What is Double Incontinence?

Although there are many different types of incontinence, many people are not aware of the variations. Since some types of incontinence are caused by weak muscles and others by muscle spasms, understanding the type of incontinence is the first step in identifying the cause of the incontinence.

One type of incontinence which often occurs due to neurological damage is urge incontinence, which manifests itself as the sudden and incredibly, overpowering urge to void. With such a strong, immediate urge it is quite common for a person to have an accident even when they are on the way to the toilet. Urge incontinence occurs when the nerves that connect bladder control to the brain have been damaged. This damage allows a violent, sudden contraction of the bladder, and makes it virtually impossible for a person to reach a bathroom in time. Urge incontinence is marked by frequent trips to the restroom, sometimes as often as every other hour, and the urge is consistent around the clock. The difficulty with urge incontinence is that as soon as a person feels that they need to urinate, it is already happening. Urge incontinence can, therefore, result in wetting the bed.

The next type of incontinence is known as stress incontinence, which shows itself as urine leakage when sudden pressure is applied to the bladder. Even laughing or lifting a heavy object can bring on symptoms of stress incontinence. This type of incontinence most often is caused by a damaged muscle, or sphincter, which allows the bladder to leak. Sometimes just standing up exerts enough pressure on the bladder to trigger stress incontinence. Other places where stress incontinence is common is in the course of exercising, coughing or laughing. It is also possible to suffer from mixed incontinence, where the incontinence is caused by a weak or damaged muscle as well as nerve damage. Mixed incontinence occurs when a person suffers from both stress and urge incontinence.

The third type of incontinence happens when there is too much urine in the bladder, so it simply overflows. This type of incontinence is known as overflow incontinence. The bladder does not signal that it needs to be emptied, so at some point, it simply becomes overfilled. There are many underlying symptoms of overflow incontinence including injury, surgery, and disease. The urine stream may be weak if you have urge incontinence and it may take a long time to be able to go to the bathroom even just a little. As a result, the bladder overfills, and small amounts of urine are leaked to relieve the pressure it places on the bladder.

When a person’s incontinence is caused by their lack of mobility, this is called functional incontinence. When a person is restricted to a wheelchair, confined to a bed or suffers a limited range of movement, it can be difficult to reach the bathroom in a timely manner. This delay then causes urine leakage, resulting in functional incontinence. A positive way to deal with functional incontinence is to remove as many roadblocks as possible so that the person can reach the toilet in time. It is recommended to and clear an easy travel path to the bathroom to help the person with functional incontinence remain dry.

Faecal incontinence occurs when the bowel involuntary leaks stool, and this type of incontinence is most common in the elderly. However, it can be brought on by injury, especially to the spinal cord; diseases such as Multiple Sclerosis; or surgery, causing muscle damage. Faecal incontinence is often due to problems with the rectum in which the rectum is unable to retain stool or problems with the sphincter muscles. On the occasion that the condition is caused by problems with the sphincter muscles, the muscles at the bottom of the rectum are not strong enough and do not work efficiently. In many other cases, faecal incontinence is caused by nerve damage, where the nerve signals sent from the rectum don't reach the brain.

When faecal incontinence occurs in tandem with urinary incontinence, it is called double incontinence. Many people refer to double incontinence as “urinary and faecal incontinence” or may be familiar with the term “combined incontinence”. Double incontinence is the most severe and debilitating manifestation of pelvic floor dysfunction. Those who suffer from both faecal incontinence and urinary incontinence have significantly greater impairment in their physical and psychosocial well-being than those suffering from isolated urinary or faecal incontinence. Double incontinence often causes twice as much embarrassment, having a greater impact on an individual’s everyday life in comparison to other forms of incontinence.

Connective tissue disease has often been suggested as a common cause of double incontinence. The presence of crossed reflexes between the bladder, urethra and pelvic floor in animal studies can also explain the comorbidity of double incontinence. It is clear that damage to the external anal sphincter can lead to the direct development of double incontinence. In women with intact external anal sphincters and pelvic floor damage, the puborectalis serves as an efficient compensatory closure mechanism for the anorectum. Increased body mass, sedentary lifestyle, depression, and diabetes are also often associated with increased risk of double incontinence. Consequently, it has been suggested that a generalised anxiety disorder may be a common causative mechanism.

Pelvic floor muscle training (PFMT) is a well-established therapy in the management of double incontinence. PFMT has been proven to be highly effective, however many studies have proven that electrical stimulation can be even more efficient in treating double incontinence. Electrical stimulation effectively improves muscle function by transforming fatigable fast twitch muscle fibres to slow twitch fibres. This treatment increases the capillary density and increases the fibre diameter. A trial in 2010 found a significant improvement in anal continence status during the treatment period in women who had electrical anal stimulation in comparison to those practising pelvic floor exercises. Mild self-limiting tissue reaction is currently the only reported side effect of electrical stimulation.

Another method of preventing the condition and treating double incontinence is through controlling your body weight and preventing obesity. Several studies have shown that obesity and a high BMI is directly associated with the development of urinary and faecal incontinence. Obesity is an independent risk factor for incontinence and has been proven to be the highest risk factor for daily urinary incontinence in particular compared to any other factor. According to recent studies into the causes of incontinence, each 5-unit increase in BMI is associated with a 60 –100% increased risk of incontinence. When followed up for 5 to 10 years the odds of urinary incontinence increases by 7% to 12% for each 1 kg/m² unit increase in BMI. Many lifestyle changes including managing your weight have been proven to be effective, however, it is important to research and understand double incontinence to treat it as successfully as possible.