title: Combined urinary and faecal incontinence.
abstract: Combined urinary and faecal (liquid or solid) incontinence (double incontinence) is the most severe and debilitating manifestation of pelvic floor dysfunction. The community prevalence is 9-19% (urinary) and 5-10% (faecal), increasing with age. Pathophysiological factors include childbirth-associated external anal sphincter injury and pudendal nerve damage, pelvic floor descent, menopause, collagen disorders and multiple sclerosis-like conditions. The presence of crossed reflexes between the bladder, urethra, anorectum and pelvic floor in animal studies may explain the comorbidity of urinary and faecal urgency. Surgical treatment is based on aetiology and combined optimum techniques such as colposuspension or suburethral sling with overlapping sphincteroplasty. Other methods for improving sphincteric control include sacral nerve neuromodulation, bulking agents and artificial sphincters.
authors.affiliation: Clinical Fellow in Urogynecology, Mayday University Hospital, Croydon, UK.
authors.forename: Dharmesh S
authors.initials: DS
authors.lastname: Kapoor
authors.forename: Ranee
authors.initials: R
authors.lastname: Thakar
authors.forename: Abdul H
authors.initials: AH
authors.lastname: Sultan
mesh_terms: D000367:Age Factors; D000818:Animals; D004195:Disease Models, Animal; D005242:Fecal Incontinence / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D017773:Pelvic Floor / Q000503:physiopathology; D014549:Urinary Incontinence / Q000150:complications* / Q000503:physiopathology / Q000628:therapy
references.citation: Gut. 1965 Feb;6:64-8
references.pmid: 14259425
references.citation: J Auton Nerv Syst. 1981 Apr;3(2-4):135-60
references.pmid: 6268684
references.citation: Dis Colon Rectum. 1967 Mar-Apr;10(2):81-4
references.pmid: 6021068
references.citation: Acta Obstet Gynecol Scand. 2003 Mar;82(3):280-6
references.pmid: 12694126
references.citation: Acta Obstet Gynecol Scand. 1999 Mar;78(3):245-53
references.pmid: 10078588
references.citation: J Urol. 2004 Mar;171(3):1152-5
references.pmid: 14767290
references.citation: Am J Obstet Gynecol. 1991 Feb;164(2):609-10
references.pmid: 1992711
references.citation: J Physiol. 1984 Jan;346:461-9
references.pmid: 6142106
references.citation: BJOG. 2002 Feb;109(2):149-54
references.pmid: 11911100
references.citation: Br J Urol. 1984 Aug;56(4):401-5
references.pmid: 6335972
references.citation: Obstet Gynecol. 1997 Mar;89(3):423-7
references.pmid: 9052598
references.citation: Dis Colon Rectum. 1996 Aug;39(8):852-9
references.pmid: 8756839
references.citation: Dis Colon Rectum. 1993 May;36(5):475-83
references.pmid: 8387002
references.citation: Am J Obstet Gynecol. 2003 Jul;189(1):127-9
references.pmid: 12861150
references.citation: Gut. 1997 Nov;41(5):669-74
references.pmid: 9414976
references.citation: Br J Obstet Gynaecol. 1994 Jan;101(1):22-8
references.pmid: 8297863
references.citation: Lancet. 1986 Apr 19;1(8486):886-8
references.pmid: 2870357
references.citation: Dis Colon Rectum. 2001 Aug;44(8):1155-61
references.pmid: 11535856
references.citation: N Engl J Med. 2002 Oct 24;347(17):1318-25
references.pmid: 12397189
references.citation: Dis Colon Rectum. 2003 Sep;46(9):1245-50
references.pmid: 12972970
references.citation: Ann Surg. 1999 Jul;230(1):45-8
references.pmid: 10400035
references.citation: Dis Colon Rectum. 2001 Nov;44(11):1575-83; discussion 1583-4
references.pmid: 11711726
references.citation: Am J Physiol. 1982 Oct;243(4):H528-35
references.pmid: 6214958
references.citation: Br J Pharmacol. 1997 Aug;121(8):1665-72
references.pmid: 9283701
references.citation: Gastroenterology. 2004 Jan;126(1 Suppl 1):S169-71
references.pmid: 14978656
references.citation: Lancet. 1995 Oct 28;346(8983):1124-7
references.pmid: 7475602
references.citation: Br J Obstet Gynaecol. 1984 Jan;91(1):41-5
references.pmid: 6691945
references.citation: Ann Surg. 2000 Jul;232(1):143-8
references.pmid: 10862207
references.citation: Urology. 2003 Oct;62(4 Suppl 1):39-44
references.pmid: 14550836
references.citation: Urol Clin North Am. 1993 Aug;20(3):383-401
references.pmid: 8351765
references.citation: Br J Surg. 1982 Aug;69(8):470-2
references.pmid: 7104636
references.citation: Am J Obstet Gynecol. 1981 Jul 15;140(6):645-50
references.pmid: 7258236
references.citation: Br J Obstet Gynaecol. 1998 Nov;105(11):1211-3
references.pmid: 9853773
references.citation: N Engl J Med. 1993 Dec 23;329(26):1905-11
references.pmid: 8247054
references.citation: Am J Physiol. 1988 Jan;254(1 Pt 1):G100-6
references.pmid: 3337228
references.citation: Br J Obstet Gynaecol. 1997 Mar;104(3):311-5
references.pmid: 9091007
references.citation: Br J Obstet Gynaecol. 1996 Aug;103(8):731-4
references.pmid: 8760699
references.citation: Cochrane Database Syst Rev. 2002;(2):CD003191
references.pmid: 12076473
references.citation: Am J Physiol. 1999 Oct;277(4 Pt 2):R1002-12
references.pmid: 10516238
references.citation: Dig Dis Sci. 1993 Nov;38(11):1953-60
references.pmid: 8223066
references.citation: Neurourol Urodyn. 1999;18(6):579-90
references.pmid: 10529706
references.citation: J Urol. 2002 May;167(5):2088-92
references.pmid: 11956446
references.citation: Br J Surg. 1988 Nov;75(11):1095-7
references.pmid: 3208043
references.citation: Br J Surg. 2003 Dec;90(12 ):1573-9
references.pmid: 14648738
references.citation: J Neurol Neurosurg Psychiatry. 1984 Dec;47(12):1269-73
references.pmid: 6512547
references.citation: Dis Colon Rectum. 2001 Jun;44(6):790-8
references.pmid: 11391137
references.citation: Br J Urol. 1987 Jan;59(1):45-9
references.pmid: 3493825
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 1999;10(6):356-60
references.pmid: 10614969
references.citation: J Urol. 1995 Aug;154(2 Pt 1):504-7
references.pmid: 7609117
references.citation: Ann Urol (Paris). 1990;24(6):463-6
references.pmid: 2176777
references.citation: J Auton Nerv Syst. 1984 May-Jun;10(3-4):243-5
references.pmid: 6481091
references.citation: Br J Obstet Gynaecol. 1996 Oct;103(10):1034-40
references.pmid: 8863705
references.citation: Aliment Pharmacol Ther. 2003 Jul 15;18(2):237-43
references.pmid: 12869085
references.citation: Brain Res. 2000 Jul 7;870(1-2):126-34
references.pmid: 10869509
references.citation: Gut. 2002 Aug;51(2):225-8
references.pmid: 12117884
references.citation: Neurourol Urodyn. 2001;20(2):167-74
references.pmid: 11170191
references.citation: Acta Obstet Gynecol Scand. 1997 Mar;76(3):266-70
references.pmid: 9093143
references.citation: Dis Colon Rectum. 1995 Nov;38(11):1206-9
references.pmid: 7587765
references.citation: Am J Obstet Gynecol. 2003 Dec;189(6):1543-9; discussion 1549-50
references.pmid: 14710059
references.citation: Neurourol Urodyn. 2002;21(5):464-9
references.pmid: 12232882
references.citation: Dig Dis Sci. 1990 Oct;35(10):1291-8
references.pmid: 2209296
references.citation: Am J Obstet Gynecol. 1982 Nov 15;144(6):636-49
references.pmid: 6890313
references.citation: Acta Obstet Gynecol Scand. 2004 Apr;83(4):383-9
references.pmid: 15005787
references.citation: Dis Colon Rectum. 1999 Jun;42(6):762-9
references.pmid: 10378600
references.citation: Am J Obstet Gynecol. 1989 Jun;160(6):1432-9; discussion 1439-40
references.pmid: 2660570
references.citation: Br J Surg. 1995 Feb;82(2):173-6
references.pmid: 7749679
references.citation: Br J Obstet Gynaecol. 1997 Dec;104(12):1409-12
references.pmid: 9422022
references.citation: Am Surg. 1999 Dec;65(12):1117-21; discussion 1122-3
references.pmid: 10597057
references.citation: JSLS. 2001 Jul-Sep;5(3):203-9
references.pmid: 11548823
references.citation: Br J Surg. 1998 Jul;85(7):978-9
references.pmid: 9692577
references.citation: BMJ. 2001 Sep 15;323(7313):593-6
references.pmid: 11557703
references.citation: Lancet. 1984 Sep 8;2(8402):546-50
references.pmid: 6147604
references.citation: Br J Urol. 1997 Jun;79(6):865-78
references.pmid: 9202551
references.citation: Br J Surg. 1998 Dec;85(12):1716-9
references.pmid: 9876082
references.citation: Br J Urol. 1998 Aug;82(2):181-91
references.pmid: 9722751
references.citation: Eur Urol. 1997;31(1):115-7; discussion 117-8
references.pmid: 9032547
references.citation: Am J Obstet Gynecol. 1994 Jun;170(6):1713-20; discussion 1720-3
references.pmid: 8203431
references.citation: Gastroenterology. 2004 Jan;126(1 Suppl 1):S152-8
references.pmid: 14978653
references.citation: J Urol. 2000 Mar;163(3):881-3
references.pmid: 10687999
references.citation: Dis Colon Rectum. 2001 Jun;44(6):779-89
references.pmid: 11391135
references.citation: Dis Colon Rectum. 2003 Aug;46(8):1083-8
references.pmid: 12907903
references.citation: J Am Geriatr Soc. 1985 May;33(5):320-4
references.pmid: 3989196
references.citation: Dis Colon Rectum. 1996 Dec;39(12):1352-5
references.pmid: 8969659
references.citation: Eur J Obstet Gynecol Reprod Biol. 2003 Sep 10;110(1):39-42
references.pmid: 12932869
references.citation: J Physiol. 1969 May;201(3):535-49
references.pmid: 5767881
references.citation: J Urol. 1958 Nov;80(5):341-53
references.pmid: 13588737
references.citation: Dis Colon Rectum. 1999 Jun;42(6):753-8; discussion 758-61
references.pmid: 10378599
references.citation: Br J Obstet Gynaecol. 1989 Jan;96(1):29-32
references.pmid: 2923841
references.citation: Am J Obstet Gynecol. 2001 Jun;184(7):1488-94; discussion 1494-5
references.pmid: 11408872
references.citation: Gastroenterology. 2003 Nov;125(5):1320-9
references.pmid: 14598248
references.citation: Gynecol Obstet Invest. 1994;37(1):48-51
references.pmid: 8125409
references.citation: Int J Colorectal Dis. 1995;10(2):107-11
references.pmid: 7636369
references.citation: Dis Colon Rectum. 1993 Feb;36(2):182-5
references.pmid: 8425423
references.citation: J Am Geriatr Soc. 1999 Jul;47(7):837-41
references.pmid: 10404928
references.citation: Gastroenterology. 2002 Nov;123(5):1441-50
references.pmid: 12404218
references.citation: Am J Obstet Gynecol. 2003 Aug;189(2):438-43
references.pmid: 14520214
references.citation: Urol Int. 1980;35(3):226-32
references.pmid: 6446182
references.citation: Gynecol Obstet Invest. 1990;30(1):27-30
references.pmid: 2227608
references.citation: Neurourol Urodyn. 1998;17(6):579-89
references.pmid: 9829422