Faecal incontinence is the inability to control the passage of faeces. Normally, the bowel acts as a reservoir for faeces, which is prevented from leaking by a ring of muscle around the back passage or anus, known as the sphincter muscle. Faeces is also supported by muscles in the pelvis. People experiencing faecal incontinence may have little or no control over these muscles.

Faecal incontinence can result from a wide variety of medical conditions, including childbirth-related anal injuries, other causes of damage to the anus or rectum, and nervous system problems.

Vaginal-delivery childbirth is a major cause of faecal incontinence. In many cases, childbirth results in damage to the anal sphincter, which is the ring of muscle that closes the anus and keeps stools within the rectum until a person can find an appropriate opportunity to defecate. Nerve injuries during childbirth may also be a factor in some cases. The removal of hemorrhoids by surgery or other techniques (hemorrhoidectomies) can also cause anal damage and faecal incontinence, as can more complex operations affecting the anus and surrounding areas. Anal and rectal infections as well as Crohn's disease can lead to incontinence by damaging the muscles that control defecation. For some people, incontinence becomes a problem when the anal muscles begin to weaken in midlife or old age.

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There are a variety of surgical options for controlling all forms of urinary incontinence. Since all surgery has its risks - especially when the patient is older - it usually is considered only after all other options have been tried. In some cases the surgery can be ineffective and the patient will then need to relook at the other treatment options available.

Interstitial cystitis (IC) is a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. The symptoms vary from case to case and even in the same individual. People may experience mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area. Symptoms may include an urgent need to urinate, a frequent need to urinate, or a combination of these symptoms. Pain may change in intensity as the bladder fills with urine or as it empties. Women’s symptoms often get worse during menstruation. They may sometimes experience pain during vaginal intercourse.

Someone who has experienced the symptoms associated with incontinence for a long period of time with no improvement.

An overactive bladder is a condition that results from sudden, involuntary contraction of the muscle in the wall of the urinary bladder. Overactive bladder causes a sudden and unstoppable need to urinate (urinary urgency). Overactive bladder is also referred to as urge incontinence and is a form of urinary incontinence (unintentional loss of urine).

Overactive bladder is especially common in older adults but should not be considered a normal part of aging.

What are symptoms of overactive bladder?

The symptoms of overactive bladder include frequent urination, urgency of urination, and urge incontinence. Overactive bladder may cause significant social, psychological, occupational, domestic, physical, and sexual problems. Again, these symptoms should not be considered a normal part of aging.

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Stress incontinence is an involuntary loss of urine that occurs during physical activity, such as coughing, sneezing, laughing, or exercise. The ability to hold urine and control urination depends on the normal function of the lower urinary tract, the kidneys, and the nervous system. You must also have the ability to recognise and respond to the urge to urinate.

The average adult bladder can hold over 2 cups (350ml - 550 ml) of urine. Two muscles are involved in the control of urine flow:

• The sphincter, which is a circular muscle surrounding the urethra. You must be able to squeeze this muscle to prevent urine from leaking out.
• The detrusor, which is the muscle of the bladder wall. This must stay relaxed so that the bladder can expand.

In stress incontinence, the sphincter muscle and the pelvic muscles, which support the bladder and urethra, are weakened. The sphincter is not able to prevent urine flow when there is increased pressure from the abdomen (such as when you cough, laugh, or lift something heavy).

Stress incontinence may occur as a result of weakened pelvic muscles that support the bladder and urethra or because of a malfunction of the urethral sphincter. The weakness may be caused by:

• Injury to the urethral area
• Some medications
• Surgery of the prostate or pelvic area

Stress urinary incontinence is the most common type of urinary incontinence in women.

Stress incontinence is often seen in women who have had multiple pregnancies and vaginal childbirths, and whose bladder, urethra, or rectal wall stick out into the vagina (pelvic prolapse). It can also affect men following treatment for prostate such as radical prostatectomy.

Risk factors for stress incontinence include:

• Being female
• Childbirth
• Chronic coughing (such as chronic bronchitis and asthma)
• Getting older
• Obesity
• Smoking

Symptoms

The main symptom of stress incontinence is involuntary loss of urine. It may occur when:

• Coughing
• Sneezing
• Standing
• Exercising
• Engaging in other physical activity
• Engaging in sexual intercourse

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Urge incontinence is the strong, sudden need to urinate due to bladder spasms or contractions.

Causes

A person's ability to hold urine depends on normal function of the lower urinary tract, kidneys, and nervous system. The person must also have the physical and mental ability to recognize and respond to the urge to urinate.

The bladder's ability to fill and store urine requires a working sphincter muscle (which controls the flow of urine out of the body) and a stable bladder wall muscle (detrusor).

The process of urination involves two phases:

• Filling and storage
• Emptying

During the filling and storage phase, the bladder stretches so it can hold the increasing amount of urine. The bladder of an average person can hold 350 ml to 550 ml of urine. Generally, a person feels like they need to urinate when there is approximately 200 ml of urine in the bladder.

The nervous system tells you that you need to urinate. It also allows the bladder to continue to fill.

The emptying phase requires the detrusor muscle to contract, forcing urine out of the bladder. The sphincter muscle must relax at the same time, so that urine can flow out of the body.

The bladder of an infant automatically contracts when a certain volume of urine is collected in the bladder. As the child grows older and learns to control urination, part of the brain (cerebral cortex) helps prevent bladder muscle contraction. This allows urination to be delayed until the person is ready to use the bathroom.

Undesired bladder muscle contractions may occur from nervous system (neurological) problems and bladder irritation. Urge incontinence is leakage of urine due to bladder muscles that contract inappropriately. Often these contractions occur regardless of the amount of urine that is in the bladder.

Urge incontinence may result from:

• Bladder cancer
• Bladder inflammation
• Bladder outlet obstruction
• Bladder stones
• Infection
• Neurological diseases (such as multiple sclerosis)
• Neurological injuries (such as spinal cord injury or stroke)

In men, urge incontinence also may be due to:

• Bladder changes caused by benign prostatic hypertrophy(BPH)
• Bladder outlet obstruction from an enlarged prostate

In most cases of urge incontinence, no specific cause can be identified.

Symptoms

• Frequent urination, in the daytime and at night
• Involuntary loss of urine
• Sudden and urgent need to urinate(urinary urgency)

Although urge incontinence may occur in anyone at any age, it is more common in women and the elderly.

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In women, it is particularly important that strength is maintained in a group of muscles known as the pelvic floor. These muscles stretch between the pubic bone at the front of the pelvis, and the sacrum (tail bone) at the back. They form a hammock-like support for the organs of the pelvis — the bladder, uterus and lower bowel. The passages leading from these organs, the urethra, vagina and anus, all pass through this muscular support. Often the pelvic floor muscles are weakened. This can happen because of childbirth, chronic constipation causing straining, being overweight, reduced hormone levels after the menopause, ageing or a general lack of exercise.