You may not expect a condition like incontinence - which describes the involuntary loss of urine and/or faeces - to be linked with constipation, but the two can actually crossover. 

Constipation is an extremely common gastrointestinal issue, with around 24% of Aussies reported to experience chronic constipation (constipation that persists for several weeks or longer) [1].

As for how it’s related to incontinence, constipation can unexpectedly cause and/or worsen incontinence symptoms and create a challenging cycle if it’s not dealt with properly.

In this article, we’ll delve deeper into the link between these two common conditions, exploring how constipation can lead to or worsen incontinence, along with how to best manage both conditions to improve overall health and quality of life.

Understanding constipation and incontinence

Before exploring the connection between constipation and incontinence, let's get to know a bit more about each of these conditions. 

Constipation is caused by infrequent bowel movements, accompanied by difficulty in passing stool. It can arise from diet factors (not eating enough fibre), lack of physical activity, stress or trauma, some medications, and medical conditions. 

Incontinence is the involuntary loss of bowel or bladder control, causing an inability to contain faeces or urine. The level and type of incontinence will vary from person to person.

The link between constipation and incontinence

Constipation can affect both urinary and faecal incontinence. 

The gastrointestinal (digestive) system and the urinary system share several connections within the body. When constipation occurs, the hard, stubborn stool can actually put pressure on the bladder. This pressure can then affect the function of the bladder and urethra in a few ways. 

It can impact the bladder from being able to fill with urine properly, not being able to empty properly or cause it to contract when it’s not ready to. Each issue can then cause a sudden urge to urinate (urge incontinence). Some who already experience bladder leaks may notice they get worse when they’re constipated.

As for how constipation affects the bowel, it’s actually the most common cause of faecal incontinence (bowel leakage). It might seem counterintuitive that constipation can cause bowel leakage, so how does it happen? 

A hard stool can cause a partial blockage high up in the bowel, so only watery stools can get around it. This can often be mistaken for diarrhoea. Sometimes these watery bowel movements cannot be controlled and leak without going to the toilet - this is faecal incontinence. 

You can refer to the Bristol Stool Chart to identify what your stool looks like. It’s particularly helpful to then pass that information on to your doctor if you need to seek help for your constipation and/or incontinence. 

In terms of what’s considered a healthy bowel movement, this will vary from person to person. However, a general rule of thumb is that a bowel movement should be soft but well-formed and easily passed. They can be passed between one to three times a day or three times a week to be considered normal. Speak to your doctor if you’re concerned.

Constipation and the pelvic floor

Another way constipation can cause or impact incontinence is through the pelvic floor muscles.

Pelvic floor strength plays a huge role in bladder and bowel control, however, they can be weakened by straining due to constipation. When strained consistently over time, the pelvic floor will lose strength and so too can the bladder and bowel. 

Constipation can also put pressure on nerves in the pelvic region which can disrupt the signals between the rectum, bladder and brain, leading to altered sensations of urgency to use the toilet.

The constipation-incontinence cycle

You can see how the connection between constipation and incontinence can become an uncomfortable cycle.

For example, someone who already has incontinence may be hesitant to pass stool regularly for fear of leaking, but this then causes constipation.

Constipation can then cause watery stool that leaks around the hardened stool.

How to prevent and manage constipation

There are thankfully many simple ways to relieve constipation - and even alleviate some incontinence symptoms for that matter.

These include:

Stay hydrated -
Drinking enough water helps maintain healthy bowel movements. Aim to drink at least two litres a day to help your digestive system break down and pass food in the gut.
 
Eat high-fibre foods -
Certain fruits, vegetables, legumes, nuts and seeds contain fibre that helps with the size and softness of bowel movements so they’re easier to pass. Generally, men should aim for 30g of fibre a day and women for 25g. For kids, take their age and add 10 to it to work out how much they should be eating. For example, if they’re five they should be eating 15g of fibre.
 
Start exercising -
This doesn’t have to be strenuous exercise, light walks, yoga and stretching can all help relieve constipation. Aim to move your body in some way for at least 30 minutes a day if you can.
 
Use a squatty potty -
Also known as a toilet stool, a squatty potty helps get your body in the optimum position and avoid straining when passing a bowel movement. It simply goes under your feet when sitting on the toilet!
 
Ask about stool softeners -
These shouldn’t be used for long-term management of constipation, but stool softener tablets or liquid can help soften hardened stool so it’s easier to pass. Speak to your doctor or pharmacist to see if these are right for you.
 
Check your medications -
As mentioned, some medications can contribute to constipation. Ask your doctor if this could be the case for you and they may be able to offer alternatives. 
 
Do pelvic floor exercises -
If your pelvic floor is strong, it may help prevent incontinence episodes. Speak to a pelvic physiotherapist for a tailored pelvic floor exercise routine. You can also try our pelvic floor exercises for beginners. 

These lifestyle changes can help break the constipation-incontinence cycle so you can continue living your life confidently. If you’re experiencing chronic constipation and/or incontinence symptoms, always speak to your doctor for professional medical advice.