Understanding Urgency and Incontinence in IBS: Fecal and Urinary Symptoms

Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, diarrhea, constipation, and bowel urgency. While its primary effects are on the digestive system, many people with IBS also experience fecal and urinary urgency and incontinence, significantly impacting their quality of life. Understanding these symptoms, their causes, and how they can be managed is essential for individuals navigating IBS.

Defining Fecal and Urinary Urgency and Incontinence

• Fecal Urgency: A sudden, intense need to defecate that may be difficult to delay, often accompanied by anxiety about reaching a toilet in time.
• Fecal Incontinence: The involuntary loss of stool or gas, ranging from mild leakage to a complete loss of bowel control.
• Urinary Urgency: A sudden and overwhelming need to urinate, often leading to frequent trips to the bathroom.
• Urinary Incontinence: The involuntary leakage of urine, which can occur due to various factors such as weak pelvic floor muscles or overactive bladder activity.

Both fecal and urinary symptoms frequently coexist in IBS, pointing to shared underlying mechanisms. Dysuria is a term used to describe any discomfort associated with urination.

How IBS Contributes to Fecal and Urinary Symptoms

• Altered Gut and Bladder Motility: IBS disrupts normal bowel movements, causing diarrhea or constipation. The same nerve pathways that regulate bowel motility also influence bladder function, leading to urinary urgency and frequency.
• Visceral Hypersensitivity: People with IBS often have heightened sensitivity in the digestive tract, making them more likely to experience urgency and discomfort. This hypersensitivity can extend to the bladder, causing increased urinary urgency and frequency. Read: Visceral Hypersensitivity: A Key Factor In Your IBS Pain and What You Can Do About It
• Pelvic Floor Dysfunction: The pelvic floor muscles control both bladder and bowel movements. When these muscles are weak or uncoordinated, they can contribute to fecal and urinary incontinence.
• Autonomic Nervous System Dysregulation: The autonomic nervous system (ANS) regulates involuntary functions like digestion and urination. In IBS, ANS dysregulation can lead to excessive bowel and bladder activity, resulting in urgency and incontinence.
• Psychological Factors: Stress and anxiety, which commonly affect IBS patients, can worsen both bowel and bladder symptoms. Psychological distress influences gut and bladder function through the gut-brain axis, amplifying urgency and incontinence. Read: IBS and Stress: Common Causes and Solutions and Understanding the Overlap Between IBS & Anxiety

Management Strategies for Fecal and Urinary Urgency and Incontinence

Let’s look at 6 treatments and approaches you can look into:

1. Pelvic Floor Therapy

• Pelvic Floor Physical Therapy (PFPT): Helps retrain the muscles controlling bowel and bladder function.
• Biofeedback Therapy: Uses sensors to provide feedback on pelvic muscle coordination, improving control over urgency and incontinence.

2. Dietary Modifications

• Low FODMAP Diet: Reducing fermentable carbohydrates can alleviate IBS symptoms, decreasing pressure on the bladder and bowel.
• Increased Soluble Fiber: Supplements like psyllium help form bulkier stools, reducing diarrhea-related urgency and incontinence.
• Avoiding Bladder Irritants: Caffeine, alcohol, artificial sweeteners, and acidic foods can worsen urinary urgency.

3. Bladder and Bowel Training

• Scheduled Toileting: Going to the bathroom at regular intervals can train the bladder and bowel to reduce urgency.
• Double Voiding: Ensures complete bladder emptying to prevent overflow incontinence.

4. Medications

• Antidiarrheals (e.g., Loperamide): Reduce stool frequency and improve consistency, decreasing urgency.
• Antispasmodics (e.g., Dicyclomine): Relax gut and bladder muscles, relieving cramping and urgency.
• Bile Acid Sequestrants: Useful for IBS patients with diarrhea caused by bile acid malabsorption.
• Bladder Medications (e.g., Oxybutynin, Mirabegron): Help relax the bladder muscle, reducing urinary urgency.

5. Behavioral and Lifestyle Modifications

• Stress Management: Cognitive Behavioral Therapy (CBT) and gut-directed hypnotherapy can help regulate the gut-brain axis and reduce urgency.
• Regular Exercise: Improves pelvic floor strength and overall bowel and bladder function, if done correctly. 
• Weight Management: Reduces pressure on the bladder and improves continence.
• Adult Diapers: Talk to your doctor about whether wearing adult diapers would help.

6. Probiotics and Gut Health

Certain probiotic strains, such as Bifidobacterium infantis, help regulate gut bacteria, reducing IBS-related inflammation and improving both bowel and bladder function.

Caveat: If you are in the Elimination or Challenge Phases of the low FODMAP diet, it is contraindicated to take probiotics at that time. Probiotics can alter your digestion of FODMAPs, which is what you are trying to assess. Please speak with a FODMAP trained dietitian before taking. (PS: Gastroenterologists are often not familiar enough with the diet and might suggest taking them).

When to See a Doctor

Seek medical advice if:

• Fecal or urinary incontinence becomes frequent or severe.
• There is blood in the stool or urine.
• Symptoms interfere with daily activities or cause significant distress.

The Takeaway

Fecal and urinary urgency and incontinence are common but often overlooked symptoms in IBS. Because they share similar nerve pathways and muscle control mechanisms, treating IBS effectively can also improve urinary symptoms. A combination of dietary changes, pelvic floor therapy, behavioral modifications, and, in some cases, medication can significantly enhance bowel and bladder control, improving overall quality of life for those with IBS.