What is mixed incontinence?

Urinary incontinence terminology sometimes adds confusion to the existing troubles of the patient. There is more to a medical term, however, than just a label. Correctly identifying the type of incontinence that a patient is suffering from offers a more specific diagnosis of the problem and improves their chances of receiving the proper treatment. However, mixed incontinence is a diagnoses that may leave a patient wondering: what is mixed incontinence?

Simply put, mixed incontinence is a combination of two types of incontinence, which are the following: stress incontinence and urge incontinence. Mixed incontinence is one of the most common types of incontinence in female patients and the elderly population. The presenting symptoms of stress incontinence are the leakage of urine upon laughing, coughing or sneezing, mixed with urge incontinence symptoms. Therefore, when a patient feels the urge to urinate, the patient is also unable to hold urine long enough to reach the bathroom.

Mixed incontinence occurs because of the overlap of two distinct medical problems: bladder muscle over activity, resulting in involuntary emptying of the bladder when full, and weakening of the sphincter charged with closing the bladder. This weakened sphincter muscle results in leakage as there is an increase in the pressure on the bladder by the surrounding organs. The bladder muscle over activity, leading to the development of urge incontinence, can be caused by conditions as simple as urinary tract infections, an abnormally large urinary volume output, or by hard to treat conditions such as Alzheimer’s disease, multiple sclerosis, and Parkinson’s disease.

Usually, patients present with one set of symptoms, the most pressing, either urge or stress incontinence and may not even be aware of the other symptoms. In many instances, females with mixed incontinence complain of urine leakage during coughing or sneezing, but fail to recognize that they suffer from an abnormal urgency to reach the bathroom. In other instances, they assume the urgency to be somehow related to their stress incontinence and assume that if they treat one the other will simply go away. Because of this, mixed incontinence can present a diagnostic challenge to the doctor. This dilemma can be sorted out through careful history taking and enquiring about the circumstances where urinary leakage occurs.

Mixed incontinence is treated through a combination of the methods used for treatment of urinary stress incontinence and urge incontinence. The doctor decides on the methods of treatment according to the underlying pathologies, severity of the symptoms, and lifestyle preferences of the patient. Treatment options include behavioral modification, biofeedback, vaginal pessaries, urethral plugs, compression rings and clamps, and even surgery. Simple measures such as Kegel exercises, regularly emptying the bladder without waiting for the urge to urinate, and removing medications which exacerbate incontinence usually bring relief in mild cases of mixed incontinence.

The answers to the questions, what is mixed incontinence, and what are its presenting symptoms, have to be clear in the minds of urinary incontinence patients; because successful management begins with proper diagnosis.

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