Effective Treatment Strategies for Mixed Incontinence: Finding the Right Solution for You

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When it comes to researching incontinence, you’ll discover a multitude of types, including a combination of “this” and “that” symptoms. In such cases of mixed incontinence, it becomes crucial to determine the appropriate treatment since many are very specific to a particular type. Additionally, understanding why symptoms change with age can provide valuable insights. Amidst the wealth of available information, confusion about urinary incontinence and its various forms can persist. By gaining a clear understanding, you can better comprehend which mixed incontinence treatment options can improve your life and reduce the number of different treatments.

What is Urinary Incontinence?

Urinary incontinence refers to the common problem of losing bladder control (as opposed to fecal incontinence, which is less common). Individuals affected by urinary incontinence experience involuntary urinary leaks, impacting them physically, emotionally, and psychologically. While urinary incontinence can manifest in several ways, the most prevalent types are explained below.

Identifying Your Type of Incontinence:

As you understand the types of symptoms that resonate with your experience, validated questions can make it easier to diagnose. Consider whether you answer “yes” to the following:

  • “Is it very difficult to control when you have a strong urge to urinate?” If so, you likely have urge incontinence.
  • “Do you lose urine with physical activities such as coughing, sneezing, or running?” If this applies to you, stress incontinence is likely the type you have.
  • “Do you have both the above?” Then you have mixed incontinence.

Understanding Stress Urinary Incontinence (SUI):

Stress Urinary Incontinence (SUI) occurs due to weakened pelvic floor muscles, including the urethral sphincter responsible for holding urine in the bladder. When external stimuli such as laughing, coughing, or jumping exert pressure on the bladder, urine is involuntarily released. SUI commonly leads to urinary leaks after sneezing, laughing, or exercising. It affects people of all ages, including teens and individuals in their 20s, particularly due to high-impact sports and childbirth.

Exploring Urge Urinary Incontinence (UUI):

Urge Urinary Incontinence (UUI) causes an involuntary loss of urine after experiencing an intense and sudden urge to urinate, even when the bladder isn’t full. This urgency, often accompanied by bladder spasms, results from overstimulated nerves triggering the surrounding bladder muscles to squeeze. UUI is also referred to as overactive bladder. If you can reach the toilet in time, it is considered urgency and increased frequency of bathroom visits. However, if accidents occur, it becomes UUI. Nocturia, which refers to waking up multiple times at night to urinate, can also be a manifestation of UUI. Sleep deprivation caused by Nocturia can negatively impact physical and mental health. UUI usually begins later in life, typically affecting individuals in their 50s and beyond.

Understanding Mixed Incontinence:

Mixed incontinence is a common occurrence in women, encompassing symptoms of both stress and urge incontinence. According to data from the National Health and Nutrition Survey, approximately 35% of women experience both stress and urge incontinence, or mixed incontinence. When considering the definition of urgency (overactive bladder), it is not considered incontinence if one can reach the toilet in time. In contrast, the inability to reach the toilet without an accident indicates a weakened urethral sphincter, which is why mixed incontinence represents the second-largest group after stress incontinence.

Often women may have more severe stress incontinence, but it is the urgency that is most bothersome and restricts their quality of life, since they need to be near a bathroom. Unfortunately, treatments are often geared for one or the other type of incontinence, and since mixed incontinence doesn’t seem to have a clear treatment (until you read to the end of this article), people with mixed incontinence often are paralyzed and get no treatment at all!

When you have SUI

When you have urgency OAB

How Can Mixed Incontinence Be Treated?

Living with mixed incontinence may seem overwhelming, but there are effective treatment options available. It’s important to note that addressing the more severe condition first may be the best approach, as the underlying causes of stress and urge incontinence differ. The recommended treatments may vary based on the severity of your incontinence. Additionally, there is a treatment option that specifically targets both stress and urge incontinence. Let’s explore some common treatments:

Behavioral Modification: Bladder training can be beneficial in reducing UUI leaks by following a structured bathroom schedule. The goal of bladder training is to gradually increase the time between bathroom visits, allowing the intense urge to diminish and leaks to become less frequent. During this process, it’s advisable to have protection against leaking, as accidents may still occur as your bladder adjusts to the new schedule.

Kegel Exercises: Kegel exercises are essential for strengthening the pelvic floor muscles, providing improved bladder control for SUI, and potentially helping with UUI. By toning the weakened pelvic floor muscles that support the bladder, uterus, and rectum, these exercises can alleviate present incontinence symptoms and prevent them from worsening. Performing Kegel exercises correctly and consistently is vital for their effectiveness. Visualizing the exercises correctly can be challenging, so using a Kegel device can help maintain proper form and technique.

Biofeedback: Biofeedback is a technique that assists in performing pelvic floor exercises correctly and learning bladder control. It employs computerized graphs or other visual aids, often with a vaginal probe, to provide feedback on the accuracy and strength of your pelvic floor muscle contractions. If you’re uncertain whether you’re performing Kegel exercises correctly, biofeedback can help ensure proper form and technique. Note that there are alternative, less expensive forms of biofeedback devices available, but they may not have FDA approval for incontinence treatment.

Electrical Stimulation: Electrical stimulation involves using gentle electrical pulses to stimulate the pelvic floor muscles, effectively performing Kegel exercises on your behalf. There are various FDA-cleared prescription and over-the-counter options for electrical stimulation. These devices eliminate the guesswork associated with Kegel exercises by automatically and accurately delivering the necessary muscle contractions. E-Stim can also send out different pulses to calm the overactive bladder or urgency.

Medications: While no medicines have been approved to treat stress incontinence, there are medications available for managing urge incontinence. Anticholinergic drugs can help alleviate symptoms by relaxing the bladder and reducing spasms. Unfortunately, they often have many side effects.

Surgery: Surgery is an option for incontinence; however, it should be considered a last resort due to the associated risks. Different surgical procedures apply to SUI or UUI. For instance, UUI may be treated with implants placed in the lower back that emit electrical signals to combat symptoms. SUI may involve physical manipulation of the urethra through sling surgery, although the use of mesh in this procedure has decreased due to negative side effects and associated complications. Before considering surgery, it’s crucial to understand the process, recovery, and potential risks or side effects.

Real Solutions for Mixed Incontinence:

Finally, some devices can treat symptoms of mixed incontinence. As previously mentioned, electrical stimulation can treat both, and only one device, ELITONE, sends out signals to both tone pelvic floor muscles as well as calm the overactive bladder. External and easy to use, it is also FDA-cleared and has almost no side effects which makes it a clear winner.