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Whether sitting on an airplane, attending a business meeting, or just gardening in the yard, the sudden or urgent need to get to a bathroom is a distressing and all-too-frequent disruption in the lives of millions of people. Bladder or bowel incontinence is surprisingly common. It has a number of causes including the complications of surgery, childbirth, or injury. These and other causes can interfere with the muscles, nerves, and other tissues that work together for 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 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; and Liliana Bordeianou, M.D., Instructor in Surgery, Harvard Medical School, Massachusetts General Hospital. 47 pages. (2009)
- Urinary incontinence
- Anatomy of urinary continence
- Types of urinary incontinence
- Evaluating urinary incontinence
- Urodynamic studies
- Uroflowmetry
- Post-void residual volume
- Cystometry
- Electromyography (EMG)
- Cystography
- Video-urodynamic study
- Other evaluation procedures
- Treating urinary incontinence
- Bladder training
- Fluid management
- Pelvic floor exercises
- Biofeedback
- Home exercise aids
- Conditioning without exercise
- Medication to treat urinary incontinence
- Neurological strategies for overactive bladder
- Injection of bulking agents
- 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
Most people take bladder and bowel control for granted — until something goes wrong. Then, unexpectedly, they find themselves hurrying to get to a bathroom on time, avoiding certain situations for fear of leakage, or relying on absorbent pads for protection. If you have had any of these experiences, you are not alone.
An estimated 32 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 typically a rarely discussed but common result of childbirth and aging. For men, it’s most often a side effect of treatment for prostate problems.
Sometimes incontinence is a minor problem. 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 fear of leakage, for example, you are giving up one of the most effective strategies for maintaining health. In addition, 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 depression.
Even more alarming, 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.
The good news is that treatments are becoming more effective and less invasive. For example, today’s medications for urinary incontinence are easier to use than earlier ones. Exercises can help strengthen the muscles of the pelvic floor, shoring up those that control both bladder and bowel. Most people don’t require surgery, but for those who do, the options often include less invasive outpatient procedures that often work as well as older, open surgical procedures.
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