Double incontinence occurs when a person experiences involuntary leakage of both urine and stool. This condition can stem from a variety of factors, including age-related changes, neurological disorders, pelvic floor dysfunction, or prior surgeries. Its complex nature requires a multidisciplinary approach, involving medical specialists, physiotherapists, and mental health professionals, to provide holistic care and support.

We know that urinary and faecal incontinence can be challenging individually, but the combination of both conditions presents a whole new set of challenges that can impact a person's physical and mental health and overall quality of life.

In this article, we’ll explore the potential causes of double incontinence, the physical and emotional impacts it can have, and explore practical strategies for ongoing management. 

By encouraging more awareness of this condition, we can empower those directly affected by double incontinence, as well as their carers, to approach the condition with knowledge and resilience.

What causes double incontinence?

While there’s plenty of information out there on urinary and faecal incontinence individually, more research still needs to be done into the causes of double incontinence. 

However, there are some factors that may make someone more likely to experience the condition. These include:

Muscle Weakness and Dysfunction

One of the primary causes of double incontinence is weakened or dysfunctional pelvic floor muscles. These muscles play a crucial role in maintaining control over both bladder and bowel functions. Factors like childbirth, aging, trauma, and surgery can lead to weakening of these muscles, impairing their ability to support the surrounding organs and maintain continence.

Neurological Conditions

Conditions that affect the nerves responsible for controlling bowel and bladder functions can result in double incontinence. Neurological disorders such as multiple sclerosis, spinal cord injuries, and Parkinson's disease can disrupt the communication between the brain and the pelvic muscles, leading to loss of control.

Chronic Constipation:

Long-term constipation can cause or worsen incontinence, and this can of course include double incontinence. Stubborn stool can put pressure on the bladder, obstructing it from properly filling with urine. Constipation can cause the bladder to contract before it’s ready to, leading to urine leaks. It can also cause a blockage high up in the bowel, meaning only watery stool can get around it. In some cases a person may not be able to control these kinds of bowel movements which leads to faecal incontinence. Both urinary and faecal incontinence causes by constipation may also occur at the same time. 

Chronic Diarrhoea:

As with constipation, chronic diarrhoea, or conditions that cause frequent and sudden bowel movements, can contribute to double incontinence. Diarrhoea can overwhelm rectal muscles and cause urgency, making it difficult to control bowel movements. This constant urgency can lead to weakened pelvic floor muscles over time and continue to not only affect bowel movements, but bladder function as well.

Excess Weight:

Excess weight can put pressure on the pelvic floor muscles and weaken them, leading to both urinary and faecal incontinence. Obesity is often associated with an increased risk of various health conditions that can contribute to incontinence, such as diabetes and cardiovascular diseases.

Childbirth:

According to the Continence Foundation of Australia, one in three women who have ever had a baby experience urinary incontinence. Some women may also experience faecal incontinence after birth. Both urinary and faecal incontinence can be caused by damage to the nerves that control the bladder, rectum and pelvic floor muscles during birth. Assisted vaginal deliveries using forceps or a vacuum, and vaginal deliveries assisted with an episiotimy (or natural tearing) can experience incontinence because of the damage to the pelvic floor and anal sphincter. As you can imagine, because of factors like these double incontinence can occur. Sometimes the symptoms of double incontinence won’t be immediate after birth, and can actually occur up to 18 months postpartum.

Ageing:

People aged 85 years and older are five times more likely to experience severe incontinence compared to people aged 65 to 84.

As we age, bladder and bowel function can change quite significantly. For example:

• Bladder muscles weaken
• The bladder can’t hold as much urine
• Softening of stools
• Loss of sensation in your bottom
• Rectal prolapse
• Pelvic organ prolapse

Lifestyle Factors:

Certain lifestyle factors can exacerbate double incontinence. Smoking, excessive caffeine or alcohol consumption, and a sedentary lifestyle can all negatively impact bowel and bladder control.

These factors can affect the muscles, nerves, and blood flow in the pelvic region.

How do you manage double incontinence?

The first thing you need to do if you’re experiencing double incontinence, or any form of incontinence for that matter, is speak to your doctor.

They will be able to give you tailored medical advice on how to manage, and hopefully treat, the condition.

In some cases, treatment may not be possible, however, there are plenty of ways to help manage double incontinence so you can continue to live your life as comfortably and confidently as possible, including:

Pelvic floor therapy:

Regaining strength and control of your pelvic floor can help ease double incontinence symptoms. You can seek advice and a personalised pelvic floor exercise program from a pelvic floor physiotherapist to target your concerns. We always recommend seeking professional advice for any health matters, however, to get an idea of what these exercises might look like you can check out our pelvic floor exercises for beginners.

Continence aids:

There are many amazing incontinence products, or continence aids, to help make your incontinence experience as comfortable as possible. We’re proud to stock a European-made, unisex range of pull-ups and all-in-one slips with patented absorbency and odour-locking technology to keep you fresh and dry between changes. They also feature leak guards and leg-cuffs for a last line of defence. Without compromising on absorbency, our products are designed to be slimline under clothes for your discretion.

Our pull-ups are designed for moderate urinary incontinence and some faecal incontinence, while our slips are recommended if you have low mobility and/or no bladder or bowel control.

Weight loss:

If obesity is a contributing factor to your incontinence, losing weight and reducing your BMI has been shown to reduce incontinence episodes, or at least the severity of those episodes. For example, one study showed that participants who lost at least 5% of their body weight were more likely to achieve a 70% reduction in the frequency of total and urge urinary incontinence [1].

Other lifestyle changes:

Avoiding food and drinks known to irritate the bladder and bowel, including caffeine and highly processed, fatty foods, can help reduce the severity of incontinence symptoms. Instead opt for whole foods, fruits and vegetables that are gentle on the bladder and bowel, such as berries, bananas, carrots, fish, poultry and legumes (to help avoid constipation). Drinking enough water is also important as dehydration can lead to urinary tract infections (UTIs) and constipation.

Protecting mental health when experiencing double incontinence

Double incontinence is said to have a greater negative effect on quality of like than urinary or faecal incontinence alone [2,3]. In particular, women who have double incontinence have greater impairment on the physical and psychological wellbeing than if they only suffered with urinary incontinence or faecal incontinence [2,4].

Please know if you’re experiencing incontinence you are not alone, and there are resources available to support your mental wellbeing. 

You can start by seeing your GP for guidance on who to speak to for support. They may recommend you speak to a psychologist.

If you’re struggling with your mental health and need immediate assistance, please call Samaritans 24/7 on 116 123, they’re available 24 hours a day, 7 days a week.

For emergencies call 999 immediately.