Rheumatology’s role: This is usually a mechanical or nerve-related spine condition treated by our pain and spine physicians. A rheumatologist may be involved when there are signs of inflammatory arthritis, such as morning stiffness, swelling in several joints or abnormal inflammation tests.
For full details on this condition, see our main page: Bladder or Bowel Control.
Overview
Problems with bladder or bowel control include overactive bladder (a sudden, strong urge to urinate), urge incontinence, non-obstructive urinary retention and fecal (bowel) incontinence. These conditions are common and can affect work, sleep and social life.
First-line care usually includes lifestyle changes, pelvic floor therapy and medication. When these do not help enough or cause side effects, neuromodulation therapies that target the nerves controlling the bladder and bowel may be an option to discuss.
Watch and learn
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Common symptoms
- Frequent urge to urinate
- Leaking urine before reaching the bathroom
- Waking at night to urinate
- Difficulty emptying the bladder
- Accidental bowel leakage
Causes and risk factors
- Miscommunication between the brain and the sacral nerves
- Pelvic floor weakness
- Nerve injury or prior surgery
- Neurological conditions
- Childbirth-related changes
How it is diagnosed
Evaluation includes a symptom history, bladder or bowel diary, exam and, when needed, urodynamic or other testing. Some causes need treatment by a urologist, urogynecologist or gastroenterologist.
Treatment options
Self-care and lifestyle
Fluid timing, limiting bladder irritants such as caffeine, bowel habits and pelvic floor exercises.
Physical therapy and medications
Pelvic floor physical therapy and medicines from your primary care provider or specialist.
Injections and nerve blocks
Other in-office treatments are directed by your urology or gastroenterology specialist.
Minimally invasive procedures
Tibial or sacral neuromodulation may help when other treatments are not enough.
Surgical evaluation
Referral for other surgical treatment when appropriate. Sudden loss of bladder or bowel control with back pain is an emergency.
Frequently asked questions
Is bladder or bowel leakage a normal part of aging?
It is common, but it is not something you have to accept. Several treatments are available, and an evaluation can help find the right one.
What is neuromodulation?
Neuromodulation uses mild electrical pulses to influence the nerves that control the bladder and bowel. Sacral neuromodulation and tibial nerve stimulation are two approaches.
Do I need to try other treatments first?
Usually yes. Neuromodulation is typically considered after conservative measures and medication have not worked well enough or were not tolerated.
This page is general patient education and does not replace advice from your own clinician. Individual results vary.