Combined urinary and faecal incontinence

Area of Science:

• Urology
• Gastroenterology
• Gynecology
• Neurology

Background:

• Double incontinence, encompassing both urinary and fecal incontinence, represents a severe form of pelvic floor dysfunction.
• Community prevalence rates are significant, with urinary incontinence affecting 9-19% and fecal incontinence 5-10%, both increasing with age.
• Contributing factors include childbirth injuries, nerve damage, pelvic organ prolapse, menopause, and neurological conditions.

Purpose of the Study:

• To review the pathophysiology and treatment of double incontinence.
• To highlight the link between urinary and fecal urgency due to crossed reflexes.
• To discuss current and emerging therapeutic options.

Main Methods:

• Literature review of studies on pelvic floor dysfunction and incontinence.
• Analysis of etiological factors contributing to combined incontinence.
• Overview of surgical and non-surgical treatment modalities.

Main Results:

• Childbirth-associated sphincter injury and pudendal nerve damage are key factors.
• Pelvic floor descent, menopause, and neurological conditions also contribute.
• Animal studies suggest crossed reflexes explain the comorbidity of urgency.

Conclusions:

• Effective management requires etiology-specific treatment, often combining surgical techniques.
• Options include colposuspension, suburethral slings, sphincteroplasty, sacral nerve neuromodulation, bulking agents, and artificial sphincters.
• Addressing pelvic floor dysfunction is crucial for improving quality of life.