Combined fecal and urinary incontinence: an update

To review last year's literature on combined fecal and urinary incontinence, highlighting the most recent contributions on prevalence, physiopathology, evaluation, and treatment.

Prevalence studies of double incontinence are rare but both conditions are frequently associated with pelvic organ prolapse. Vaginal delivery and chronic straining are risk factors for double incontinence, and pudendal neuropathy may be responsible for deterioration of continence. Electrophysiological studies in patients with combined fecal and urinary incontinence are necessary to confirm this hypothesis. Patients with double incontinence should be evaluated by a multidisciplinary group of specialists. A complete evaluation including urodynamics, anal manometry, anal ultrasound and electrophysiologic tests is recommended in most cases. Conservative therapy including pelvic floor exercises combined with bladder training and biofeedback has been demonstrated to be effective. Surgery is indicated in very few selected patients and may be performed simultaneously for both fecal and urinary incontinence. New studies are necessary that focus on identification of other risk factors and preventive strategies before deterioration of continence occurs.

Combined fecal and urinary incontinence is not uncommon and its pathophysiology involves multiple factors. These patients should be evaluated by a multidisciplinary group of specialists and offered appropriate measures to improve their quality of life.