Mixed incontinence happens when someone has more than one type of urinary incontinence at the same time. The two types are stress and urge. Stress type means that urine leaks because of pressure in the bladder or pelvic muscles. Urge-type implies an urgent need to go without warning, but it's not always possible to make it to the toilet on time.
Sometimes people with urge urinary incontinence can also have stress leakage or vice versa depending on where they are in their menstrual cycle or other medical conditions such as diabetes, gastroesophageal reflux disease (GERD), and overactive bladder syndrome (OAB).
What Is Incontinence?
Urinary incontinence can occur due to several factors, but the most common cause is an overactive bladder. When your bladder contracts and pushes urine out without you realizing it or intending for it to happen, this condition might have taken hold. Over 3.3 million Canadians suffer from urinary incontinence on some level, with about 33% having symptoms that are severe enough they require professional help to find relief from their symptoms.
As you age, your bladder muscles start to lose some of their strength, which is why you're more likely to develop a form of incontinence over the age of 65. This can lead to urgency and leakage and difficulty controlling when the need for urination arises, even when you are sleeping. Roughly half of Canadians 65 and over report feelings of urgency, urinary leaking, or both.
What Are the Types of Incontinence?
There are five common types of incontinence diagnosis:
Stress Incontinence: Stress incontinence is the sudden urine leakage due to pressure on your bladder when you sneeze, cough, laugh, lift heavy objects, exercise. Stress urinary incontinence can happen even if you don't have a medical condition that causes it.
Urge Incontinence: Urge incontinence, or overactive bladder (OAB), is a common type of urinary tract disorder that causes you to leak urine after feeling an intense and sudden urge to go. You may have OAB if you need to go to the bathroom eight times in one day and more than once at night. Or this could be dry form: even though there's no longer any fluid left inside your bladder, it still feels like you want to urinate.
Mixed Incontinence: Mixed incontinence is a combination of stress and urge incontinence. It is more common in women due to their hormones affecting bladder muscles.
Overflow incontinence: Overflow incontinence is when you cannot empty your bladder completely, resulting in leakage when your bladder is full. This is more common in men struggling with an enlarged prostate, which blocks urine flow out of the bladder.
Functional incontinence: Functional incontinence occurs when a mental or physical condition such as arthritis restricts you from going to the bathroom in time.
Incontinence can be chronic or transient. Chronic incontinence occurs over the long-term but is often treatable, whereas Transient incontinence goes away after treating the cause.
What Differentiates Mixed Incontinence from Urinary Incontinence?
Mixing bladder disorders can make the symptoms difficult to manage. Women are more likely than men to have incontinence in general. About 45% of women report having some form of it, and 14% experiencing mixed types that often involve both urge-based and stress-related events like laughing or sneezing.
Common Symptoms of Mixed Incontinence
Mixed incontinence is a combination of stress and urge incontinence. You may have mixed urinary control if you often experience urine leakage when you:
- Lift something heavy
You may also endure urine leakage after the sudden urge to urinate or experience Nocturnal Enuresis (Bed-Wetting). Some people also have issues with mixed incontinence when they drink a small amount of water or touch or hear it run.
What Causes Mixed Incontinence?
Mixed incontinence can be caused by various factors stemming from both stress incontinence and urge incontinence.
Stress incontinence results from childbirth, pregnancy, menopause, obstruction, prostate cancer, chronic sneezing and/or coughing and other factors that have led to weakened muscles that support and control the bladder. If there is increased pressure on the bladder, stress incontinence can also occur.
Involuntary actions of the bladder muscles cause urge incontinence. This could be due to nerve damage in the bladder, the nervous system, or muscles themselves. Such impairment may be caused by injury or surgery to the rectum, prostate, or vagina or conditions such as multiple sclerosis, Parkinson's disease, diabetes, or stroke.
Thyroid problems and uncontrolled diabetes can magnify incontinence symptoms, as can medications such as diuretics.
What Complications Arise with Mixed Incontinence?
According to the Mayo Clinic, complications of chronic urinary incontinence include:
- Rashes, skin infections, and sores can occur from constantly wet skin.
- Incontinence increases your risk of recurrent urinary tract infections.
- Urinary incontinence can affect your social, work, and personal relationships.
Can You Prevent Mixed Incontinence?
While mixed incontinence isn't entirely preventable, there are some lifestyle changes you can make to prevent it from becoming a significant stressor. Ways to prevent or curb your incontinence include:
Limiting fluids: Drink only a small amount and stop drinking at least two hours before bedtime.
Avoid drinks: Caffeinated soda, alcohol, and coffee all make you go more often.
Increase your fiber intake: Eat fresh fruits, vegetables, and whole grains to prevent constipation, which can cause urine incontinence.
Avoid irritable bladder foods: Steer clear from citrus fruits, acidic foods, spicy foods, and any artificial sweeteners.
Maintain a healthy weight: Being overweight puts extra pressure on your bladder.
How to Treat Mixed Incontinence
The treatment for mixed incontinence will require a combination of approaches used to relieve both stress and urge. There is no single solution that works for everyone, so the treatments you choose with your doctor depend on the severity and what kind of lifestyle or preferences you may have.
Treating the pelvic floor is a specialized aspect of physical and occupational therapy. The muscles in this area can be weakened to different degrees, leading to problems such as urinary frequency or incontinence. Patients typically attend in-office appointments 2-3 times per week for 12 weeks. Treatment requires manual digital manipulation of the pelvis, vagina, and/or rectum's external and internal tissues, effectively relieving pain caused by pelvic floor dysfunction (PFD).
Treating your pelvic floor requires special training by an experienced therapist who will explore potential concerns with you before beginning treatment plans. Depending on the severity of your mixed incontinence, your treatment might involve kegel exercises at home for strengthening these areas, education on what causes issues and how they affect people's daily lives, or expert advice on surgical treatment if needed.
Medically Inserted Devices
Medical devices help build and strengthen pelvic floor muscles, treating the root cause of incontinence instead of just managing its symptoms.
According to the Mayo Clinic, "gentle electrical stimulation can be effective for stress incontinence and urge incontinence, but you may need multiple treatments over several months."
This can include the use of Electrical Muscle Stimulation, Sacral Neuromodulation Therapy (Interstim), Percutaneous Tibial Nerve Stimulation (PTNS), or InControl Medical Attain and Medtronic InterStim devices.
There are currently no medications explicitly marketed for the treatment of stress urinary incontinence. However, several experimental drugs in development can help relax and soothe a bladder when it becomes overactive.
Botox is a popular and effective treatment for those who suffer from urge incontinence, which does not respond to other treatments. Botulinum toxin A paralyzes bladder muscles to decrease unwanted organ spasms; this can be seen as early as seven days after injection with maximum relief often lasting six-12 months following repeat injections.
Surgery can be used to restore the normal position of the bladder, neck, and urethra. Two main types are available, including sling procedures and bladder neck suspension operations (or VP-NL). The effectiveness of each kind of urinary incontinence surgery is still being debated in clinical circles, so you should discuss your options with a professional before making any decisions about which surgery will work best for you.
Relying on Products
If you or a loved one struggles with incontinence, chances are you are already aware of the products out there. Items such as adult diapers, panty liners, and more are widely available on the market, and products like bed pads and chair pads ensure comfort and modesty. We invite you to shop MIP Cares' line of reusable incontinence products.