What is Mixed Incontinence?

There are several forms of incontinence. In urge incontinence — also called overactive bladder — the
woman experiences loss of urine that is associated with a sudden, strong desire to urinate that can't be
postponed. In stress incontinence, increased pressure in the abdomen momentarily puts physical stress
on the pelvis, resulting in urine loss. Activities such as coughing, sneezing, laughing, exercise, and even
standing up can cause leakage in women with stress incontinence.
It's common for women to experience symptoms of both urge and stress incontinence. This condition is
called mixed incontinence.
About 45 percent of women report having incontinence, and about 14 percent have mixed incontinence.

What are the causes?

Causes of Mixed Incontinence:
Mixed incontinence also shares the causes of both stress incontinence and urge incontinence.
Stress incontinence often results when childbirth, pregnancy, sneezing, coughing, or other factors lead
to weakened muscles that support and control the bladder or increase pressure on the bladder, causing
urine to leak.
Urge incontinence is caused by involuntary actions of the bladder muscles. These may occur because of
damage to nerves of the bladder, the nervous system, or muscles themselves. Such damage may be
caused by certain surgeries or diseases such as multiple sclerosis, Parkinson's disease, diabetes, stroke,
or an injury.
Other medical conditions, such as thyroid problems and uncontrolled diabetes, can worsen symptoms of
incontinence, as can certain medications such as diuretics.
Risk Factors & Complications
Mixed incontinence is more common among older women, but gender and age are not the only factors.
According to the Urology Care Foundation, risk factors of getting urinary incontinence include:
● Pregnancy and childbirth
● Chronic coughing
● Smoking
● Nerve injuries to the lower back
● Pelvic surgery
● Caucasian or Hispanic race
● Overweight or obesity

If urinary incontinence goes untreated, it can lead to infections and other problems. While physical
discomfort affects your daily life, the emotional stress of dealing with urinary incontinence is an
important factor to consider. The Urology Care Foundation, official foundation of the American
Urological Association, says many people who have urinary incontinence don’t tell anyone about their
symptoms; they’re embarrassed and believe nothing can be done, and so suffer in silence. Dealing with
urinary incontinence without treatment can affect the emotional, psychological and social life – those
who suffer are not able to live their full lives, afraid to stray too far from a toilet.

How is mixed incontinence treated?

Exercise and training
Pelvic muscle exercises (Kegels): You squeeze and relax the muscles you use to hold in and release urine.
Over time, these muscles will strengthen and keep your urethra closed.

Bladder training: You go to the bathroom at set periods of time, such as every 45 minutes. Gradually,
you increase the amount of time between bathroom visits. This helps strengthen your bladder muscles.
Medication
Your doctor may prescribe one of the following to calm overactive bladder muscles:
oxybutynin (Ditropan)
tolterodine (Detrol)
darifenacin (Enablex)
Injections of botulinum toxin (Botox) into your bladder can also calm overactive bladder muscles.
Procedures
In more severe cases of incontinence, one of the following may be necessary:
● Pessary: This isinserted into the vagina to support the vaginal walls. This can prevent the bladder
from collapsing downward on the vagina.
● Urethral inserts: These are inserted inside the urethra to help prevent leakage.
● Pelvic floor stimulation: An electric current is sent to the pelvic floor muscles that can affect the
emptying of your bladder. This stimulation causes the muscles to contract, which may improve
the closure of the urethra.
● Injections: A bulking material is injected into the area around the urethra to keep it closed and
prevent urine from leaking.
● Surgery: In rare instances, a sling procedure may be necessary. Your doctor will create a
hammock out of tissue from your own body or man-made material to support the urethra and
prevent leakage.