Mixed Urinary Incontinence
Mixed urinary incontinence (UI) is the involuntary and urgent leakage of urine as a result of exertion; such as sneezing, exercising and coughing. It is a combination of both stress UI and urge UI, and as such is considered to have a greater impact on quality of life than each of them separately, with 32% of sufferers aged 40-64 reporting symptoms of depression.
There are many treatments available for mixed incontinence, with both those for stress UI and urge UI benefiting you. So there is no reason to allow your incontinence to go untreated for longer than needed. Even though it is not life threatening, it can greatly reduce your quality of life as it develops into fully emptying your bladder each time it is put under pressure.
Symptoms of Mixed Urinary Incontinence
If you suffer from mixed UI, you may leak urine:
- if you touch or hear running water
- when you have drank only a small amount of water
- when you are asleep
- when you sneeze, cough or laugh
- when you are exercising
Causes of Mixed Urinary Incontinence
The detrusor smooth muscle is the main muscle in the bladder wall, it contracts to expel urine from the body, otherwise it is relaxed to allow the bladder to fill with urine. To urinate the urethra relaxes in coordination with the bladder contracting, otherwise the urethra is empty and unconsciously contracted to prevent leaks. Issues with bladder functionality always relate to the coordination and efficiency of these organs; as a result of physcological issues, damage to the associated nerves, a weak pelvic floor, and/or a change in hormones.
Mixed UI is caused by an over activity of the detrusor muscle (detrusor instability), meaning it contracts more often than required and can spasm when you sneeze, cough or exercise. You may be unaware of it occurring or unable to suppress it, resulting in a leak or fully emptying your bladder.
There are many events that can lead to the detrusor muscle not functioning correctly:
- Pelvic organ prolapse - 25% of women suffering from a later stage pelvic organ prolapse will experience mixed UI as the bladder and urethra become unsupported by the pelvic floor and more vulnerable.
- Pelvic surgery - Even during surgeries that do not directly include the bladder or urethra, nerve damage to the surrounding area can occur through any pelvic surgery. Resulting in the detrusor muscle not functioning correctly.
- Serious health issues such as diabetes, MS or suffering from a stroke - These cause nerve damage which can lead to the bladder muscles involuntary contracting.
- Pregnancy - The extra weight of your growing baby puts strain on your pelvic floor. Combined with the change in hormones that you experience, your pelvic floor can stretch beyond its rebound limit. Leaving you more vulnerable to developing mixed UI.
- Childbirth - Even uncomplicated vaginal births and caesareans can leave you vulnerable to developing mixed UI due to the change your pelvic floor experiences during pregnancy. If you are unfortunate and experience a complicated birth, you are more likely to have suffered nerve damage which can lead to mixed UI.
- Ageing and the menopause - Hormone changes mean the pelvic muscles, ligaments and fibres lose their resilience and your pelvic floor weakens, no longer supporting the organs correctly.
- Overweight - If you carry extra weight, this pressure will consistency weigh on your bladder acting as contraction. Extra weight also weakens you pelvic floor, leaving you vulnerable to incontinence.
- Smoking - The chronic cough you will develop from smoking cigarettes weakens your pelvic floor and causes your detrusor muscle to spasm.
- Medication - Some medications unfortunately contribute to stress incontinence, for instance muscle relaxants such as Statins and anti-depressants are a lethal combination for your pelvic floor and urinary system. Hay fever medication plays havoc too. Do not stop any prescribed medications until you have consulted your GP.
To read more about these causes, and the events that can lead to you developing any form of urinary incontinence, visit the Causes and Diagnosis page.
How to Stop Mixed Urinary Incontinence
As the symptoms of mixed UI can vary in intensity and frequency, recommending treatments without examination is difficult. However, treatments include those for both stress UI and urge UI; behaviour and lifestyle changes, alongside pelvic floor muscles exercises. Surgery is available, however is reserved for extreme cases due to its comparatively low success rate at improving the condition, and its reduced success over time.
20-30% of individuals suffering from mixed urinary incontinence are considered to have chronic incontinence. This means their symptoms are unlikely to be greatly improved with conservative therapy's alone. In this situation your GP may prescribe a course of medicine as well, to help relax your detrusor muscle.
To read about the other treatments available for general urinary incontinence, visit our incontinence treatment page.
Andersson, K-E. Arner, A. (2004). Physiological Reviews. Urinary Bladder Contraction and Relaxation: Physiology and Pathophysiology. [online] 84(3), p935-986. [viewed 19/04/18] Available from: https://www.physiology.org/doi/full/10.1152/physrev.00038.2003
Chughtai, B. Laor, L. Dunphy, C. Lee, R. Te, A. Kaplan, S. (2015). Reviews in Urology. Diagnosis, Evaluation, and Treatment of Mixed Urinary Incontinence in Women. [online] 17(2), p78-83 [viewed 18/04/18] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857898/#__ffn_sectitle
Fitz, F. Sartori, M. Girão, M. J. Castro, R. (1992). Revista da Associação Médica Brasileira. Pelvic floor muscle training for overactive bladder symptoms – A prospective study. [online] 63(12), p1032-1038. [viewed 18/04/18] Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302017001201032&lng=en&nrm=iso&tlng=en
Gomelsky, A. Dmochowski, R. R. (2011). Central European Journal of Urology. Treatment of mixed urinary incontinence. [online] 64(3), p120-126. [viewed 18/04/18] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921730/
Khandelwal, C. Kistler, C. (2013). American Family Physician. Diagnosis of Urinary Incontinence. [online] 87(8), p543-550. [viewed 23/04/18] Available from: https://www.aafp.org/afp/2013/0415/p543.html
National Association For Continence. (2017). Mixed Incontinence. [online] NAFC, 2017. [viewed 19/04/18]. Available from: https://www.nafc.org/mixed-incontinence/
NICE, (2013). Urinary incontinence in women: management. National Institute for Health and Care Excellence, 2015. [viewed 18/04/18] Available from: https://www.nice.org.uk/guidance/cg171/resources/urinary-incontinence-in-women-management-pdf-35109747194821