Definition and Overview

Bladder and bowel management refers to different approaches to treating waste-related dysfunctions. The bladder is part of the urinary system along with the kidneys, which are responsible for filtering wastes and other by-products that are drawn from the bloodstream as they pass through the organs. These wastes, along with excess water and salt, combine to become urine. Urine then moves onto the ureter and into the bladder, a bag-like organ that collects the normally yellowish fluid. Below the bladder is the sphincter muscle that keeps the bladder closed to ensure there is no involuntary leak of the urine. The bladder continues to store urine until it is filled. The nerves in the bladder then signal the brain that it is full, which then delivers a message to the sphincter muscle and bladder to eliminate urine, which then passes through the urethra.

On the other hand, the bowel refers to the intestines (both large and small intestine). It is an integral part of the digestive process and is the last stop for the food consumed. Food, after digested by the stomach, proceeds to the small intestine where it is delivered into the bloodstream as nutrients for the different cells of the body. Any excess is then converted into stool (feces), which then proceeds to the large intestine and is eliminated from the body through the rectum and anus.

A bowel or bladder dysfunction can lead to a variety of problems including incontinence or loss of fecal and urinary control. Usually, this is characterized by the sudden and often involuntary leak of the wastes. However, it can also include a consistent urge to urinate or defecate, or weak retention ability.

There are different types of interventions that can be implemented to make this condition more manageable for patients.

Who Should Undergo and Expected Results

Bladder and bowel management may be recommended to:

  • Older people – Seniors, especially those who are 70 years old and above, have less ability to control their bowel and urine. In fact, this problem is often one of the leading causes for geriatric long-term care.

  • Those diagnosed with incontinence

  • People with degenerative disease such as Alzheimer’s disease

  • Those who have spinal or brain injury – The nervous system plays a critical role in the communication between the brain and the organs, including how they function. The nerves serve as the communication pathway for the signals, and if they are damaged for whatever reason, these signals are affected. The brain, for example, may signal the release of urine even if the bladder is not full yet, or the bladder’s nerves become extra sensitive.

  • Those who have gone through stroke – A stroke occurs when a part of the brain stops receiving an adequate supply of oxygen, and in the process, the brain cells die. Many patients who have gone through stroke normally lose their ability to control certain parts of their body including their waste process.

  • Patients who have limited mobility – These may refer to people who are currently bedridden due to a lingering illness, injury, coma, or paralysis, as well as men and women who are in a wheelchair or in need of assistance to travel for proper urination or defecation.


For anyone who has gone through bowel and bladder dysfunction, the problem can be a cause of major embarrassment and significant reduction of quality of life. The management approaches, therefore, can increase the level of confidence of patients, allow them to enhance living, and give them more opportunity to be more proactive in handling their disease.

How Does the Procedure Work?

Bladder and bowel management can include the following:

• Correct diagnosis – For the right treatment to be employed, it is important that the accurate diagnosis is also provided. At this point, the patient goes through a series of tests to determine the exact cause.

  • Surgery – Surgery may be recommended if there are obstructions including tumors or cysts in the bladder or bowel. Some diagnostic exams such as colonoscopy can already include the removal of polyps that may be causing the problem. The tumor removed can then be sent to the lab for further testing, especially when determining whether it is malignant or benign.

  • Better toilet accessibility – Patients may be placed a lot closer to the toilet or an additional toilet may be added to the room. Another option is to provide the patient greater mobility with walker and wheelchair, as well as equip the toilet with grip handles that can assist the patient in standing and sitting.

  • Exercise – Sometimes the problem originates from weak pelvic floor or sphincter muscles, which may be corrected through exercising the muscles. However, if the condition is already severe, surgery may be the next best option.

  • Decrease in abdominal pressure – Intense abdominal pressure may lead to stress incontinence. Interventions may include reduction of excess weight (or obesity management), as well as treatment of disease that may cause abdominal pressure like coughing.

  • Patient medication review – Certain medications may have side effects that affect bladder and bowel functions. A review of these drugs ensures that the patient is able to cope with the possible side effects while maximizing the full benefits the drug can bring.

    Possible Risks and Complications

There is no standard management plan for those with bladder and bowel problems. Simply put, it needs to be customized depending on the condition of the patient, the actual problem, age, lifestyle, and medical history, to name a few. This could mean that some of them may not be applicable. For example, a very old person may no longer benefit from surgery where the risks could possibly outweigh the benefits.

Further, there is the possibility that the initial management plan will not work. The patient may then end up feeling frustrated or depressed over the situation. For this reason, the healthcare provider and the patient should work closely together for proper monitoring of the impact of the approaches applied. This will allow doctors to modify the plan immediately before the problems get worse.

References:

  • Cohan ME, Pikna JK, Duecy E. Urinary incontinence. In: Duthie EH, Katz PR, Malone ML, eds. Practice of Geriatrics. 4th ed. Philadelphia, PA: Elsevier Mosby; 2007:chap 16.

  • Minaker KL. Common clinical sequaelae of aging. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 24.

  • Patel SR, Wiggins J. Renal and electrolyte disorders. In: Duthie EH, Katz PR, Malone ML, eds. Practice of Geriatrics. 4th ed. Philadelphia, PA: Elsevier Mosby; 2007:chap 44.

  • Smith PP, Kuche GA. Aging of the urinary tract. In: Fillit HM, Rockwood K, Woodhouse K, eds. Brocklehurst's Textbook of Geriatric Medicine and Gerontology. 7th ed. Philadelphia PA: Elsevier Saunders; 2010:chap 18.

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