Loss of bladder and bowel control

What causes loss of bladder and bowel control?

Bladder and bowel control problems can happen on their own or together, and often share similar causes.

• Constipation: A full, stretched bowel can press on the bladder and make it harder to empty fully, and hard stools can leak around softer stool, which can be mistaken for diarrhoea
• Weak pelvic floor muscles: The group of muscles supporting your bladder and bowel, which can weaken after childbirth, pelvic surgery, or simply as you get older
• Urinary tract infections (UTIs): Can cause a sudden, strong need to pass urine, and pain or a burning feeling when you do
• Dehydration: Not drinking enough can make constipation and UTIs more likely, and concentrated urine can irritate the bladder
• A digestive condition: Such as irritable bowel syndrome (IBS), Crohn's disease or ulcerative colitis
• A nerve or health condition: Such as diabetes, multiple sclerosis, dementia, stroke or a learning disability, which can affect your awareness of needing the toilet or your muscle control
• Medication: Some medicines can affect bladder or bowel control – do not stop taking any medicine without speaking to a healthcare professional first
• Difficulty getting to a toilet in time: Because of mobility problems, an unfamiliar place, or clothing that's hard to undo quickly (sometimes called functional incontinence).

Are there different types of bladder and bowel control problems?

Yes. Bladder control problems are usually described by their pattern of symptoms:

• Stress incontinence: Leaking a small amount of urine when you cough, sneeze, laugh or exercise
• Urge incontinence: A sudden, strong need to pass urine that's hard to put off, sometimes with leaking before you reach the toilet
• Overactive bladder: Needing to pass urine more than 7 times a day, often with urgency
• Urinary retention: Not being able to empty your bladder fully, which can cause a weak stream or frequent dribbling and leaking
• Functional incontinence: Leaking because you cannot get to, or use, the toilet in time, even though you're aware you need to go.

Bowel control problems tend to be described by pattern rather than named types, and can include not being able to stop stools leaking out, not always being aware in time that you need to go, or watery stool leaking around a build-up of hard, constipated stool.

How are bladder and bowel control problems diagnosed?

Your GP will usually start by asking about your symptoms, general health and any medicines you take. Try not to feel embarrassed; this is a common problem and doctors are used to discussing it. They may use the following:

• A physical examination – which may include feeling your tummy, and, for bowel symptoms, an internal examination of your bottom
• A urine or stool sample – to check for infection or other problems
• A bladder or bowel diary – recording what you drink and eat, how often you go to the toilet, and any leaks, usually over 3 days
• Blood tests
• Further tests, if needed – such as a colonoscopy (a camera test to look inside your bowel), an ultrasound scan, or a bladder scan to see how well your bladder empties.

How are bladder and bowel control problems treated?

Treatment depends on the cause, and you may be offered more than one approach.

• Pelvic floor exercises: Regularly tightening and relaxing the muscles that support your bladder and bowel, which a specialist nurse or physiotherapist can teach you
• Bladder training: Gradually holding on for longer between toilet visits, to help your bladder hold a more normal amount of urine
• Bowel retraining: Developing a regular routine and technique for fully emptying your bowel
• Diet and fluid changes: Such as cutting down on caffeine, alcohol and fizzy drinks, eating more fibre, and drinking 6 to 8 cups of fluid a day
• Medicines: Such as those to treat constipation or diarrhoea, calm an overactive bladder, or treat an underlying infection
• Continence products: Such as pads, pants or anal plugs, which don't treat the underlying cause but can help you manage day-to-day life while waiting for other treatment to work
• Surgery: Only considered if other treatments have not helped.

When should you see a doctor?

See a GP if you're having any loss of bladder or bowel control, however mild, or if it's affecting your day-to-day life. Contact a GP urgently, or call 111, if you notice:

• blood in your stools or urine, or black or dark red stools
• bloody diarrhoea
• a change in your bowel habit that lasts more than 3 weeks, or new constipation or diarrhoea that isn't usual for you
• a lump in your tummy, or unexplained weight loss
• pain when going to the toilet
• a fever, or feeling generally unwell.