Types of incontinence

Urge incontinence is when someone registers the filling of the rectum and can feel the urge to go, but they may have to rush to the toilet to make it on time.

With flatus incontinence the person feels the sensation of filling in the rectum, but their body's sensation mechanisms don't work properly and they can't tell whether it's gas or stool in there.

Passive incontinence is when there's no urge instruction to go to the toilet, or the message isn't registered by the brain. In other words, the person is unaware that the rectum is full and ready to empty.

Because people never feel any sensations in their back passage, they can't consciously control their bowel movements and stool is passed without their knowledge.

Anal and rectal incontinence happen because of an inability to control the rectal canal and the anal sphincter muscles. Nerves in these areas help the brain control movement and expulsion of stool and gas.

When the nerves, the rectum's structure or the muscles of these specific areas are damaged then control problems and leakage can result.

Overflow incontinence is usually a result of a blockage in the colon caused by constipation. The blockage, caused by stool that's stuck, blocks yet more stool. Only watery faeces can pass around it. That discharge then leaks out because it's so hard to control.

Dual incontinence is when someone has both bowel and bladder control problems.

Why bowel and continence problems?

People may have some degree of incontinence due to structural problems of the colon, muscles or nerves. This could show itself at birth, such as organs or structures that don't form sufficiently in a newborn baby.

People may also experience damage later in life, due to childbirth, accident or surgery.

Conditions and disease can affect continence control, such as diabetes, spina bifida, stroke, epilepsy and Parkinson's.

Most people, though, know bowel problems through two common conditions: constipation and diarrhoea.

Constipation: a symptom and a cause

Constipation causes incontinence, but it's also a sign that something is wrong. For instance, you can get it because of health issues, such as irritable bowel syndrome, or because you're stressed.

Constipation is when you can't empty your bowels. Stool sometimes becomes lodged in the colon. It dries out, hardens and builds up to a mass. This mass then creates a blockage in the colon.

Nothing other than watery discharge can pass around the blockage. Controlling this discharge is hard and it leaks.

Also, when the colon is blocked, people often strain and push to try and empty the colon. Straining can injure muscles and the rectal canal. Small lesions or open sores on the surface of the colon can also develop. Both these consquences of straining can cause bowel control problems.

Everyone gets constipation to some degree. Inactivity and ageing may both make it more likely. Usually it passes. If it persists and is left untreated it can cause damage.

Things to look out for are

• A change in toilet habits and going less often than you would ordinarily
• Having to strain
• Passing hard or pellet-like stool
• Feeling like you haven't fully emptied your bowel
• Bloating, stomach cramps and nausea

Diarrhoea: a symptom and a cause

Diarrhoea is also both a symptom and cause of incontinence. It can be chronic (ongoing or recurring) or acute (sudden).

A range of things can cause acute diarrhoea, such as a bacterial or viral stomach infection or reactions to food. It usually passes within a week or two.

Chronic diarrhoea is ongoing and can last weeks. It can pass and then recur. It can be a result of disease or digestive disorders, such as irritated colon or inflammatory diseases such as Crohn's disease.

Symptoms of diarrhoea are

• Unwanted and frequent passing of watery stool
• Abdominal pain, cramping and bloating
• Nausea and loss of appetite
• Sometimes it's accompanied by a fever or blood in the stool

It's important to see a doctor as both acute and chronic diarrhoea can cause a loss of fluids in the body. Babies, children and older people are especially vulnerable to dehydration.