Second, the condition can also cause nerve damage that leads to incontinence. Your symptoms are intolerable, you no longer have the quality of life you desire and you cant do or enjoy everyday life activities. Symptoms include back and/or neck pain, and numbness, tingling and weakness in your arms and legs. Inflammation is caused by the presence of sympathetic and parasympathetic nerves that connect directly to the digestive system in the lower spine, and interference directly affects these nerves. Some leg muscles, including the bladder and bowel external sphincters, as well as some external sphincters (particularly in men and women) that regulate sexuality and bladder function, are in the sacral spinal cord. Spinal stenosis: Spinal stenosis occurs when the spinal bones start to narrow, usually due to injury or aging. First, spinal stenosis develops slowly over time, so you may not have symptoms even though changes are occurring in your spine. Problems controlling urine or bowel movements; Exams and Tests. Chronic lower back pain usually lasts for 12 weeks or longer. The NIDDK recommends that a person sees a doctor right away if they have lower back pain and constipation together or experiences frequent bouts of constipation or unexplained instances of lower back pain. Elsevier; 2021.https://www.clinicalkey.com. The healing process takes six months to one year. In some cases, it can also affect bowel movements. Any damage to the spinal cord can interfere with the digestive systems ability to communicate with the brain. The following are examples of conditions that can cause both constipation and lower back pain at the same time: Learn about the differences between IBD and IBS here. Urology Care Foundation. Treatments are self-care remedies, physical therapy, medications, injections and surgery. If both symptoms occur together, a person should contact a healthcare professional. Heart failure: Could a low sodium diet sometimes do more harm than good? American Association of Neurological Surgeons. It begins at the base of your skull and ends at your pelvis. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). If the T-12 level in the spinal cord is higher, it is possible that the ability to feel the full rectum will be lost. Spinal stenosis is common because osteoarthritis begins to cause changes in most peoples spines by age 50. An infection of the urinary tract. Ferri FF. Physical therapy can help you alleviate lower back pain while also assisting you in finding relief from your pain. If the narrowing causes pressure on the nerve root it will can cause problems. The sacral nerves, which control the muscles and organs in the bowel and bladder, play an important role in the bowel and bladder functions. 2023 Brandon Orthopedics | All Right Reserved, Spinal Stenosis Is A Serious Condition That Requires Ongoing Treatment Chronic Back Pain: Spinal Stenosis, After Shoulder Arthroscopy: What To Expect, The Truth About Spinal Stenosis: Causes Symptoms And Treatments, Can Years Of Surfing Contribute To Spinal Stenosis, The Effects Of Spinal Stenosis And Carpal Tunnel, Should I Apply Ice Or Heat To A Compression Fracture, How Does A Soft Bed Prevent Healing Of Herniated Disc, Herniated Discs: How To Sleep Without Worrying About Rupturing Your Discs, If You Have A Herniated Disc You Know The Excruciating Pain It Can Cause. Symptoms usually worsen when walking or standing and might decrease when lying down, sitting, or leaning slightly forward. Solid waste is transported out of the body via this passageway. This narrowing can put pressure on the spinal cord and nerves, leading to pain, numbness, and weakness. Advertising revenue supports our not-for-profit mission. BMC Surgery. Wald, A. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. However, you can take certain measures to lower your risk or slow the progression, including: Also keep in mind that although there is no cure for spinal stenosis, its symptoms can be successfully managed with the nonsurgical or surgical options discussed in this article. Repeated straining during bowel movements. They must be kept healthy because they send pleasure and pain signals from these parts. WebMost people with spinal stenosis cannot walk for a long period without having significant pain. If you are suffering from back pain as a result of spinal stenosis, consult your doctor about interspinous spacers, which can reduce pain and fatigue. Abrams GM, et al. This is called passive incontinence. The lumbar spine, or lower back, includes the sacrum and is particularly vital in terms of nerve function. Treatment can include physical therapy, medicine, and sometimes surgery. 2023 Brandon Orthopedics | All Right Reserved, The Benefits Of Weight Loss For People With Severe Spinal Stenosis, The Benefits Of Strengthening The Core Muscles For Herniated Disc Sufferers, The Truth About Spinal Stenosis: Causes Symptoms And Treatments, Can Years Of Surfing Contribute To Spinal Stenosis, The Effects Of Spinal Stenosis And Carpal Tunnel, Should I Apply Ice Or Heat To A Compression Fracture, How Does A Soft Bed Prevent Healing Of Herniated Disc, Herniated Discs: How To Sleep Without Worrying About Rupturing Your Discs, If You Have A Herniated Disc You Know The Excruciating Pain It Can Cause. Chronic constipation may cause a dry, hard mass of stool to form in the rectum and become too large to pass. There is no cure for this condition, but there are steps you can take to alleviate your symptoms. Part of the lamina called the spinous process is the ridge you feel when you run your hand down your back. A physical therapist will be able to advise you on which exercises will be beneficial to you. The tunnel is called the spinal canal. WebSpinal stenosis happens when the spaces in the spine narrow and create pressure on the spinal cord and nerve roots. Best food forward: Are algae the future of sustainable nutrition? These conditions can make it difficult to control your bladder or have a bowel movement. Cervical spinal stenosis causes pain in the neck area and is caused by the constriction of the spinal cord. Because of disrupted signals between the colon and the brain, you may not feel the urge to have a BM. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Loss of bladder or bowel control (in severe cases). For instance, manipulation may worsen symptoms or cause other injuries if a herniated disk is the cause of your spinal stenosis. In some cases, it can also affect bowel movements. Signs and symptoms of neurogenic bladder may include: Loss of bladder control Inability to empty the bladder Urinary frequency Urinary tract infections. WebA spinal cord injury or a nerve disease may damage the nerves that help control the lower part of your colon. Treatment depends on the severity and location of the stenosis and its effects on the quality of your life. There are treatments that can be used to alleviate pain. Surgery results depend on your general health and presence of other medical conditions, severity and location of your spinal stenosis, experience and skills of your surgeon and your commitment to your recovery plan. As stenosis worsens and your quality of life is no longer acceptable to you, talk with your healthcare provider. Although it is not a life-threatening condition, it can cause pain, numbness, and weakness in the affected areas. If you have a follow-up appointment, write down the date, time, and purpose for that visit. Problems controlling urine or bowel movements; Exams and Tests. While spinal stenosis cant be reversed, treatment is available to address your pain. In severe cases, it can cause paralysis. EMMY NOMINATIONS 2022: Outstanding Limited Or Anthology Series, EMMY NOMINATIONS 2022: Outstanding Lead Actress In A Comedy Series, EMMY NOMINATIONS 2022: Outstanding Supporting Actor In A Comedy Series, EMMY NOMINATIONS 2022: Outstanding Lead Actress In A Limited Or Anthology Series Or Movie, EMMY NOMINATIONS 2022: Outstanding Lead Actor In A Limited Or Anthology Series Or Movie. Lumbar spinal stenosis is a narrowing of the spinal canal in the lower part of your back. WebForaminal stenosis is a narrowing of the opening where the nerve enters or exits the spinal column and goes to its destination. The American Society of Colon & Rectal Surgeons states that growths and tumors in the colon can also cause constipation. If youve had a laminectomy, you may be in the hospital for a day or two. The sacral spinal cord is the most primitive of the spinal cords. If you do develop symptoms, there are many options up to and including surgery that can be considered to relieve your pain and other symptoms so you feel better. Gently wash the area with water after each bowel movement. Is there a link between back pain and incontinence? What should I avoid with spinal stenosis? Constipation and bowel accidents can occur as a result of this condition. As a result, the cerebrum allows you to regulate bowel movements. SECCA procedure for anal incontinence and antibiotic treatment: A case report of anal abscess. Constipation can occur as a result of this. It is possible for the condition to affect your urinary system and stomach. The spinal cord and nerve roots are compressed in this case, causing the small spinal canal to become compressed. spinal stenosis can result in paralysis, loss of bladder control, and even death if not treated. 11th ed. He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. You may also have pain or numbness in your legs. The spinal cord is a bundle of nerves that comes out of the base of the brain and runs down the center of the spine. Accessed Feb. 7, 2022. It's a site that collects all the most frequently asked questions and answers, so you don't have to spend hours on searching anywhere else. Gently wash the area with water after each bowel movement. Accessed Oct. 13, 2020. Cancers rarely start in the back, but they can spread from somewhere else to the back. This pain, however, is usually a gradually worsening pain. In: Current Diagnosis & Treatment: Physical Medicine & Rehabilitation. Stroke. Constipation and lower back pain are two examples of bowel conditions that can cause problems. The narrowing of the spinal canal is usually a slow process and worsens over time. These actions may help: Mayo Clinic does not endorse companies or products. Healthcare professionals recommend supportive treatment, Treatment will depend on the condition affecting the liver. Constipation and fecal incontinence in the elderly. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. It makes the space within the spinal canal bigger by creating a hinge on the lamina. Neurogenic bladder and bowel management includes treatments to help control when you urinate or have a bowel movement. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Symptoms & causes of constipation. Sacral nerves control the muscles and organs that contribute to bowel movement when they are located in the pelvic area just above the tailbone. Constipation. (2015). WebIf you have lumbar spinal stenosis, you may have trouble walking distances or find that you need to lean forward to relieve pressure on your lower back. If needed, use assistive devices such as a cane or walker to safely move about. Compression of these nerves can interrupt their function, and the effects can be severe. A physical therapist to develop a healthy back and back surgery recovery exercise plan. The spine is in charge of controlling the nervous system throughout the body. Cauda equina syndrome can lead to bladder and bowel dysfunction (loss of bladder/bowel control) and even permanent paralysis in the muscles of one or both legs. It is possible that you will have difficulty controlling your bowel and bladder in more severe cases. Additionally, using an ice pack may ease pain before and after exercise. This is because the nerves of both the back and the abdominal area run through the lower part of the spine. Sometimes, the cause of lower back pain can lead to constipation. Pain that lessens when leaning, bending slightly forward, walking uphill or sitting. This surgery is done only on spinal bones in the neck. You have lost bowel or bladder control or have sexual function problems. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetic neuropathy may distort the control of intestinal motility, which can lead to diverse symptoms such as diarrhoea, constipation, intestinal distension and abdominal pain. Pain that worsens when standing for long periods of time, walking or walking downhill. If you have lumbar spinal stenosis, you may have trouble walking distances or find that you need to lean forward to relieve pressure on your lower back. People with more severe stenosis may have problems with: Bowel function. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Anal irrigation is a novel, conservative bowel management method that assists in bowel movement and management while reducing constipation. This condition gets in the way of your normal ability to store and get rid of waste. Know how you can contact your provider if you have questions. Cauda equine syndrome can develop as a result of spinal vertebrae stenosis, and it should be diagnosed as soon as possible. This is why it is especially important to see your healthcare provider right away if you experience numbness or weakness in your arms or legs. Can poor sleep impact your weight loss goals? Spinal stenosis occurs when compression in the spine causes pain, numbness, and weakness, usually in the legs. It is usually normal for the cross-sectional area of the dural sac at the narrowest point to be greater than 100 mm2, but if it is greater than this, it is moderately stenotic. Your first noticeable symptoms may be pain, numbness, tingling or weakness in your back or neck or arms and legs depending on the location of the stenosis. Paraplegia and/or incontinence of the bladder/bowel are uncommon occurrences in rare cases of severe spinal stenosis. An osteoporosis-related bone spur is one of the most common complications of osteoporosis, Pagets disease, and other conditions that lead to excessive bone growth. Other conditions that affect the spine, such as scoliosis, or injury to the spine can put you at risk for developing spinal stenosis. Causes new bowel or bladder problems. Our team of experts, doctors, and orthopedic specialists are here to share their knowledge and experience with you in order to help you make informed decisions about your health and well-being. Stroke. Know what to expect if you do not take the medicine or have the test or procedure. Reflex bowel problems may cause a sudden, unplanned BM when the rectum is full. Is accompanied by a fever. Urinary tract infections (UTIs) are caused by a variety of infections of the urinary system, including those in the kidneys, ureters, bladder, and urethra. Constipation and bowel problems are frequently caused by it. It is critical to have your spine examined if you are experiencing back pain. You will have imaging tests to examine your spine and determine the exact location, type and extent of the problem. Spinal stenosis usually occurs as a person ages, however, some patients are born with less space for their spinal cord. But some people's symptoms stay the same or get worse after As a result, a pinching sensation occurs, which causes pain, cramping, weakness, or numbness in the spinal cord and/or nerve roots. Spinal stenosis in the neck can cause: Numbness Tingling or weakness in a hand, leg, foot or arm Problems with walking and balance Neck pain Problems with the bowel or bladder Request an Appointment at Mayo Clinic From Mayo Clinic to your inbox (2016). What type of pain does spinal stenosis cause? As a result, signals are sent to the anus lining, which contracts and pushes the bowel out. If you notice any of these symptoms, you should seek medical attention. The most common cause of spinal stenosis is osteoarthritis, the gradual wear and tear that happens to your joints over time. Yes, a back injury can affect bowel movements. Constipation and bowel accidents are frequently associated with it. Lower back pain is widespread and usually resolves without treatment. Interspinous spacers are inserted into the bone between two adjacent vertebrae, which is then fused. Treatment typically involves a combination of physical therapy, pain medication, and surgery. In the intestinal tract, there are Intrinsic nerves that carry sensory information to the gut. An acupuncturist to administer acupuncture therapy. How does vagus nerve affect bowel movements? Loss of function in hands, like having problems writing or buttoning shirts. Constipation. Treatment usually starts with nonsurgical options and may move to surgical options if other methods no longer relieve your pain. Your legs may also feel numb or tender at times. It is possible for the condition to affect your urinary system and stomach. In addition to the symptoms of upper back (thoracic) spinal stenosis, there are some additional symptoms. Fecal incontinence is sometimes called bowel incontinence. Cleveland Clinic offers expert diagnosis, treatment and rehabilitation for bone, joint or connective tissue disorders and rheumatic and immunologic diseases. Before your visit, write down questions you want answered. Often, people are too embarrassed to tell a provider about fecal incontinence. There are a few ways in which spinal stenosis can affect bowel movements. Provider profile. Get useful, helpful and relevant health + wellness information. Symptoms vary from person to person and may come and go. Symptoms of lower back (lumbar) spinal stenosis include: Symptoms of neck (cervical) spinal stenosis include: Symptoms of abdomen (thoracic) spinal stenosis include: While the narrowing of the spine can cause pain, it usually doesnt cause paralysis. If youve had spinal fusion, you may have a three- to five-day hospital stay. Age-related changes in your spine is a common cause. To establish that the product manufacturers addressed safety and efficacy standards, we: We do the research so you can find trusted products for your health and wellness. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, American Society of Colon & Rectal Surgeons, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), https://www.breastcancer.org/symptoms/types/recur_metast/metastic/bone, https://www.cancerresearchuk.org/about-cancer/coping/physically/bowel-problems/types/constipation/causes, https://www.cancerresearchuk.org/about-cancer/coping/physically/bowel-problems/types/chronic-constipation, https://fascrs.org/patients/diseases-and-conditions/a-z/constipation, https://www.niddk.nih.gov/health-information/digestive-diseases/constipation, https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/definition-facts, https://creakyjoints.org/about-arthritis/fibromyalgia/fibromyalgia-symptoms/fibromyalgia-back-pain/, https://www.womenshealth.gov/a-z-topics/endometriosis, https://www.cdc.gov/arthritis/basics/fibromyalgia.htm, https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6526158/, https://pubmed.ncbi.nlm.nih.gov/30843436/, https://www.ncbi.nlm.nih.gov/books/NBK441888/, https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet, https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC7573391/, https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4846465/, https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4325863/, https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4514689/, https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/symptoms-causes, https://www.cancer.org/cancer/liver-cancer/treating.html, https://www.cancer.org/cancer/pancreatic-cancer/treating.html, https://www.crohnsandcolitis.org.uk/about-crohns-and-colitis/treatments, https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/treatment, https://gi.org/topics/constipation-and-defection-problems/, https://www.hepb.org/blog/when-is-that-pain-hep-b-related-and-when-is-it-something-else/. WebSpinal stenosis happens when the spaces in the spine narrow and create pressure on the spinal cord and nerve roots. (n.d.). Some leg muscles are also represented by the sacral spinal cord. To relieve anal discomfort and eliminate any possible odor associated with fecal incontinence: Wash with water. In addition, the condition may affect the digestive system. Lower back pain can occur due to the growing fetus adding additional pressure on the back, and increasing progesterone levels can lead to constipation. Stenosis, which means narrowing, can cause pressure on your spinal cord or the nerves that go from your spinal cord to your muscles. Is Spinal Stenosis a Permanent Disability? Spinal stenosis, a narrowing of the spaces in your spine, can compress your spinal cord and nerve roots exiting each vertebrae. National Digestive Diseases Information Clearinghouse. However, talk with your healthcare provider about surgical options when: Surgery options involve removing portions of bone, bony growths on facet joints or disks that are crowding the spinal canal and pinching spinal nerves. How does vagus nerve affect bowel movements? There is a problem with "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. This surgery is done only on spinal bones in the neck. Your ability to store and dispose of waste is hampered as a result of this condition. National Institute of Diabetes and Digestive and Kidney Diseases. Initially, simple things like an anti-inflammatory medication, such as Advil or Aleve, sometimes Tylenol, minor pain medications, change in positioning will help. In: Ferri's Clinical Advisor 2023. There are nerves carrying motor commands from the brain to the muscle and nerves carrying sensations up to the brain. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis. This condition is known as sciatica. You may also have pain or numbness in your legs. But some people's symptoms stay the same or get worse after Usually a patient with spinal stenosis has more pain when standing upright or walking with relief when bending forward. This is known as stool impaction. Spinal stenosis is the narrowing of the spaces within the spine, which eventually results in pressure on the spinal cord or nerve roots. 2020; doi:10.1007/s11894-020-00791-1. A variety of factors, including poor posture, smoking, being overweight, and being physically inactive, can aggravate spinal stenosis, and flare-ups can be more severe. This surgery is done only on spinal bones in the neck. People with more severe stenosis may have problems with: Bowel function. There is no cure for lumbar spinal stenosis but your healthcare provider can help you manage the condition. It also looks at conditions that cause both symptoms, potential individual causes, and treatment options. However, if the cause of your spinal stenosis is a herniated disk, it can sometimes get better on its own with a short amount of rest or with treatments such as physical therapy, anti-inflammatory medications or spinal injections. Cardiovascular health: Insomnia linked to greater risk of heart attack. Symptoms include back and/or neck pain, and numbness, tingling and weakness in your arms and legs. He is the founder and main author of brandonorthopedics.com, a website that offers valuable resources, tips, and advice for patients looking to learn more about orthopedic treatments and physiotherapy. Mayo Clinic. If you are a Mayo Clinic patient, this could As a result of a spinal cord injury or a nerve disease, a narrowing of the spinal cord may occur, which prevents blood and spinal fluid from flowing properly. If the stenosis is severe, surgery may be required. For example, treatment for liver cancer, irritable bowel syndrome and irritable bowel disease, medications that have constipation as a side effect. It is common for UTI patients to experience lower back pain, constipation, and a bowel obstruction. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. All rights reserved. Age-related changes in your spine is a common cause. Welcome to Brandon Orthopedics! The procedure involves removing bone or tissue this area to provide more space for the nerve roots. Learn more about the causes of lower back pain here. Laminoplasty: In this procedure, performed in the neck (cervical) area only, part of the lamina is removed to provide more canal space and metal plates and screws create a hinged bridge across the area where bone was removed. This means that issues such as digestive conditions can occur at. Diabetes. Multiple sclerosis. Walking becomes more difficult as a result of this. WebForaminal stenosis is a narrowing of the opening where the nerve enters or exits the spinal column and goes to its destination. In more severe cases, you may Also write down any new instructions your provider gives you. Keep your lower back as healthy as possible by maintaining a healthy weight, practicing good body mechanics, and getting regular exercise. Spinal stenosis usually occurs as a person ages, however, some patients are born with less space for their spinal cord. There are difficulties with breathing. A spinal spinal cord canal can form when the vertebral column narrows. Spinal stenosis can occur anywhere along the spine but most commonly occurs in two areas: Lumbar canal stenosis is the narrowing of the spinal canal or the tunnels through which nerves and other structures communicate with that canal. A healthcare professional may recommend the following to treat the causes of lower back pain and constipation. Ask if your condition can be treated in other ways. A spinal canal narrowing can cause a variety of issues, including: The symptoms of urinary incontinence and bowel discomfort may not be pleasant. Accessed Oct. 8, 2020. Stroke. Neurogenic bowel & bladder. This can cause bladder and bowel dysfunction known as neurogenic bladder or neurogenic bowel. Spinal cord injury. In a laminectomy, the lamina portion of the vertebral bone is removed. Showering or soaking in a bath also may help. Causes new bowel or bladder problems. Soap can dry and irritate the skin. When someone is injured in the spinal cord, it can cause damage to the nerves that control their bowel movements. A sudden and severe increase in blood pressure is the most dramatic. http://www.carf.org/providerProfile.aspx?cid=8020. However, if a spinal nerve or the spinal cord is compressed for a long period of time, permanent numbness and/or paralysis is possible. The nutritional supplements glucosamine and chondroitin have been recommended as nutritional supplements for osteoarthritis, but recent studies have been disappointing. Your provider will check your balance, watch how you move and walk and check your arm and leg strength. People with more severe stenosis may have problems with: Bowel function. But the sooner you're evaluated, the sooner you may find some relief from your symptoms. This content does not have an Arabic version. Back pain is a very common ailment and is most likely related to a musculoskeletal issue. A number of factors may increase your risk of developing fecal incontinence, including: Complications of fecal incontinence may include: Depending on the cause, it may be possible to improve or prevent fecal incontinence. Problems in this part of the spine may result in symptoms such as constipation, diarrhea, bloating, gas, and bladder malfunction. Welcome to Brandon Orthopedics! The most common cause of spinal stenosis is aging, but it can also be caused by injuries, tumors, or birth defects. Spinal stenosis occurs when the spinal canal narrows, which can put pressure on the spinal cord and nerves. It is one of the most common causes of aging-related conditions. When the spaces in the spine narrow, the spinal cord and nerves become compressed, resulting in spinal stenosis. If you are experiencing difficulty with bowel control, it is critical to consult a healthcare professional to determine the best course of action. for Neurogenic bladder and bowel management, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Spinal Cord Injury Rehabilitation Program, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition.