Everything You Need To Know About Double Incontinence
Double incontinence, a combination of urinary and faecal incontinence, can be extremely debilitating and embarrassing.
What is double incontinence?
The term ‘double incontinence’ refers to faecal and urinary incontinence occurring together. However, most people do not realise that there are multiple types of incontinence, each with different symptoms and causes. Understanding the kind of incontinence someone is experiencing is the first step in helping address the problem.
Different types of urinary incontinence:
Urge incontinence – Urge incontinence is often caused by nerve or muscle damage but can also be caused by some medical conditions. A group of symptoms called ‘overactive bladder’ can often result in urge incontinence, when the bladder muscle is more active than normal. It manifests as a sudden, intense urge to urinate, and can lead to accidents as the individual rushes to the toilet. Often, when someone experiences urge incontinence, they do not recognise the urge to void until it is too late.
Stress incontinence – Stress incontinence occurs when the bladder experiences sudden pressure. Laughing, sneezing, and lifting heavy objects can all cause urine leakage. Stress incontinence is usually caused by a weak pelvic floor muscle or damaged sphincter muscle in the urethra, allowing urine to leak out. Some people also experience mixed incontinence, a combination of both stress and urge incontinence.
- Overflow incontinence – Overflow incontinence occurs when the bladder is filled with too much urine, and it overflows. It can also be referred to as Chronic Urinary Retention. For a variety of reasons, the bladder nerves do not signal to the brain that it needs to be emptied or cannot be emptied fully. It can take a long time to completely empty the bladder, and it therefore becomes overfilled and leaks to relieve pressure.
- Functional incontinence – Functional incontinence can occur when a person has difficulty with one or more of the steps required to use the toilet. For example if someone has limited mobility and cannot get to the toilet in time or if someone is confused and doesn’t know where to find the toilet. Functional incontinence can also occur if a person struggles to remove their clothing due to limited dexterity.
Faecal incontinence occurs when a person cannot control their bowel movements. This form of incontinence can occur after an injury to the nerves, or after an illness such as inflammatory bowel disease or inflammatory bowel syndrome. However, a common cause of faecal incontinence is severe or prolonged constipation or diarrhoea. For many sufferers, the nerve signals from the rectum do not reach the brain in time, causing a person to defecate before they can reach the toilet.
When a person experiences faecal incontinence concurrently with urinary incontinence, the condition is referred to as double incontinence, or combined incontinence. This is one of the most debilitating and embarrassing forms of incontinence and can severely impact a person’s physical and psychosocial wellbeing.
What are the symptoms of double incontinence?
Double incontinence has a variety of symptoms, including:
you feel sudden and violent urges to defecate, and you can’t control them
you soil yourself without feeling the need to defecate
you leak faeces when you pass wind
you have stopped socialising and/or found your working life affected due to toileting issues
you feel anxious or depressed about your symptoms
you suffer from bloating, constipation, diarrhoea, or excessive passing of wind
you experience skin rashes or irritation from the prolonged presence of urine or faeces
your quality of sleep is hindered by frequent trips to the toilet in the night
Treatment options for nocturnal enuresis include:
- A specialist begins with a medical history. Possible psychological causes are also investigated.
- There is a physical examination, testing of urine samples for UTIs and potentially an ultrasound.
- Urine flow is measured to see the amount of urine released per second, and to determine how much urine may remain in the bladder after attempting to void.
- It’s also common practice for the physician to ask you to keep a fluid diary to monitor fluid intake and urination.
What causes double incontinence?
Double incontinence can have many different causes. It is important to note that it is not a disease, but is instead a symptom of a bigger problem that can be related to physical problems, lifestyle factors, or other underlying medical conditions. These underlying issues will need to be addressed before the double incontinence can be treated.
Remember, the factors leading to a loss of bladder control and faecal incontinence might not indicate a serious problem. There are many simple lifestyle changes that can help ease the problem.
Double incontinence is usually caused by damage to the network of muscles and nerves that control urination and bowel movements. This damage can be caused by straining during bowel movements, medical conditions (such as multiple sclerosis) and physical problems, and is often reversible. Connective tissue diseases could be the underlying cause of double incontinence. Crossed reflexes between the pelvic floor, urethra, and bladder could explain the problem, as can damage to the muscles and sphincters.
The following factors have all been linked to the occurrence of double incontinence:
Age – Double incontinence can occur at any age, but it is more common in people over the age of 65.
Nerve damage –Conditions and illnesses that cause nerve damage have been shown to cause double incontinence. Diabetes and multiple sclerosis are both common causes.
Gender – Women suffer from double incontinence more often than men, mainly due to the fact that faecal incontinence can sometimes be a complication of childbirth.
Weight – People who have a BMI (body mass index) above 30 are classified as obese, and they are at a much higher risk of suffering from all kinds of incontinence.1
Dementia – People suffering with dementia late-stage Alzheimer's disease are at a higher risk for double incontinence.
Physical disability – Different physical disabilities can make it difficult for a person to get to the toilet on time, especially if they are confined to a wheelchair or a bed.
Can a stroke cause double incontinence?
Many people who have suffered a stroke also develop incontinence. This is due to weakening of the muscles and nerves that control the bladder and the bowel. The most common type of incontinence for stroke patients is overflow incontinence, causing a slow leak out of the urethra.
How to treat/manage double incontinence.
Double incontinence is not always the sign of a serious problem or disease. In many cases, double incontinence can be successfully managed with simple lifestyle changes.2 The most important thing to do when trying to manage double incontinence is to schedule a visit to your GP or local Continence Nurse Consultant (CNC). They can help you come up with a plan to manage and treat your problem.
Here are some lifestyle changes and products you can utilise to manage double incontinence.
- See your GP or local Continence Nurse Consultant (CNC) - Book an appointment with your GP, and speak with them openly about your symptoms – there is no need to be embarrassed.
- Limit caffeine and alcohol - Reduce the amount of caffeine and alcohol you consume, as these can be diuretics for your bladder and stimulate your bowel.
- Check your medications - Ask your GP or pharmacist about the effects that certain medications and supplements can have on your bladder and bowel.
- Use continence products - Using continence pads and other continence products can help people to carry on with their daily routine. MoliCare offers a special product designed to help those with faecal incontinence. MoliCare Premium Form STOOL is worn with MoliCare Premium Fixpants.
Your local Continence Nurse Consultant (CNC) should be able to advise around which products best meet your needs.
- Be prepared - Use tools like the National Public Toilet Map to plan ahead when you are out.
- Change your diet - Making changes to your diet, including eating more foods high in fibre.
- Do pelvic floor exercises - Engage in pelvic floor exercises at least twice a day in order to tone and strengthen your muscles and sphincters.
- Surgery is a last resort - Surgeries to strengthen your pelvic floor and rectal muscles can be a last resort in the most severe cases.
How can you avoid double incontinence?
- Strengthen your pelvic floor - Practice pelvic floor exercises throughout your life, so that your pelvic floor muscles are strong and in good condition as you age, or in the event of illness.
- Reduce episodes of constipation – Ensure that your diet is rich in high-fibre food so that you can defecate without straining.
- Don’t strain when defecating or urinating – Straining can put real pressure on the muscles in your elimination system, so make sure you don’t strain too much when using the toilet.
- Reduce your weight – Having a high BMI can lead to instances of incontinence, and put you at risk for many other illnesses.
- Control diarrhoea - Treating or preventing the causes of diarrhoea, including food intolerances and intestinal infections, can help you prevent double incontinence.
- Quit smoking – Smoking can cause coughing, which can weaken the muscles in your bladder and bowel.
- Drink 6-8 glasses of fluid per day – Ensure that you are well hydrated by drinking 6 to 8 glasses of water, juice, or herbal tea each day (unless otherwise advised by your GP).
Double incontinence doesn’t have to ruin your life
By addressing the causes of double incontinence, using continence products, and making lifestyle changes, you can prevent and treat the problem. While you might feel embarrassed or anxious about the problem, remember that your GP or Continence Advisor has seen this before, and they are trained to help. You are not alone – and you can overcome or manage double incontinence.
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