Managing Urinary Incontinence

No one wants to talk about it, but 5.5 million Americans are affected by it. Women are eight times more likely to suffer from it than men. And older women are afflicted more than younger women.

Disorders of the pelvic floor muscles are often associated with loss of control of the bladder and bowels, and can lead to “dropping” of the pelvic organs. Unfortunately, psychological barriers may keep patients from reporting their symptoms to a doctor. But fecal incontinence, urinary incontinence, and constipation are often treatable, and many options are now available for women at Women & Infants' Division of Urogynecology and Reconstructive Pelvic Surgery and from Women & Infants' Center for Women's Gastrointestinal Health.

The first step is to find out what may be causing the problem. Those diagnostic tests may include colonoscopy, anal manometry and ultrasound to evaluate the muscle strength in the rectum, as well as a nerve study, pelvic MRI and defecogram to look at the bowel and muscle contraction during a bowel movement.

Once a cause is determined, a therapy program is developed. Therapy may include:

• Dietary modifications to avoid foods that cause diarrhea or constipation.
• Medications that change the consistency of stools to make bowel movements easier.
• Physiotherapy, including bowel retraining and muscle strengthening exercises.
• Sacral nerve stimulation devices for patients affected by nerve damage.

For some patients, therapy may not help, and surgery may be required to reconstruct the anal sphincter or to correct the pelvic prolapse.

The Spaulding Outpatient Center for Pelvic Health at Care New England is designed to offer interdisciplinary treatments and services to address the specific needs in pelvic health patients.