Double incontinence (combined incontinence) is when you suffer from, one or more forms of, both bowel and bladder incontinence. Often you will suffer from urinary incontinence first, and if you do not seek treatment soon enough, faecal incontinence will follow. Both forms of incontinence occur as a result of weak and/or damaged pelvic floor muscles, related ligaments and nerves. This often also results in a pelvic organ prolapse occurring alongside the double incontinence.<!–– ADD IMAGE[59.0 Image of a pelvic organ prolapse; either one or both a bladder prolapse and rectal prolapse]-->
Double incontinence is considered to be the most debilitating and isolating consequence of pelvic floor dysfunction. It is thought that at least 9.4% of the population suffer from double incontinence, the majority of which are over 45 years old. 1/3 women that suffer from urinary incontinence will also suffer from bowel incontinence. The most common combination is believed to be stress urinary incontinence alongside flatus incontinence, and be experienced by women who have had one or more children and are going through the menopause. Urge urinary incontinence most commonly occurs alongside faecal incontinence. All these statements are considered only as estimations, however, as true figures remain unknown as many individuals do not seek diagnosis or treatment for fear of embarrassment.
If you are suffering from double incontinence your GP will diagnose the cause(s) of each form of incontinence you are experiencing. A treatment plan will then be designed that treats the symptoms alongside the causes. It is important that you do not delay treatment as other pelvic floor disorders can follow, further threatening your quality of life.
Symptoms of Double Incontinence (Bladder and Bowel)
There are many symptoms you can possibly experience with double incontinence, depending on the types of urinary incontinence and bowel incontinence you are suffering from. This list is just a few of the most common symptoms you may experience. You may:
- leak urine and loose faeces when your pelvis is put under stress (i.e. during exercise, when you sneeze)
- frequently leak urine without any warning
- have the sensation to visit the toilet frequently
- often suffer from stomach pain
- have a reduced or broken stream of urine
- do not feel as if you can fully empty your bladder and/or bowel
- frequently soil your underwear
- are unable to prevent wind from escaping
Causes of of Double Incontinence (Bladder and Bowel)
Any event that reduces the strength of your pelvic floor muscles, and sensitivity of your nerves, can cause incontinence. It may be a sudden event such as childbirth, or long-term such as ageing:
- Age - The prevalence of incontinence increases with age as a result of losing muscle tone and strength.
- Neurological diseases - Double incontinence is often a feature of conditions such as multiple sclerosis, Parkinson's disease and dementia. These can result in functional incontinence, where you are unable to reach a toilet due to mobility, or are no longer concerned about soiling yourself. These conditions can also result in nerve damage, leading to faecal incontinence and urge urinary incontinence.
- Nerve damage - Usually as a result of injury or trauma, nerves can be damaged through vaginal childbirth, a stroke, or chronic straining (from constipation). The reduced sensitivity can often leave you without the sensation of needing to use a toilet, or not being aware of when you soil yourself.
- Childbirth - 1/3 of women who have an uncomplicated vaginal delivery, or a complicated delivery which requires the use of a vacuum, experience double incontinence. Symptoms are often not immediate, and can arise 18 months postpartum.
- Being overweight - If your BMI is over 30, you are at an increased risk of developing a pelvic floor disorder due to the damage the extra weight causes to the pelvic floor.
- Chronic cough - You may cough as a result of chronic bronchitis, smoking, or allergies. Chronic coughing strains your pelvic floor as it consistently adds pressure to it.
- Genetic predisposition - Unfortunately you can be more likely to develop a pelvic floor disorder due to your genetics.
To read more about these causes, and the events that can lead to you developing any form of incontinence, visit the Causes and Diagnosis page.
How to Stop Double Incontinence (Bladder and Bowel)
Most treatments for double incontinence aim to resolve the muscle and nerve weakness that is stopping you from having control. Your GP will likely recommend multiple treatments which can occur in conjunction with each other.
Incontinence should be considered as a lifelong condition, and therefore conservative therapy's and lifestyle treatments should be followed throughout your life as maintenance to prevent any incontinence from returning.
Conservative therapy's - Conservative therapy's, such as lifestyle changes and non-surgical medical treatments, resolve 25% of incontinence cases, and are the first course of treatment.
- Pelvic floor therapy - Pelvic floor exercises, alongside biofeedback therapy and electrical stimulation, can be all you need to see a resolution in your incontinence.
- Lifestyle treatments - Including a review of your diet, medications and weight. Introduce more exercise into your routine and stop smoking.
Surgery - Surgery cannot be considered as a one-time solution to resolving your pelvic floor disorder(s). They should be included within a programme of conservative and lifestyle treatments which are followed throughout your life.
- Sacral neuromodulation (SNM) - If conservative treatments have not resolved your incontinence, and you continue to experience an episode of incontinence at least once a week, you can undergo SNM. Considered minimally invasive, this treatment was originally developed to resolve urinary incontinence, but recently is being used to also resolve faecal incontinence that occurs as a result of an anal sphincter tear or stretch, or neurological causes. To ensure you are suitable for this treatment you will be tested over a two week period with an external stimulator. If it reduces your incontinence you will have electrodes implanted under the skin of your lower back. On an external stimulator you will work with you doctor to determine the electrical pulse that can stimulate the sacral nerve to reduce your incontinence episodes. Although not yet fully understood, it is believed SNM improves muscle strength, as well as nerve sensation and reflexes. Studies suggest that this treatment often sees an improvement in quality of life (70-80% patients), although over time the effectiveness does fall.
- Antegrade irrigation (malone) - This surgical treatment aims to keep the colon empty by creating a caecostomy, where a section of the colon (the caecum) is brought through the abdomen to allow you to irrigate your colon yourself when needed. The treatment is often combined with an artificial urinary sphincter, to treat urinary incontinence as well. Studies have shown its success in restoring continence in children suffering from myelomeningocele (a type of spina bifida).
- Artificial urinary or anal sphincter - This procedure has limited success, and associated risks include infection and erosion. Originally designed for the urethra, the procedure has now been adapted to be used on the anus. Compromising of an inflatable cuff which is placed around the sphincter; a balloon (placed in the abdomen); and a pump (placed in the labia in women and scrotum in men). The cuff is filled with fluid to keep the sphincter closed, the pump is activated when you wish to use the toilet, causing the fluid to move to the balloon which allows the cuff to relax. Advice from the Australian Safety and Efficacy Register of New Interventional Procedures-Surgical and the National Institute for Health and Care Excellence, is for the procedure to currently only be done within the context of research.
- Injected bulking agents - Under local anaesthetic, bulking agents can be injected into your weak or damaged sphincters to increase their strength.
To see the specific treatments for the forms of incontinence you are suffering from, visit the homepage of the Incontinence Hub.
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