Mixed incontinence is a combination of urge and stress incontinence. It's diagnosed when both forms of incontinence produce symptoms and result in involuntary actions of the bladder muscles, such as a loss of urine or a sudden, urgent need to urinate. For more information, here's everything you need to know about mixed incontinence.
Causes of Mixed Urinary Incontinence
Several things can result in urge and stress incontinence, but the underlying cause of one may not be the same as the other. The difference in mixed incontinence is that you experience both forms at once.
Stress incontinence occurs when there's involuntary urine leakage during activities that increase abdominal pressure, such as coughing, sneezing, laughing, or exercising. The most common causes of stress urinary incontinence include the following:
- Weakening of pelvic floor muscles and tissues that support the bladder and urethra.
- Vaginal delivery during childbirth, which can stretch and damage the muscles, ligaments, and nerves of the pelvic floor.
- Decreased estrogen levels during menopause can thin and weaken the tissues in the urethra and bladder.
- Conditions like chronic bronchitis, asthma, or smoking can lead to frequent coughing, increasing abdominal pressure, and stressing the pelvic floor.
- Excess body weight increases pressure on the bladder and pelvic floor muscles.
- Surgeries, particularly those involving the pelvic organs (e.g., hysterectomy or prostate surgery).
- Natural aging processes can lead to a decline in muscle tone and function.
- Regular participation in heavy lifting, running, or jumping activities.
- Chronic constipation and straining during bowel movements.
- Trauma to the pelvic area, such as from an accident.
The causes of urge incontinence don't typically overlap with those of stress incontinence, except when it comes to aging and hormonal changes during menopause. Some of the most common causes of urge incontinence include the following:
- Overactive bladder muscles with involuntary contractions result in a strong and sudden urge to urinate.
- Diseases and conditions that affect the nervous system, such as Parkinson's disease, multiple sclerosis, stroke, or spinal cord injuries.
- Urinary tract infections (UTIs), which irritate the bladder lining.
- General bladder lining irritation due to factors like bladder stones, tumors, or inflammation (cystitis).
- Diuretics or medications that affect the nervous system.
- Decreased estrogen levels after menopause.
- Benign prostatic hyperplasia (BPH).
- Diabetes can affect bladder control if nerve damage has occurred.
- Ingesting bladder irritants like coffee and alcohol.
- Aging can lead to changes in bladder function, including reduced bladder capacity and increased involuntary contractions.
Symptoms of Mixed Incontinence
Symptoms of mixed incontinence will include symptoms of both stress and urge incontinence. To ensure you get the proper treatment, see your doctor if you notice any of the following symptoms:
- Urine leakage when you sneeze, laugh, cough, exercise, lift something heavy
- A strong and sudden urge to urinate that often results in leakage
- Increased urinary frequency
- Urine leakage after drinking only small amounts of water
- Urine leakage while you're sleeping
- Waking up to use the bathroom two or more times (nocturia)
- Urine leakage when you hear water running or when you touch water
How Are Stress Incontinence and Urge Incontinence Diagnosed?
Understanding the cause of each type of UI is important to determining the appropriate treatment, which is why your doctor will begin with a few diagnostic tests. Your doctor will likely start by performing a physical examination and asking about your family health history.
Then, your doctor may have you keep a diary for a day or two that includes a detailed record of when you urinate, your urine output, and any details you may find important (i.e., food or drinks ingested, location, feelings of stress). This can give them a better idea of your symptoms and whether incontinence may be causing them. After reviewing, your doctor will likely perform one or more of the following:
- Urinalysis
- Ultrasound
- Cystoscopy
- Bladder Stress Test
- Catheterization Test
If your doctor believes that incontinence symptoms are caused by problems with the bladder nerves, they may recommend that you see a neurologist for further testing.
Treatment for Mixed Incontinence
The best treatment is often a mixture of several different options. Your doctor may recommend starting with lifestyle changes or behavioral modifications, but in severe instances, surgery may be the right choice. Always discuss your options with your doctor beforehand, and if you have any questions or concerns, don't hesitate to ask. Some potential treatment options for mixed incontinence include the following:
Behavior Modification
Diet and lifestyle can have a big impact on bladder control. Some people may find that acidic foods can trigger urgency or cause irritation that may result in problems with incontinence. Adjusting your diet can help; your doctor may also recommend reducing caffeine and alcohol intake. If you're a smoker, quitting is also a great way to ease symptoms of UI. If you're overweight, working with your doctor to lose a few pounds can also help relieve some of the pressure on the pelvic floor muscles, which has also been shown to treat or manage UI effectively.
Contrary to what you might think, increasing fluid intake may help with incontinence. When you're dehydrated, your urine is more concentrated and acidic. This can further irritate your bladder, leading to involuntary urine loss throughout the day.
Bladder Training
Another option is to try bladder training. Your doctor will work with you to create a schedule that will help you manage the sense of urgency over time. Typically, it starts with going to the bathroom every one or two hours, regardless of whether you feel the need to go. Once you feel comfortable, you can start gradually increasing the time between your bathroom visits. This can help you feel more confident about managing bladder leakage when traveling or somewhere with limited access to the bathroom.
Biofeedback Physical Therapy
The pelvic muscles that support your bladder, urethra, and rectum can weaken over time, resulting in a bigger risk of incontinence. However, like any muscle, these can be trained and strengthened with strategic exercises like Kegels. Although Kegel exercises can be quite simple in theory, it might be difficult to know whether you're pinpointing the correct muscles. If you're unsure, talk to your doctor about physical biofeedback therapy. This will give you a better understanding of whether you're activating the correct muscles, thus improving bladder control over time.
Medications
Urge incontinence can be treated with certain medications that work to relax bladder muscles and reduce spasms that contribute to urgency. One type of medication is an anticholinergic, which is an effective treatment for an overactive bladder.
However, the medication will only be effective at targeting the symptoms associated with urge incontinence, as there are currently no approved medications for stress incontinence.
Neuromodulation
Neuromodulation involves electrical stimulation to help influence nerve activity in the bladder and pelvic floor. This treatment is particularly useful for individuals who haven't found success with other treatments. There are different types of neuromodulation, including sacral nerve stimulation (SNS) and tibial nerve stimulation (TNS). They help reduce urgency and frequency by modulating the signals sent between the bladder and the brain.
Neurostimulation
Neurostimulation, often used interchangeably with neuromodulation, refers specifically to implantable devices that stimulate nerves controlling bladder function. One common type is the InterStim device, which is surgically implanted to stimulate the sacral nerves and regulate bladder control. This is usually considered when other treatments have not provided relief.
Vaginal Pessary and Other Devices
A vaginal pessary is a device inserted into the vagina to support the pelvic organs and is particularly useful for stress incontinence in women. The pessary helps to reduce the pressure on the bladder and urethra, thereby preventing leakage. There are various types of pessaries, and your doctor will help you choose the one that best fits your needs. Other devices, such as urethral inserts or slings, can also be considered depending on the severity of incontinence and individual patient needs.
Bulking Agents
Bulking agents are substances injected into the tissues around the urethra to help it close more tightly, which reduces leakage, especially in cases of stress incontinence. These injections can be done in a doctor’s office and typically involve a synthetic material, gel, or collagen. The effects may diminish over time, so repeat treatments may be necessary.
Surgery
In cases where other treatments have not been effective, surgery might be recommended. Surgical options vary depending on the type and severity of incontinence. Some options include a sling surgery, colposuspension, or an artificial sphincter. Surgery is usually only considered when other treatments have failed.
To complement your doctor's treatment plan, Byram Healthcare carries several high-quality incontinence products to help manage symptoms and improve quality of life. Contact us today to learn more about how we strive to empower our customers with the knowledge and resources they need to manage their health effectively.
