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.

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.

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After surgery you will want to get back to your normal routine as soon as possible. However, gynaecological surgery can have an incredible impact on pelvic floor muscles, with many women often finding that they feel weak, unsupported, or de-conditioned in the weeks following their operation. Doing regular pelvic floor exercise sessions several times a day, straight away after your surgery, will help the healing process by improving blood circulation to the area, reducing swelling, and strengthening your muscles so they can support you. The next step is to build up good muscle strength and endurance again which you need for secure bladder and bowel control. Exercises will also improve the muscle tone which we need to prevent pelvic organ prolapse, to feel supported.

In the first 12 weeks after your surgery, you should perform pelvic floor exercises, but as the body is healing and sensations can be altered, it is not advised to use a muscle STIM device. Instead, perform your Kegels independently. However, after 12 weeks post-op, it is safe to use the Kegel8® Ultra 20 and follow the simple 12-week plan, which promises more effective pelvic floor exercise. The Kegel8 Ultra 20 V2 Electronic Pelvic Toner removes the guesswork and essentially acts as a Sat-Nav for your pelvic floor muscles, correctly targeting and stimulating a contraction within them using a small electric current. These contractions build strength and tone in a matter of weeks! With 20 clinically proven pelvic floor exercise programmes which vary in frequency, intensity and duration, the Ultra 20 is proven to treat a variety of different conditions and has been shown to be effective for rehabilitation post-surgery. And, in addition to tailored programmes, the specific 12-week exercise plans created by Amanda Savage advise exactly how the device should be used, depending upon the user’s specific requirements/condition, to ensure the very best treatment.

You’ll find an easy 12-week exercise plan created by Amanda Savage to aid pelvic floor rehabilitation post gynaecological surgery included with your Kegel8 Ultra 20. It utilises a unique combination of programmes to help the healing process by improving blood circulation to the area, reducing swelling, and strengthening your muscles so they can support you. It subsequently builds up good muscle strength and endurance again, which is needed for secure bladder and bowel control, and it will calm the ‘jumpy’ nerves responsible for a sensitive bladder. This plan will also improve the muscle tone which we need to prevent pelvic organ prolapse, to feel supported.

Sources

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: https://www.scielo.br/j/ramb/a/RPNPsYzMrqjhNJfYfDJVv5t/?lang=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/pubs/afp/issues/2013/0415/p543.html

National Association For Continence. (2017). Mixed Incontinence. [online] NAFC, 2017. [viewed 19/04/18]. Available from: https://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