Understanding Mixed Urinary Incontinence in Women
Mixed urinary incontinence is a common yet complex condition that affects many women. This article will help you understand what mixed incontinence is, its causes, symptoms, and the various treatment approaches available.
What is Mixed Urinary Incontinence?
Mixed urinary incontinence (MUI) is a condition where a person experiences symptoms of both stress urinary incontinence (SUI) and urge urinary incontinence (UUI). This means you may experience urine leakage in two distinct ways:
- When physical stress is placed on the bladder (e.g., during coughing, sneezing, laughing, or exercise)
- When you feel a sudden, strong urge to urinate that’s difficult to control
Key Point
Mixed incontinence can be particularly challenging because it combines two different types of incontinence, each with its own set of triggers and treatment approaches.
How Common is Mixed Urinary Incontinence?
Mixed incontinence is more common than many realize:
- Affects approximately 30-40% of women with incontinence
- Prevalence increases with age
- Often underreported due to embarrassment or misconceptions about it being a normal part of aging
Remember, while mixed incontinence is common, it is not a normal part of aging or an inevitable consequence of childbirth. It’s a medical condition that can be managed effectively with proper treatment.
Causes and Risk Factors
The causes of mixed incontinence are a combination of factors that contribute to both stress and urge incontinence:
- Weakened pelvic floor muscles: Often due to pregnancy, childbirth, or menopause
- Neurological issues: Affecting nerve signals between the brain and bladder
- Hormonal changes: Particularly during menopause
- Obesity: Excess weight puts additional pressure on the pelvic floor
- Chronic conditions: Such as diabetes or multiple sclerosis
- Previous pelvic surgeries: Including hysterectomy
- Lifestyle factors: Including smoking, excessive caffeine or alcohol consumption
Symptoms of Mixed Urinary Incontinence
The symptoms of mixed incontinence combine those of stress and urge incontinence:
- Leaking urine when coughing, sneezing, laughing, or during physical activity
- Sudden, strong urges to urinate that are difficult to control
- Leaking large amounts of urine before reaching the bathroom
Mixed incontinence also often travels with other symptoms:
- Frequent urination (more than 8 times in 24 hours)
- Nocturia (waking up to urinate at night)
Diagnosis
If you’re experiencing symptoms of mixed incontinence, it’s crucial to consult a healthcare provider. Diagnosis typically involves:
- Medical history: Your doctor will ask about your symptoms, medical background, and lifestyle
- Physical examination: To check for any physical abnormalities or pelvic organ prolapse
- Urinalysis: To rule out urinary tract infections or other issues
- Bladder diary: You may be asked to keep a log of your fluid intake, urination frequency, and incontinence episodes
- Urodynamic testing: In some cases, to measure bladder pressure and urine flow
- Cystoscopy: A scope may be used to examine the inside of your bladder and urethra
Treatment Approach
Treating mixed incontinence can be challenging because the two types of incontinence often require different treatment approaches. The general strategy is to:
- Identify which type of incontinence (stress or urge) is more bothersome
- Treat the most bothersome type first
- Address the other type of incontinence if symptoms persist
Important Note
In most cases, the urge component is treated first because it often involves large volume leaks and can be more disruptive to daily life.
If you’re unsure which type of incontinence is more bothersome, keeping a detailed bladder diary can be extremely helpful in identifying patterns and severity of symptoms.
Treatment Options
Treatment for mixed incontinence may include a combination of approaches:
Conservative Treatments
- Pelvic floor exercises (Kegels): Strengthen the muscles that support your bladder
- Bladder training: Techniques to increase the time between feeling the urge to urinate and passing urine
- Biofeedback: Helps you identify and control your pelvic floor muscles
- Pelvic floor physical therapy: Specialized therapy that combines various techniques, including exercises, manual therapy, and education, to improve pelvic floor function and overall bladder control
Lifestyle Changes
- Weight loss: If overweight, losing excess pounds can reduce pressure on the bladder
- Fluid management: Avoiding bladder irritants like caffeine and alcohol
- Scheduled toilet trips: Going to the bathroom at set times, rather than waiting for the urge
Medications
- Anticholinergics or beta-3 agonists: For urge symptoms
- Topical estrogen: For postmenopausal women, may help improve urethral and vaginal tissue health and decrease bladder irritation
Devices and Products
- Vaginal pessaries: Support devices inserted into the vagina to reduce stress incontinence
- Disposable vaginal inserts: Small tampon-like devices inserted into the vagina before activities
- Absorbent products: Pads or protective underwear for managing leaks
Advanced Therapies
- BOTOX injections: Can help relax the bladder muscle for urge symptoms
- Percutaneous or implanted tibial nerve stimulation: A form of neuromodulation that may improve bladder control in patients with urge symptoms
- Sacral neuromodulation: Implanted device that stimulates the nerves controlling the bladder - can help with urge urinary incontinence (and fecal incontinence)
- Bulking agents: Substances injected around the urethra to help close the sphincter and improve stress incontinence
Surgical Options
- Sling procedures: For stress incontinence symptoms
- Colposuspension: Another option for stress incontinence
Remember
Treatment plans are highly individualized. Your healthcare provider will work with you to find the best approach for your specific situation.
Living with Mixed Urinary Incontinence
While seeking treatment, there are strategies to manage mixed incontinence in your daily life:
- Use absorbent products for peace of mind
- Wear easily removable clothing for quick bathroom access
- Locate bathrooms before you need them when out in public
- Practice both pelvic floor exercises and relaxation techniques
- Stay hydrated, but limit fluids before bedtime and activities
Take Action!
If you’re experiencing symptoms of mixed urinary incontinence:
- Don’t be embarrassed – it’s a common, treatable medical condition
- Keep a detailed bladder diary to share with your healthcare provider
- Schedule an appointment with a urogynecologist or pelvic health specialist
- Be open about your symptoms and how they affect your quality of life
3-day diary
Download and print three copies of bladder diary to bring to your first visit with Dr. Stewart. This will help us better understand your symptoms and develop a personalized treatment plan.
Remember, mixed urinary incontinence may be common, but it’s not something you have to accept as a normal part of life. With the right care and treatment, you can significantly improve your symptoms and quality of life.