Bladder and Bowel Dysfunction

Bladder and bowel dysfunction covers a range of conditions affecting the ability to control urination or bowel movements, including urinary urgency (a sudden, hard-to-defer need to urinate), urinary urgency incontinence (leakage associated with that urgency), non-obstructive urinary retention (difficulty emptying the bladder despite no physical blockage), and fecal incontinence (difficulty controlling bowel movements). These conditions are common, can affect people at any age, and are frequently under-reported because patients are reluctant to discuss them; but they are genuinely treatable, and most patients improve substantially with the right conservative treatment.

Most patients are managed successfully with conservative measures: pelvic floor physical therapy, bladder training, dietary and fluid adjustments, and medication where appropriate. Sacral nerve stimulation (SNS) is generally considered for patients whose symptoms have not responded adequately to these measures, and for whom the pattern of symptoms is one that sacral neuromodulation is known to help; most commonly urinary urgency incontinence, urgency-frequency, non-obstructive urinary retention, and fecal incontinence, particularly when these do not have a clearly reversible cause.

Evaluation for sacral nerve stimulation is generally considered once appropriate conservative treatments have been tried without adequate relief, and once other causes, including structural, neurological or reversible causes, have been assessed and addressed as needed.

• Detailed history of urinary or bowel symptoms, including a symptom diary
• Physical examination, and further testing (such as urodynamic studies) where appropriate to characterize the specific problem
• Review of conservative treatments already tried
• Assessment for any underlying or reversible cause that should be addressed first
• A trial period, described on the Sacral Nerve Stimulation page, before any permanent decision is made

Treatment goals are realistic and individual: for many patients, the aim is a meaningful reduction in urgency, frequency or leakage episodes, and improved quality of life, rather than complete elimination of all symptoms. Full detail on what sacral nerve stimulation can achieve is on its own page.

Risks and limitations are specific to the treatment being considered and are described on the Sacral Nerve Stimulation page. Not every patient with bladder or bowel dysfunction is a candidate, and the right approach depends on individual assessment.