Double incontinence: causes and treatment

Double is the occurrence of bladder (urinary) incontinence and bowel (faecal) incontinence in the same individual .  In this article, we will outline the causes of double incontinence, treatments, and how you can help ease the life for someone living with this problem.

Double Incontinence Causes and Symptoms

Bowel meaning and symptoms

Faecal incontinence or bowel incontinence means you are unable to control bowel movements, meaning that stool or faeces will leak unexpectedly.

There are different levels of bowel incontinence symptoms – from lighter leakage to a total loss of bowel control. Bowel incontinence can cause a lot of emotional distress since a big part of a person’s dignity is affected when  they can’t fully control bodily functions. 

Avoiding social activities is fairly common too, unfortunately, and this is something that a caregiver can try and support with.If you’re caring for someone with bowel incontinence  make sure to read our guide on how to support someone with incontinence emotionally.

Skin irritation is another issue to be aware of. It happens when the skin is in repeated contact with faeces, which can lead to pain and itching.

Why does bowel incontinence occur?

Bowel incontinence can be caused by diarrhoea, constipation, or through nerve or muscle damage. The latter two are usually connected to a previous operation or with giving birth. If bowel incontinence is caused by diarrhoea or constipation, it’s usually temporary, but it can also become chronic.

Bowel incontinence is more common in old age, but it’s important to emphasise that neither bowel incontinence, nor double incontinence are a normal part of ageing.

  1. Nerve damage

    Injury to the nerves that control the anal sphincter (typically through childbirth, spinal cord injury or a stroke),  can lead to faecal incontinence. 

  2. Muscle damage

    If the muscles at the end of the rectum are injured, it can be difficult to hold the stool back properly.

  3. Constipation

    Chronic constipation can cause a hard mass of stool to form in the rectum, which then becomes too hard to pass. This can eventually lead to weakening muscles, which, in turn, leads to a lack of control, that allows stool to leak out.

  4. Diarrhoea

    Faecal leakage during diarrhoea is usually not a sign of a chronic state of incontinence, but it is harder to keep loose stool in the rectum than regular stool.

  5. Haemorrhoids

    Haemorrhoids can keep the anus from closing completely, which can allow stool to leak out.

If you want more information on bowel incontinence specifically, then be sure to read out in-depth guide on what bowel incontinence is as well as what the causes are and how can it be treated.

What is bladder incontinence?

Urinary incontinence

This is a common problem and  how it occurs varies from occasionally leaking urine when coughing or sneezing to more acute urge feelings and larger leakage throughout the day. Urinary incontinence is  more common in older adults. There are several different types of urinary , including:

Stress urinary incontinence

This usually happens when someone is coughing sneezing or laughing. It’s the most common incontinence type among women, but rare in men.

Urge urinary incontinence

This is incontinence associated with urgency, the desperate need to urinate which cannot be deferred.. The amount of leakage varies, from small dribbles to complete emptying of the bladder. It can be caused by a number of reasons, like an enlarged prostate, or a urinary tract infection.

Mixed urinary incontinence 

A combination of both stress urinary incontinence and urge urinary incontinence. It means the person can have leaks both connected with urgency and when exerting themselves.

Overflow urinary incontinence 

Occurs when the bladder cannot empty completely. The most common cause for this type of problem is an obstruction of the urethra, for example, due to an enlarged . It can also be caused if the bladder wall is incapable of completely emptying, normally a consequence from nerve damage around the bladder (for instance via multiple sclerosis or diabetes), or as a side effect from certain medications.

Post-micturition dribble 

The involuntary loss of urine immediately after passing urine. It happens because there is still urine remaining in the urethra. The problem is more common for men and can sometimes be avoided by pressing forward on the perineum to evacuate the remaining urine. It can also affect women who have poor muscle support for the urethra.

Functional urinary incontinence 

While in other forms of incontinence there is a basis in some form of loss of function to the urinary tract, functional urinary incontinence is different. With functional urinary incontinence there is no basis for incontinence from the urinary tract itself.

Functional urinary incontinence occurs when there’s some form of impairment in the act of passing urine, for example:  

  • When a person cannot reach the toilet in time due to impaired mobility
  • Impaired vision
  • Difficulty removing clothing in time
  • Any type of cognitive decline where an individual becomes incapable of processing the information required to complete the series of complex actions required to manage the passing of urine

Double incontinence treatment

First off, in order to obtain the most effective treatment for bladder and bowel incontinence, you must first understand the root cause for your . Consult a professional and discuss your treatment options.

For pre-emptive measures, and as a general treatment for many types of incontinence, a pelvic floor workout is a well-established form of treatment that you can do anywhere. By strengthening your pelvic floor muscles, you can increase bladder control.   

It's also worth looking into TENA's incontinence product offering. For lighter leakage, we'd recommend incontinence liners for women and pads for men.

Incontinence pants are also available for both men and women are incredibly effective against heavier leakage.

Faecal incontinence can, depending on the cause, be helped by these two actions:

1. Avoid constipation

Exercise, drink a lot of water and add more high-fibre foods to the diet.

2. Treat the diarrhoea

Treating the cause of diarrhoea, which can be brought about by an intestinal infection, may actually take away the faecal incontinence too.

For overweight or obese individuals, another effective measure  to prevent and treat loss of bladder and bowel control is reducing body weight. Studies show that obesity is one of the highest risk factors for both bowel and bladder incontinence.

Caring for someone with double incontinence

Double incontinence in particular, will probably be a sensitive matter to talk about, so be delicate about it. Listen to the needs of the person you’re helping and look for a product that really fits with the person’s own individual preferences, lifestyle, and activities. People are often reluctant to tell their doctors about faecal , but treatments are available. The sooner your loved one gets a diagnosis, the sooner you can start to treat their symptoms.

Remember that patients with a larger bowel leakage may need a completely different product than someone with a prominent urinary leakage, and you might need to try a range of incontinence products for men and women before you find the perfect match. 

Moreover, we want to emphasize the importance of proper skin care for people suffering from incontinence as leakage can often cause dermatitis (skin damage and irritation). In particular, if the person in question suffers from double incontinence, the dermatitis effects are severely increased.

Finally, always make sure that the person you take care of is toileted when needed and dried carefully. Use products with a soft surface that are gentle to the skin and add skin care products when needed.

Double incontinence in the elderly can be especially challenging for carers, so we hope our in-depth guide to bladder and bowel incontinence proved useful. Consulting a doctor is always a good starting point, but in the meantime, be sure to look at our full range of incontinence products - some of which are available to purchase online via the TENA store.

Plus, learn how to emotionally support your patients by reading our study on incontinence and mental health.