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Double incontinence – what it is and how to handle it

Three old women dancing
Double incontinence is when bladder and bowel incontinence occurs at the same time.  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.

Bowel incontinence

Fecal incontinence or bowel incontinence means you are unable to control bowel movements, and as an effect of that stool or feces 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 such a big part of a person’s dignity are affected when he or she can’t control bodily functions anymore.  Avoiding social activities is fairly common too, unfortunately, and this is something that you as a caregiver can try and support with. Skin irritation is another issue to be aware of. It happens when the skin is in repeated contact with feces, which can lead to pain and itching.

What causes bowel incontinence?

Bowel incontinence is a symptom that can be caused by a number of reasons, like diarrhea, constipation, or through nerve or muscle damage. The latter two is usually connected to a previous operation or with giving birth. If it’s caused by diarrhea or constipation, it’s usually temporary, but it can also become chronic. Bowel incontinence is statistically more common in old age, but it’s important to understand that it’s not a normal part of ageing.

Nerve damage

If there’s an injury to the nerves that control the anal sphincter (typically through childbirth, spinal cord injury or a stroke), it can lead to fecal incontinence. 

Muscle damage

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

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, that allows stool to leak out.

Diarrhea

Fecal leakage during diarrhea 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.

Hemorrhoids

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

Bladder incontinence

Urinary incontinence is a common problem and the severity varies from occasionally leaking urine when coughing or sneezing to more acute urge feelings and larger leakage throughout the day. Urinary incontinence is definitely more common for older people, but it can also happen for other reasons as well. There are several different types of urinary incontinence:
 
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 
Incontinence problems with a large urgency to urinate. The amount of leakage varies, from small dribbles to complete emptying of the bladder. Can be caused by a number of reasons, like enlarged prostate, a urinary tract infection, or simply if you drink too much. 
 
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 and then gradually fills with residual urine. The most common cause for this type of problem is an obstruction of the urethra, for example, due to an enlarged prostate. On the other hand, it can also be caused by an inactive bladder muscle, 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 
When the person cannot reach the toilet in time due to some sort of immobility. Impaired vision, lowered cognitive function, and reduced mobility can cause functional urinary incontinence.

What treatments and recommendations are there?

First off, in order to obtain the most accurate treatment, you must first understand the root cause for your incontinence. Consult a professional and plan your treatment from there.
 
For preemptive measures, and as a general treatment for any type of incontinence, a pelvic floor workout is a well-established exercise that you can do anywhere. By strengthening your pelvic floor muscles, you increase your control over your bladder.  
 
Fecal incontinence can, depending on the cause, be helped by these two actions:
 
Avoid constipation
Exercise, drink a lot of water and add more high-fiber foods to the diet.
 
Treat the diarrhea
Treating the cause of diarrhea, which can be caused by an intestinal infection, may actually take away the fecal incontinence too.
 
Another recommendation on how to prevent and treat double incontinence is through keeping control over the body weight. Studies show that obesity is one of the highest risk factors for both bowel and bladder incontinence.

What can I do as a caregiver if my patient has double incontinence?

Incontinence in general, but double 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 fecal incontinence, but treatments are available. The sooner your loved one gets a diagnose, 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 different products before you find the perfect match. 
 
Moreover, we want to emphasize the importance of proper skin care for people suffering from incontinence as leakage 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’s gentle to the skin, and add moisture creme and skin care products when needed.