Understanding Mixed Incontinence

There are four main types of incontinence: stress incontinence, urge incontinence, overflow incontinence, and functional incontinence. Mixed incontinence refers to people experiencing two or more different types of incontinence at once. In this guide, we explain what mixed incontinence is, how your doctor will go about diagnosing it, and what you can do to treat mixed incontinence.

What Is Mixed Incontinence?

Mixed incontinence means that you have several different types of incontinence. The main types of incontinence are:

• Stress incontinence: This refers to bladder leakage that is caused by physical stressors placed on the pelvic muscles. Common triggers for stress incontinence include peeing while running, coughing, sneezing, laughing, and jumping.
• Urge incontinence: People with urge incontinence experience an overwhelming urge to urinate, followed by the involuntary loss of urine. Due to the frequent urges, they need to use the bathroom much more frequently than normal, which can really disrupt their daily life.
• Overflow incontinence: This type of incontinence occurs when you experience bladder leakage in the form of urine dribbling out of your bladder. In contrast to urge incontinence, most people with overflow incontinence don’t realize that they have bladder leakage until it is too late because they don’t get the urge to urinate.
• Functional incontinence: Functional incontinence is a secondary symptom that occurs when the urinary system functions properly, but another neurological or physical condition — such as arthritis — keeps you from making it into the bathroom in time.

Most people with mixed incontinence usually have a combination of stress incontinence and urge incontinence, though other combinations of mixed incontinence do exist. Because mixed incontinence incorporates several different types of bladder leakage, it’s important to take a multi-pronged approach to diagnosing and treating it. We’ll dive more into that in the next sections, so keep reading if you’re looking for relief.

Learn More About Bladder Leakage Here

Causes of Mixed Incontinence

Different types of incontinence are caused by different reasons. The immediate trigger for stress incontinence is a physical activity, such as coughing, sneezing, or even having sex. However, these activities don’t trigger bladder leakage in most people. So what lies behind the stress incontinence?

Stress incontinence usually occurs because your pelvic floor muscles are weak due to childbirth, lack of exercise, or other reasons. Your pelvic floor already has to do a lot of work on a daily basis to hold your organs in place and contract and release them at the right times so you can use the restroom. If those muscles are already weak, the added pressure of coughing or jumping can be too much for them, resulting in bladder leakage.

Urge incontinence occurs when your bladder muscles contract even though there might not be urine in the bladder. This makes you feel like you need to use the bathroom even if you don’t necessarily need to go yet. Urge incontinence can be triggered by many different things. An infection is the most common reason, but it can also be caused by bladder stones, nerve injuries, and other reasons.

Certain things do increase your risk of developing any type of incontinence. Age is a major factor because age-related physical changes can lead to weakened pelvic muscles that result in bladder leakage. In addition, the reduction of estrogen that occurs during menopause can cause the bladder’s lining to become thinner and more prone to irritation, aggravating incontinence.

Women who have given vaginal birth (vs. C-sections) are also more likely to develop postpartum incontinence, as vaginal childbirth puts a huge amount of stress on the pelvic floor. Previous pelvic surgery such as a hysterectomy also increases your chances of developing incontinence later on.

Being overweight can also increase your odds of developing incontinence, as the excess weight puts added pressure on your bladder. Smoking creates inflammation in your body and promotes coughing, both of which can worsen bladder leakage, especially stress incontinence. Certain neurological diseases and also diabetes can also increase your chances of developing incontinence. Finally, if you have a family history of incontinence, then you have a higher chance of developing incontinence yourself.

Diagnosing Mixed Incontinence

Since mixed incontinence involves several different types of bladder leakage at once, your doctor will work with you to sort out which types of incontinence you are experiencing and determine what the causes are behind them.

First, your doctor will want to talk about your symptoms and how often you are experiencing them. It may be helpful to keep a log for the three to four days prior to the appointment. You should track what symptoms you experience and when (i.e., urge to urinate at 10 a.m., bladder leakage after running at 5 p.m.). You should also keep track of what you eat and drink, as well as how much, as your diet can be a significant trigger for incontinence. Your doctor will also ask about your family health history to determine if there is a hereditary link.

After this, your doctor may run a series of tests to help narrow down the potential causes of your incontinence. Here is a list of some potential tests they might order:

• Urinalysis and urine culture: This test will show if you have a urinary tract infection (UTI) and if you have blood or sugar in your urine.
• Bladder stress test: This simulates the accidental release of urine caused by jumping, sneezing, coughing, and other physical activities. The test is performed while you have a full bladder, or the bladder will be artificially filled with a catheter. The doctor will ask you to cough and examine whether or not urine is released during this stress test.
• Bonney test: This is very similar to the bladder stress test, except that a finger or instrument is inserted into the vagina and used to slightly lift the neck of the bladder. This will confirm whether or not the incontinence is caused by the bladder’s neck being pushed down too far.
• Pad test: A pad test helps gauge an estimate of how much urine is leaking. The pad is weighed before and after you wear it to help medical professionals get a sense of the scale of the bladder leakage.
• X-ray or ultrasounds: These will reveal if the bladder or urethra change position during urination, coughing, sneezing, and so on. You might also see the term cystourethrogram, which specifically refers to an X-ray of your bladder and urethra during urination.
• Urodynamic testing: Usually done as part of a consultation for surgery, urodynamic testing may involve uroflowmetry, pressure flow studies, post-void residual volume, and cystometry.
• Electromyogram: Sometimes abbreviated as EMB, this test measures electrical activity in your bladder muscles.

• Cystoscopic exam: The doctor will use a thin, lighted tube to examine your urinary tract.

Managing Mixed Incontinence

You don’t have to live with bladder incontinence — mixed or otherwise. Thankfully, there is a full range of treatments that you can pursue (with medical guidance, of course) to help address the underlying causes of your incontinence. Here are some potential treatments that your doctor might recommend:

Bladder control products

While there are many effective treatments available for mixed incontinence, they do take time to take effect. In the meantime, wearing incontinence products for women such as pads, absorbent underwear, and other items can help keep you dry and comfortable while you go about your day. If you’re not sure which bladder control products you need, take our perfect product quiz to discover your ideal products and get your first two-week supply for only $2.99.

Dietary changes

Both the beverages you drink and the food you eat can contribute to incontinence. If you drink too much fluid of any kind, you will have to use the bathroom constantly, so your doctor will likely have you monitor your fluid intake (without reducing it so much that you get dehydrated, of course). You will also likely need to reduce or eliminate your consumption of beverages known to contribute to incontinence, including alcohol, caffeine, and carbonated drinks. The same goes for foods that are known for irritating the bladder and thus making incontinence worse. This includes citrus and acidic fruit, tomato-based products, spicy foods, and chocolate.

Bathroom schedules

Your doctor might recommend putting yourself on a bathroom schedule in order to manage your incontinence. A bathroom schedule works just like it sounds: you use the restroom only at specified times of day, ideally two to four hours apart. So you might decide to use the restroom when you get up in the morning at 8 a.m., again at 10 a.m., after lunch at 1 p.m., again at 4 p.m., and so on. Over time, you move your bathroom stops further and further apart until you can comfortably hold your pee for several hours.

Interval training

If you get urges far too often to put yourself on a bathroom schedule right at the start, then interval training might be a better fit for you. This involves waiting a specified amount of time after you use the restroom before you go again, and increasing this interval over time. After you use the restroom, you might wait one hour until you go again. During the next week, you can increase this to one hour and 15 minutes, and so on until you can wait two to four hours between bathroom stops without a problem. If you get an urge to go before then, try to wait at least five minutes after it passes until you head to the restroom. Over time, you can increase this waiting period to 10 minutes, then 15 minutes, and so on until you aren’t getting the urges anymore.

Bladder Training 101: Easy Tips to Get You Started

Pelvic floor exercises

Pelvic floor exercises can help strengthen weak pelvic muscles that can contribute to stress incontinence. Exercises such as Kegels, pelvic tilts, and more target the pelvic muscles when done correctly, building them the same way that push-ups build your upper body muscles. If you struggle with spasms from overly tight pelvic muscles — which can contribute to urge incontinence — then your doctor might recommend pelvic floor relaxation instead. These techniques are used to help the muscles relax out of a contracted state, reducing your chances of having a spasm.

Quit smoking

Smoking causes inflammation in pretty much all your bodily systems, and this is true of your urinary system as well. Smokers also often develop a chronic cough, which puts a lot of pressure on their pelvic floor, weakening it over time. Because of these factors, smokers are at an increased risk for developing incontinence. If you are struggling with incontinence and you currently smoke, talk to your doctor about what resources are available to help you quit.

Medication

There are many different medications available to treat incontinence, including many different types of anticholinergics as well as Mirabegron. Other drugs such as Botox for spasming muscles and estrogen creams for deteriorating vaginal tissue may also be used. Your doctor will work with you to determine if medicine is a good treatment option for you, and if so, which medications are most likely to treat your particular incontinence symptoms.

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