Treatments for Mixed Urinary Incontinence.

Patients who suffer from an overactive bladder and stress incontinence are said to have mixed urinary incontinence. They experience loss of urine whenever they get a sudden strong urge to urinate, and urinary leakage upon coughing, sneezing or physical activity. Mixed urinary incontinence is more common in women, with symptoms of stress incontinence typically being more pronounced than symptoms of an overactive bladder.

Treatment strategies for mixed urinary incontinence include treatment modalities aimed at both of its components. The first prescribed line of treatment is pelvic floor exercises, known as Kegel exercises, combined with bladder training. Keeping a urinary diary helps to ascertain that the cause of urinary incontinence is diagnosed correctly. Pelvic floor muscle exercises are a series of contractions and relaxations preformed by the patient in order to strengthen the muscles responsible for opening and closing the bladder on demand. Strong pelvic floor muscles keep urine from leaking when the intra-abdominal pressure rises. Normally, a rise in intra-abdominal pressure is naturally and momentarily brought upon by sneezing, laughing or coughing. Weakened pelvic floor muscles ‘give way’ when the pressure rises, which is the main contributor to the development of stress incontinence. Pelvic floor muscle training also helps the patient learn to use urge suppression in order to combat the sudden, seemingly uncontrollable, urge to urinate. Pelvic floor exercises are aimed at improving both components of mixed urinary incontinence. They are very effective, but they are only effective if preformed using correct technique.

Most patients are also instructed to use a bladder training schedule as a line of behavioural modification. The patient is instructed to void the bladder at regular intervals, not when the urge hits. The intervals are determined using the bladder diary and are increased gradually first by fifteen minute increments, then by half an hour, until the bladder gets accustomed to comfortably holding urine for three to four hour intervals.

When these treatment modalities fail, physicians often resort to more invasive interventions and pharmacological measures. Some medications may be used in cases of mixed urinary incontinence to appease the hyper excitable bladder and relax the involuntary bladder muscle so as to allow the urinary bladder to hold more urine and improve its function. The most common drug class that is prescribed for mixed urinary incontinence is the anti cholinergic drug. Anti cholinergics are drugs that block the action of a chemical transmitter known as Acetyl Choline responsible for the contraction of bladder muscles. The resultant effect is that of muscle relaxation. These anti spasmodic preparations are available as formulas to be conveniently consumed once a day.

When the above measures, usually referred to as the conservative measures by the medical community, fail the physician may discuss interventional therapies or minimally invasive surgical procedures to mixed urinary incontinence patients. Most of these procedures are aimed at alleviating the stress incontinence component. The surgery used when urge incontinence is the main complaint is a bladder enlarging surgery known as augmentation cystoplasty.

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