Mixed Urinary Incontinence
Marja Sprock, MD FACOG

Mixed urinary incontinence is a combination of stress and urge incontinence. Often there is more than one reason for the leakage of urine and when not recognized it may feel like nothing helps. Mixed incontinence is one of those more challenging to recognize leakages. Urge incontinence is where you know all the bathrooms around, but often just seem to not make it in time. Stress is not caused by people stressing you out, but more the pressure of exercise, coughing or the ultimate, jumping on a trampoline. There are numerous reasons for a woman to be incontinent for urine and often more than one kind of incontinence is responsible for leakage. It is often overlooked and will lead to frustration trying to get urinary incontinence treated. You get a little better with medications or making your muscles stronger, but never seem to be as dry and continent as you would like.

The occurrence of any urine leakage at least once in the past year ranges from 25 to 45 percent in women. Obviously most women are not really worried about leakage once a year, unless it happened in the middle of a store when everybody was watching. Weekly urine leakage was reported in 10 percent of women aged 30 to 79 years. In other words it is quite common, however for some people it can severely diminish their quality of life and there is no need to just tolerate it.

The prevalence of incontinence increases with age, which means it is more common when you get older, however it also can happen in very young adults. In other words you are not alone. However your incontinence may not be the same as your sister's or your neighbor's.

The severity of incontinence, measured by how often you have to go and how much or how little you empty with a visit, also increases with age. One third of women aged 54 to 79 years, in the Nurse's Health Study, who reported urine leakage once monthly at baseline progressed to leaking at least once a week over a two-year follow-up. Daily incontinence was reported in 12 percent of US women between the ages of 60 and 64 years, and in 21 percent of women 85 years and older

Daily incontinence or leakage a couple times a week, or just the fact that you never know what to expect can severely influence your quality of life.

In general, about half of women with incontinence for urine have stress incontinence, with combined stress and urge also called mixed incontinence next common, and urge incontinence least common. These estimates change with age, with urge incontinence becoming more common when we get older.

Mixed urinary incontinence makes adequate treatment more challenging, since the stress as well as the urge incontinence will have to be recognized and treated. Typical complaints are, having tried different forms of treatment without the desired success. When and how you leak urine has a lot to do with which treatment will be more effective for you.

A good history and physical exam as well as urodynamic testing (bladder filling and trying to mimic what makes you leak) and cystoscopy (taking a peek in the bladder) in the office can aid in making the correct diagnosis. Once a diagnosis has been made correctly, treatment can be discussed and started.
In stress incontinence, the urethral area closest to the bladder stays open

When treatment is started it also needs to be understood that it consists of 2 stages. Whether the stress or the urge component of the mixed incontinence gets treated first, depends on the severity of each. It is really dependent on the patient which incontinence to treat first. Treating the stress incontinence closes "the open door" from bladder to urethra (the tube through which urine gets expelled), and treating bladder spasms/urgency will help the overactive bladder.

Once mixed incontinence has been recognized and is treated in stages, it can solve incontinence problems that had appeared to be unresponsive to therapy for years. Urinary incontinence can appear to be pretty complicated, but once the reason has been determined, can often be treated very effectively. Often small changes can make a big difference.

Your quality of life can improve significantly if you seek treatment for your urinary incontinence.

Talk with your healthcare provider about your incontinence.

Dr. Marja Sprock at Central Florida UroGynecology in Rockledge, is fellowship trained in urogynecology and has years of experience treating urinary incontinence and achieving successful outcomes.

If you are tired of leaking, wearing pads or diapers,call 321-806-3929 for an appointment or leave a note.