Introduction
A condition where urine is leaked involuntarily, be it little leaks or the total emptying of the bladder, is called urinary incontinence. It is a common problem found among women and the elderly. Mixed incontinence is one of the many types of urinary incontinence. It can be embarrassing and can negatively impact the quality of life. However, it can be treated and managed appropriately.
What Is Mixed Incontinence?
There are three main types of urinary incontinence which include stress, urge, and overflow incontinence. When a patient has a combination of at least two incontinence, they are said to have mixed incontinence. The patient might show symptoms of stress and urge urinary incontinence together. They may also leak urine with exertion, effort, sneezing, or coughing. Studies show that about 30 percent of women have mixed incontinence following childbirth or as they age. It can negatively impact their quality of life as well. Healthcare professionals find it difficult to be treated, as they have more than one cause. Identifying them accurately can be challenging.
What Are the Symptoms of Mixed Incontinence?
Since mixed incontinence shows the symptoms of a number of urinary incontinence, it can be confusing. The symptoms of one is more troublesome than the other type. The common symptoms can include:
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A sudden urge to pass urine, followed by the inability to control the bladder losing urine.
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An urge to pass urine even after taking small amounts of liquids.
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Passing urine while asleep.
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Passing urine while sneezing, coughing, or laughing.
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Urge to pass urine or loss of urine while exercising or lifting heavy weights.
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An urge to pass urine while hearing the sound of flowing water or touching water.
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Leaking urine while walking, running, or trying to stand up.
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Loss of bladder control during sexual intercourse.
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Increase in the frequency of urination, more than eight times in a day.
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Nocturia (urge to pass urine frequently at night).
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A sudden urge to pass urine though the bladder is not full.
What Are the Causes of Mixed Incontinence?
There can be different causes for mixed urinary incontinence. It can be similar to that of stress or urge incontinence. They can include:
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An injury or following surgery in the prostate, vagina, or the rectum.
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Pregnancy and delivery.
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Multiple sclerosis.
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Parkinson’s disease.
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Damage to the nerves.
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Damage to the spinal cord.
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Being overweight.
How Is Mixed Incontinence Diagnosed?
Diagnosing a mixed incontinence can be challenging, as the symptoms may overlap. A detailed case history can help in diagnosing the condition. This can include the history of incontinence, past surgeries, illnesses, and medications taken by the patient. Maintaining a journal for recording the symptoms can be helpful.
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Physical Examination: Physical examination, especially in the pelvic area, is done to find out the exact cause. It can depend on the history of the patient and any medical condition they might have. The strength, sensation, and reflexes in the legs can be evaluated through a neurological examination. A pelvic examination will help to asses any pelvic prolapse (a condition where an organ in the pelvis pushes down and bulges into the vagina). The strength of the muscles in the pelvic floor, particularly the ability to contract and relax the appropriate muscle group, is assessed by a pelvic floor muscle assessment.
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Urine Tests: Post-voiding residual urine assessment helps to understand the volume of urine left behind in the bladder after voiding. This can give information about the bladder’s ability to empty completely. A urinalysis will help to know the presence of blood, sugar, crystals, or any signs of infection. If there is a sign of infection, a urine culture will help to understand the pathology of the infection and get it treated accordingly.
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Stress Test: The patient is asked to perform maneuvers like coughing, sneezing, trying to stand up, etc., after filling the bladder. It can help to diagnose stress incontinence.
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Cystometrogram: The bladder is filled with fluid using catheters placed in the bladder and vagina or rectum. It helps to evaluate the perception of water filling in the bladder, any urgency to urinate, and uncontrollable bladder contractions. It also assesses the volume at which the bladder can not comfortably hold any more fluid and the pressures within the bladder during the fluid storage process.
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Uroflowmetry: The rate of urine flow and the duration of urination are measured using this test.
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Cystoscopy: The internal anatomy of the bladder and the urethra is viewed using a camera in this procedure. It helps to find out the presence of any pus cells or blood in urine, infections in the bladder, any foreign body in the bladder, or any other abnormality that can cause incontinence.
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Imaging Studies: A CT (computed tomography) or an ultrasound of the abdomen and pelvis may be advised. Intravenous pyelogram (IVP) is an imaging test done after injecting a contrast dye into the patient’s bloodstream. The entire urinary tract is viewed to check for any abnormalities.
How Is Mixed Incontinence Treated?
A combination of treatments might be required, as the condition involves more than one type of urinary incontinence. It can include
Behavioral Treatments: They are simple and self-directed treatment options that can be combined with other methods. It has been proven effective in many cases. It can include:
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Bladder Training: This aims at increasing the interval between the voiding and filling of the bladder. It can help to reduce urgency and the chances of leakage. The patient is advised to void at fixed intervals, irrespective of whether they have the urge. If the patient feels an urge before the interval, they are advised to practice relaxation techniques and other methods, like Kegel exercises, to suppress the urge. The interval is increased gradually as the patient gains control over the bladder.
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Biofeedback: This method helps the patient to strengthen and control their bladder muscles, thereby preventing leakage. It has been effective in treating urinary incontinence in many people.
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Urge Suppression: This helps control the urge to urinate and delays visits to the washroom.
Electric Stimulation: In this method, electric currents are used to stimulate the inactive muscles in the bladder. This prevents the bladder from voiding inappropriately, preventing leakage of urine.
Percutaneous Tibial Nerve Stimulation (PTNS): The nerves give signals to the muscles to contract and relax for voiding. Hence, by controlling these nerves, unnecessary leakage of urine can be prevented. It is done by a minimally invasive surgical procedure.
Botox Bladder Injections: Urge incontinence that does not improve with medications or other conservative therapies is treated using Botox injections. It paralyzes the bladder muscles, thereby reducing bladder contractions. Patients usually see improvement after six days of getting the injection, and it lasts six to twelve months.
Surgery: When all other methods to treat urine incontinence remain fruitless, surgery can be the last resort. The procedure can depend on the severity and duration of the condition.
Conclusion
A condition where a person leaks urine due to more than one type of urinary incontinence is termed mixed incontinence. Diagnosing it can be challenging, as the symptoms of the conditions overlap the symptoms of many types of urinary incontinence. However, it can be diagnosed and treated effectively with the help of an experienced healthcare professional.
