The first and second reasons tend to go together, because you usually lose both feeling and muscle control when the nerves to the bladder or bowel are damaged. The trouble spot could be in the pelvis or spinal cord. If it is in the spinal cord you are likely to have some loss of strength and feeling in the legs as well.

Incontinence due to nerve damage can take a special form called overflow incontinence. Here the bladder muscle is so weakened that to start with you can’t pass urine at all. Then the bladder gets so full that small amounts of urine start to leak away, quite out of your control. A similar thing can happen with the bowels—they can get stretched with motions which you cannot pass. At that stage, small amounts of slimy fluid may start to come away, again, quite out of your control. This form of incontinence in the case of the bladder can be mistaken for cystitis and in the case of the bowel can be mistaken for diarrhoea. Such mistakes will not be made if a doctor or nurse examines you properly, including examining inside your rectum and your vagina with a gloved finger. In fact, this form of examination is necessary to work out the reason for every form of incontinence.

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