Medically reviewed by Gregory J. Bailey, MD, board-certified urogynecologist
In a recent educational webinar hosted by Medtronic, our urogynecologist Dr. Gregory J. Bailey walked through one of the most common, and most under-discussed, problems he treats: loss of bladder and bowel control. If any of these symptoms sound familiar, the full recording is worth your time.
You are not alone, and these problems are treatable
Dr. Bailey noted that roughly 1 in 6 adults in the United States deals with bladder control issues, and about 1 in 12 has bowel control issues. Many people never bring it up with their doctor because they feel embarrassed or assume nothing can be done. His central message: in most cases, there is something that can help.
What causes bladder and bowel control problems
The causes vary, which is why a visit starts with a thorough history. Among the factors he discussed:
- Everyday habits, such as sipping fluids constantly throughout the day
- Diet, including foods that loosen stool (having the gallbladder removed can play a role)
- Certain medications, like a diuretic taken too late in the day
- Pelvic floor weakness, often linked to childbirth and the drop in hormones after menopause
- Prolapse, when the bladder or other organs shift out of position
- Nerve-pathway problems, since the brain controls the bladder and bowel through the same nerve roots
The common conditions
He walked through several distinct conditions, because each one is treated differently:
- Stress incontinence: leaking when you cough, sneeze, laugh, or jump. It is a mechanical problem and is often very fixable.
- Urinary retention: trouble emptying the bladder, which can be caused by an obstruction, a prolapse, or a nerve issue.
- Overactive bladder: urgency, frequency, and sometimes leaking on the way to the bathroom.
- Fecal incontinence: either passive leakage or an urgency that does not allow you to reach the bathroom in time.
Treatment, starting with the simplest options
A theme throughout the talk was starting conservative and moving to advanced treatments only if needed.
Lifestyle and diet. Cutting back on bladder irritants (caffeine, chocolate, citrus, and sodas), adjusting when a medication is taken, and using an over-the-counter product that lowers urine acidity can all help.
Pelvic floor exercises. Beyond standard Kegels, Dr. Bailey described “quick flicks,” rapid contractions that can calm a sudden urge.
Medications. Two categories exist: anticholinergics, which work but carry side effects and a caution about cognitive effects in older adults, and beta-3 agonists such as Myrbetriq and Gemtesa, which tend to have fewer side effects.
Advanced therapies. When conservative steps are not enough, options include bladder Botox, a short sling procedure for stress incontinence, bulking procedures for the urethra or anal sphincter, and neuromodulation. He spent the most time on neuromodulation, including tibial nerve stimulation (now available as a small rechargeable implant) and InterStim, a sacral neuromodulator placed under the skin that can improve both bladder and bowel control. One feature he highlighted: InterStim can be tested first, so you know whether it will work for you before anything permanent is placed.
How an evaluation works
Depending on your symptoms, an evaluation may include a urodynamic study (similar to an EKG, but for bladder function) or a quick look inside the bladder with a cystoscope to rule out stones, polyps, or other causes.
A few questions from attendees
The session closed with audience questions on medication costs, what to do when physical therapy has not brought relief, whether the stimulation is noticeable day to day (once it is set, it generally is not), and what recovery looks like after a sling or an implant (usually quick). The full answers are in the recording above.
Talk with us
If this sounds like what you have been living with, you do not have to simply manage it. To discuss your options with Dr. Bailey and our team, request an appointment. You can also learn more about the conditions we treat.
This was an educational webinar hosted by Medtronic and is shared here for general information. It is not medical advice, and individual results vary. Product and device names are mentioned only as they were discussed during the presentation.