If the pelvic muscles (rather than the muscle of the bladder itself) are weakened, you can get what we call stress incontinence. Here small amounts of urine come away when you sneeze, cough or laugh. This is much more common in women, whose pelvic muscles can be weakened by difficult childbirths or pelvic surgery. Oestrogen treatment can cause or aggravate this symptom.

The third type of incontinence—urge incontinence—is when you know you need to go, but you can’t get there quickly enough. This symptom is the case of the bladder often means cystitis— perhaps due to injection, bladder radiation or cyclophosphamide. In the case of the bowels it can go with severe diarrhoea of any cause.

Now let’s go on to incontinence where urine or faeces is coming away through a passage that doesn’t normally exist. This can happen if you have a large cancer in the pelvic area, which grows through to open up an abnormal passage between the bowel or bladder and the skin or vagina (a fistula). If the opening of the fistula is through the skin of the abdominal wall or down below, this problem is easy to diagnose—it is quite obvious that the urine or faeces is coming through an opening that normally doesn’t exist. If the opening is into the vagina the diagnosis is more difficult. It shoud be suspected whenever small amounts of urine or faeces are coming away almost continuously, but you still have normal feeling in the bladder or bowel as the case may be. You could also be passing some of your urine and faeces normally, with normal control. Ask your doctor to check for a fistula if you think that urine or faeces is coming away through your front passage.

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