What Is Double Incontinence and how to manage it

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 life for someone living with this problem.

Double incontinence is when someone experiences the involuntary loss of control over both their bladder and bowels.1 In simpler terms, it means leaking urine and stool without being able to control it. This condition can really affect someone's quality of life, leading to physical discomfort, skin irritation, and even feelings of stress or social withdrawal.

Understanding both aspects—bladder and bowel control—is key because managing both at the same time can be a bit trickier than dealing with just one. It’s not just about the physical discomfort; it can impact daily activities, personal hygiene, and even one’s confidence in social situations.

Double incontinence is more common in older adults.1 If you or someone you know is dealing with this, getting the right support and medical advice can make a huge difference in managing the condition and improving overall well-being.

Fecal incontinence or bowel incontinence means you are unable to control bowel movements, and, as a result, 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 is 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 help 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.

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. Stress incontinence is the most common incontinence type among women, and 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. Urge incontinence 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 also 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 of 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. Post-micturition dribble 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.

Double incontinence happens when something affects the body’s ability to control both the bladder and the bowels, sometimes at the same time. There are several factors that can lead to this, and they often overlap, making things feel even more complicated for those experiencing it.

For bladder incontinence specifically, some of the key causes include:

• Pelvic floor damage or weakness. The pelvic floor muscles support both the bladder and the bowel. If these muscles are weakened (often due to aging, childbirth, or strain) it can lead to leaks from both areas.¹
• Prostate issues or surgeries. For men, problems with the prostate or surgery on the prostate can affect bladder control1 and, in some cases, also put pressure on the bowel.
• Childbirth-related trauma. Childbirth can stretch or strain the pelvic floor muscles and nerves,1 making it harder for women to control both their bladder and bowel, sometimes long after delivery.
• Urinary tract infections (UTI). A UTI can irritate the bladder and make it harder to hold urine. In some cases, the irritation and muscle spasms can also affect the bowel.

Bowel incontinence is a symptom that can be caused by a number of reasons, like diarrhea, constipation, or nerve or muscle damage. The latter two are 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 aging. Some of the key causes include:

• 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.

Double incontinence can show up in different ways, and the symptoms often affect both the body and the mind. Here are some common signs to look out for:

• Frequent or sudden need to urinate or defecate. You might feel an urgent or constant need to go to the bathroom, sometimes without much warning. This can include frequent urination, where you need to pee much more often than usual.
• Leaking urine or feces without warning. This is one of the most noticeable symptoms: sudden leaks that happen even if you didn’t feel the urge or couldn’t make it to the toilet in time.
• Feeling of incomplete bowel or bladder emptying. After going to the toilet, you might still feel like your bladder or bowel hasn’t fully emptied, leading to discomfort and repeated trips.
• Skin irritation or discomfort. Constant leakage can lead to irritated, sore, or sensitive skin, especially around the genital or anal areas because of the moisture.¹
• Psychological impacts like anxiety or embarrassment. Living with double incontinence can take an emotional toll, making people feel self-conscious, anxious, or even socially isolated.

Recognizing these symptoms early is important so that you can get the right help and support and start feeling more comfortable and confident in daily life.

First off, 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.

Double incontinence can, depending on the cause, be helped by these incontinence management strategies:

• Avoid constipation. Exercise, drink a lot of water and add more high-fiber foods to the diet.
• Treat diarrhea. Treating the cause of diarrhea, which can be caused by an intestinal infection, may actually take away the fecal incontinence too.
• Pelvic floor exercises and physiotherapy. Strengthening the pelvic floor muscles with Kegels can make a big difference in controlling both bladder and bowel leaks. ¹ These are simple exercises that can be done anytime, anywhere. Check out this guide on pelvic floor exercises to get started.
• Double void urination. In some cases, double incontinence may be associated with incomplete bladder emptying. Double void urination, which involves urinating twice in quick succession to fully empty the bladder, can help reduce urinary retention and improve bladder control. This technique can be beneficial for individuals with urinary incontinence as part of their overall management plan.
• Toileting schedules and bladder/bowel training. Planning regular bathroom visits and gradually training to wait between trips can help reduce accidents and improve control.¹
• Dietary adjustments. Avoid constipation and support bladder health by drinking plenty of water and eating a high-fiber diet. Here’s a helpful guide on what to eat and drink for bladder health.
• Skin care solutions. Ongoing leakage can cause skin irritation,¹ so it’s essential to care for the skin gently and regularly. For tips and product recommendations, check out caring for intimate skin with incontinence.
• Use of continence aids or incontinence briefs. High-quality incontinence briefs and other products can help protect clothing and skin while boosting confidence when out and about.
• Medications. In some cases, medications can help calm an overactive bladder or regulate bowel movements, depending on the underlying cause.¹

Another recommendation on how to prevent and treat double incontinence is through keeping control over body weight. Studies show that obesity is one of the highest risk factors for both bowel and bladder incontinence.²

Incontinence, including double incontinence, becomes more common as people get older, and there are a few key reasons why. As we age, our bodies naturally go through changes that can affect bladder and bowel control.

One of the biggest factors is weakening muscles and nerves.² The pelvic floor muscles, which help keep the bladder and bowels in check, can lose strength over time.

Chronic conditions such as diabetes, stroke, Parkinson’s disease, and multiple sclerosis³ are also more common in older adults, and these can directly impact bladder and bowel function.

Then there’s the effect of medications. Certain medications prescribed for blood pressure, sleep, or heart conditions can relax muscles or cause side effects that increase urgency or frequency.

Lastly, mobility issues play a big role. When getting to the bathroom becomes difficult or slow due to arthritis, injuries, or general frailty, accidents can happen more easily.²

It’s important to remember that while incontinence is more common with age, it’s not something anyone has to simply “live with.” There are plenty of ways to manage and improve symptoms, from pelvic floor exercises and toileting schedules to specialized products and medical treatments. If you or a loved one is experiencing incontinence, there’s support available and with the right care, comfort and confidence can absolutely be regained.

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 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 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 leakages often cause dermatitis (skin damage and irritation). 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 moisture cream and skincare products when needed.