Mixed Incontinence: What is It?

Mixed incontinence remains a condition that is poorly researched. The taboo of incontinence further reduces the likelihood of people talking about this issue. However, mixed incontinence is one of the most common forms of incontinence. Just like any other type of incontinence, mixed incontinence can disrupt a person’s day to day life.

What are the Symptoms of Mixed Incontinence?

Mixed incontinence is a combination of urge incontinence and stress incontinence. The condition is defined by the International Continence Society as “the complaint of involuntary leakage of urine associated with urgency and also with exertion and effort”. Mixed incontinence, therefore shares the causes and symptoms of both urge and stress incontinence. If you have mixed incontinence, you will experience unintentional leaks when pressure is put on the bladder in addition to a sudden urge to urinate. Working out which type of incontinence you have can be difficult, therefore it is important to understand both stress and urge incontinence. Stress incontinence is the experience of leaks when physical movement puts pressure on the bladder. This results in leakages during exercise, activities such as coughing or laughing or when lifting something heavy. Urge incontinence, on the other hand, is the urgent desire to pass urine, which often results in leaking before reaching the toilet.

Do you want to find out more about these types of incontinence? Read our blogs about stress incontinence and urge incontinence.

What Causes Mixed Incontinence?

Stress incontinence symptoms can occur when the muscles supporting the bladder are weakened. This is commonly caused by pregnancy, childbirth, surgery or radiation to the vagina, injury to the pelvis and obesity. Urge incontinence however, occurs when the bladder experiences abnormal bladder contractions. This often causes due to damaged nerves from various diseases such as Diabetes, Stroke, Multiple Sclerosis or Parkinson’s Disease.

Just like other forms of incontinence, the condition is much more common amongst elderly individuals. However, there are also many other surprising factors that cause mixed incontinence. These can include age, health factors and lifestyle habits. The Urology Care Foundation also lists smoking and having a chronic cough as risk factors for mixed incontinence.

The Psychological Impact of Mixed Incontinence

The impact of mixed incontinence on an individual’s mental health is often underestimated. According to the Urology Care Foundation, the majority of people suffering from mixed incontinence do not seek treatment due to embarrassment and fear of judgement. Previous research has shown that patients with mixed incontinence suffer from more anxiety than those with pure stress incontinence. This is thought to be due to the added emotional stress caused by common symptoms of an overactive bladder. A recent study evaluated and compared the degree of anxiety between stress incontinence and mixed incontinence. Surveyed regarding their anxiety using the Beck Anxiety Inventory Questionnaire, the mean anxiety severity score was 12.0+8.8 in the MI group compared to 7.8+5.2 in the SUI group. This alone serves as objective evidence that patients with MI often have a higher degree of anxiety than those with pure stress incontinence. Another recent study set out to compare the daily bother of incontinence in women with mixed incontinence versus pure incontinence subtypes. Women with mixed incontinence reported significantly greater bother due to their condition compared women with pure stress or urge incontinence.

Urology specialist Dr. Melville claims, “incontinence so severely affects some women’s quality of life that they may become socially isolated and embarrassed. Over time, this could lead to depression.” It is clear that more needs to be done to increase awareness of mixed incontinence. If you are suffering from mixed incontinence, it is vital to find treatment. If the condition is not treated, it can lead to many infections and other problems.

Getting Diagnosed

If you visit a Doctor about your incontinence, effective history-taking of your health is vital. It is useful to take a bladder diary to the Doctor, which records your incontinence leakages. In your bladder diary, you should keep a record of any leakages. Make a note of the fluids you consumed, how much you urinated and whether you did any activities that put pressure on the pelvic floor muscles.

Your Doctor will conduct an initial test to diagnose the issue. They are likely to perform one of the following diagnostic tests:

-Urine Test. This will help Doctors will out whether you have a urinary tract infection that is causing symptoms.

-Urine Volume Test. A doctor will need to determine the amount of urine left in the bladder after urinating.

-Neurological Exam. The doctor will be able to determine if symptoms may be caused by dysfunction in nerves.

-Bladder Examination. The Doctor will use a camera to examine the bladder and urethra

As mixed incontinence consists of both stress and urge incontinence symptoms, treatment for the condition may require multiple treatment modalities. When looking for treatment, it is ideal to consider whether the stress or urge incontinence symptoms are the most troublesome. If stress incontinence symptoms affect you more than urge, a Doctor is likely to use the option of surgery as a last resort. Do not worry if you are diagnosed with mixed incontinence; there are numerous methods of treatment your Doctor can recommend. Your Doctor is likely to recommend non-surgical methods first, which can include pelvic floor muscle exercises and bladder training. There are various options of medications, devices and surgery procedures that may be recommended depending on your circumstance.

In addition to finding treatment, you can also try some lifestyle changes that can lessen the symptoms of your mixed incontinence. The impact of caffeine on your bladder is often underestimated. It can be a severe bladder irritant, therefore you should avoid drinks that contain a lot of caffeine, such as coffee and tea. Smoking is also an activity that irritates the bladder and can worsen the condition. Lastly, do not be tempted to stop drinking water. This can cause dehydration, which can be dangerous to your health and irritate the bladder further.

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