Fecal incontinence (FI), also known as anal incontinence, or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents—including flatus (gas), liquid stool elements and mucus, or solid feces. FI is a sign or a symptom, not a diagnosis. Incontinence can result from different causes and might occur with either constipation or diarrhea. Continence is maintained by several inter-related factors, including the anal sampling mechanism, and usually there is more than one deficiency of these mechanisms for incontinence to develop. The most common causes are thought to be immediate or delayed damage from childbirth, complications from prior anorectal surgery (especially involving the anal sphincters or hemorrhoidal vascular cushions) and altered bowel habits (e.g., caused by irritable bowel syndrome, Crohn’s disease, ulcerative colitis, food intolerance, or constipation with overflow incontinence). An estimated 2.2% of community dwelling adults are affected.
Bladder training. Bladder training is changing urination habits to decrease incidents of UI. Based on a woman’s bladder diary, the health care professional may suggest using the bathroom at regular timed intervals, called timed voiding. Gradually lengthening the time between trips to the bathroom can help by stretching the bladder so it can hold more urine. Recording daily bathroom habits may be helpful. More information is provided in the NIDDK health document, Daily Bladder Diary (PDF, 80 KB) .
Overactive bladder occurs when abnormal nerves send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. Voiding up to seven times a day is normal for many but women with overactive bladder may find that they must urinate even more frequently.
Nerve stimulation: This procedure changes the electrical signal of the nerves that carry impulses to the bladder. The procedure can be performed using a small wire inserted into the low back or a small needed inserted through the skin of the lower leg. Some studies have shown this can relieve the frequency and urgency of an overactive bladder.
An OAB occurs when the bladder squeezes (contracts) suddenly without you having control and when the bladder is not full. OAB syndrome is a common condition where no cause can be found for the repeated and uncontrolled bladder contractions. (For example, it is not due to a urine infection or an enlarged prostate gland.)
This severe type of incontinence is characterized by constant or near constant leakage with no symptoms other than wetness. Generally, this represents a significant breech in the storage capabilities of the bladder or urethra. Urogenital fistulas are a classic example.
Learn where your pelvic floor muscles are and then strengthen them by doing Kegel exercises — tighten (contract) muscles, hold the contraction for two seconds and relax muscles for three seconds. Work up to holding the contraction for five seconds and then 10 seconds at a time. Do three sets of 10 repetitions each day.
Most people can sleep 6 to 8 hours without having to urinate. But it’s usually not a big deal if you get up once a night to pee. Drinking caffeinated drinks or alcohol or just drinking too much liquid too close to bedtime can cause it. If you’re concerned or waking up several times to pee, you may want to see your doctor. Excessive nighttime urination can also be caused by medications; diabetes; or kidney, heart, prostate, or other health problems, so it’s worth getting checked out.
Overactive bladder (OAB) may be caused by an underlying disorder such as Parkinson’s disease, diabetes, multiple sclerosis, or kidney disease. Other times it can be linked to medications, surgery, or childbirth. However, for some people, there appears to be no underlying cause.
Rehder P, Haab F, Cornu JN, Gozzi C, Bauer RM. Treatment of Postprostatectomy Male Urinary Incontinence With the Transobturator Retroluminal Repositioning Sling Suspension: 3-Year Follow-up. Eur Urol. 2012 Feb 25. [Medline].
Electrical nerve stimulation. If behavioral and lifestyle changes and medications do not improve symptoms, a urologist may suggest electrical nerve stimulation as an option to prevent UI, urinary frequency—urination more often than normal—and other symptoms. Electrical nerve stimulation involves altering bladder reflexes using pulses of electricity. The two most common types of electrical nerve stimulation are percutaneous tibial nerve stimulation and sacral nerve stimulation.4
A sling is a piece of human or animal tissue or a synthetic tape that a surgeon places to support the bladder neck and urethra. Two sling techniques are shown — the retropubic and transobturator. Both are designed to reduce or eliminate stress incontinence in women.
Bladder cancer can lead to overactive bladder. In most cases, the American Academy of Family Physicians (AAFP) does not recommend routine screening for bladder cancer unless you have symptoms of overactive bladder.
Urinary incontinence is common, especially in women. It can occur at any age but it is more likely to develop as you get older. It is estimated that about three million people in the UK are regularly incontinent. Overall, this is about 4 in 100 adults. However, as many as 1 in 5 women over the age of 40 have some degree of urinary incontinence.
Botox, more commonly known for removing wrinkles, can be injected into the bladder muscle causing it to relax. This can increase capacity in the bladder and lessen contractions. Botox is only recommended for people who can’t control symptoms with behavioral therapies or oral medications.
Patients whose urinary incontinence is treated with catheterization also face risks. Both indwelling catheters and intermittent catheterization have a range of potential complications (see Treatment).
Burgio KL, Goode PS, Locher JL, Umlauf MG, Roth DL, Richter HE, et al. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA. 2002 Nov 13. 288(18):2293-9. [Medline].
Idiopathic OAB is OAB in the absence of any underlying neurologic, metabolic, or other causes of OAB, or conditions that may mimic OAB, such as urinary tract infection, bladder cancer, bladder stones, bladder inflammation, or bladder outlet obstruction.
The PNS causes contraction of the detrusor, while the muscles of the pelvic floor and external sphincter relax. The PNS fibers, as well as those responsible for somatic (voluntary) control of micturition (urination), originate from the S2 to S4 segments of the spinal cord in the sacral plexus. The somatic fibers innervate the external sphincter and are responsible for the voluntary control of continence in the face of a pressing desire to void.
Melody Denson, MD, a board-certified urologist with the Urology Team in Austin, TX, recommends these exercises for OAB. She says, “They will trigger a reflex mechanism to relax the bladder. If you feel a tremendous urge to urinate, doing a kegel before you run to the bathroom will help settle down the bladder spasm and help you hold it until you get there.” (16)
When it isn’t full of urine, the bladder is relaxed. When nerve signals in your brain let you know that your bladder is getting full, you feel the need to urinate. If your urinary system is normal, you can delay urination for some time.
Mills and colleagues conducted a comparison study of bladder muscle strips from patients with severe idiopathic detrusor overactivity and from organ donors with no known urologic problems.  The following are some of the findings: