Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed May 14, 2026
What is mixed urinary incontinence?
Mixed urinary incontinence means you have symptoms of both stress incontinence and urge incontinence. You might leak when you cough, sneeze, or exercise (the stress part) and also feel sudden, strong urges with leaking on the way to the bathroom (the urge part). Up to half of women with incontinence have this pattern, and it’s especially common after age 50.
How it shows up
Women with mixed incontinence often notice a combination of:
- Leaking during physical activity, laughing, or sneezing
- Sudden, hard-to-control urges to urinate
- Leaking before reaching the bathroom
- Frequent bathroom trips during the day and night
One part is usually more bothersome than the other. We call that the “predominant” type, and it helps guide where we start with treatment.
Mixed incontinence is actually the most common pattern I see. The good news is that we don’t have to fix everything at once. We focus on whichever part bothers you most, and often improving one makes the other better too.
Treatment options
The first step is figuring out which type of leaking bothers you more. That conversation shapes the plan we build together.
For the stress component
- Pelvic floor physical therapy — this goes well beyond Kegels, and includes muscle coordination, relaxation, core and hip work, and breathing strategies. We have pelvic floor PTs in our office.
- Weight management
- A pessary (a removable support device)
- Urethral bulking (an office-based injection)
- A midurethral sling (a short outpatient surgery)
For the urge component
- Bladder retraining and behavioral strategies
- Dietary changes (cutting back on caffeine, alcohol, and bladder irritants)
- Medications
- Tibial nerve stimulation (a low-risk office procedure)
- Botox injections into the bladder (lasts about 6 to 9 months)
- Sacral neuromodulation, or a “bladder pacemaker” (battery lasts 10 to 15 years)
Where the two overlap
Pelvic floor therapy helps both types. Strengthening the pelvic floor improves support around the urethra (stress) and can help quiet urgency signals (urge). Research from the ESTEEM trial showed that adding pelvic floor therapy and behavioral training to sling surgery cut the need for additional treatment nearly in half, especially in women whose urgency symptoms were more severe.
What to expect
When you have both types of incontinence, it helps to set realistic expectations up front. Treating the stress part alone may not fully fix things if urgency is also playing a role, and the reverse is true too.
A sling for the stress component typically brings a big improvement. In the ESTEEM trial, both groups saw more than an 80% drop in symptom scores. But about 30% of women still needed some form of additional urge treatment after surgery. That number dropped when pelvic floor therapy was part of the plan from the start.
I have this conversation with every patient before surgery. If we do a sling, you’ll likely feel much better, but you may still have some urgency that needs its own treatment. Knowing that going in leads to better results and less frustration.
References
- Sung VW, Borello-France D, Newman DK, et al. Effect of behavioral and pelvic floor muscle therapy combined with surgery vs surgery alone on incontinence symptoms among women with mixed urinary incontinence: the ESTEEM randomized clinical trial. JAMA. 2019;322(11):1066-1076. doi:10.1001/jama.2019.12467
- Sung VW, Richter HE, Moalli P, et al. Characteristics associated with treatment failure 1 year after midurethral sling in women with mixed urinary incontinence. Obstet Gynecol. 2021;138(2):225-233. doi:10.1097/AOG.0000000000004444
- Harvie HS, Sung VW, Neuwahl SJ, et al. Cost effectiveness of behavioral and pelvic floor muscle therapy combined with midurethral sling surgery vs surgery alone among women with mixed urinary incontinence. Am J Obstet Gynecol. 2021;225(6):640.e1-640.e13. doi:10.1016/j.ajog.2021.06.099
- Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019;31(6):485-493. doi:10.1097/GCO.0000000000000584
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