontinence, including sphincter repair. One warning: Manufacturers have discovered that there is money to be made in selling products for incontinence. Your best bet is to choose products or treatments recommended by your doctor, using this report as a guide.

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