30-50% of women who leak urine experience “mixed” urinary incontinence, but what does this mean?
What is mixed urinary incontinence?
It’s all in the name, “mixed” incontinence is a combination of both stress and urge incontinence. Ensure you familiarise yourself with both types by heading on over to their respective articles on our website.
If you are experiencing mixed incontinence, you leak urine with urgency (a sudden need to wee) but also with exertion like coughing, sneezing, or exercising. It can be tough because you might feel like you are always leaking (or always “just about” to leak). And frustrating because you don’t fit the typical straightforward descriptions of stress and urge incontinence.
Rest assured, this type of incontinence can still be treated with simple, non-invasive strategies such as bladder retraining and pelvic floor muscle training Pelvic Health Hub
What are common symptoms of mixed incontinence?
The most common symptoms of mixed incontinence are:
- Leaking wee with a very strong and urgent desire to wee
- The feeling of needing to wee more frequently than most people.
- Leaking wee with activity such as coughing, sneezing, laughing and exercising
Most women will be presenting with mixed incontinence will have predominantly one type of incontinence that affects them most – this is often stress incontinence.
What causes mixed incontinence?
It is unlikely that there is a single cause for mixed incontinence. Most likely it is a result of multiple factors combining over time. This includes:
Pregnancy and childbirth
Neurological disorderssuch as Parkinson’s Disease, Multiple Sclerosis, Spinal Cord injury
Pelvic floor muscle weakness
Pelvic organ prolapse
Pelvic surgery (e.g., Hysterectomy)
Urinary tract infections
Long history of poor bladder habits(Like emptying your bladder “just in-case”)
As you can see, there are lots of reasons why you might leak urine. And many of these factors can occur simultaneously. Your GP (General Practitioner) is the best person to help rule out medical conditions requiring urgent care (such as a urinary tract infection) and then refer you onto a specialist who can help you work out the root cause of your leaking. This may be a urologist, urogynaecologist or speciality pelvic floor physiotherapist. You can find a pelvic floor physio near you here
These professionals will take a full history and utilise assessment tools like an internal vaginal exam, bladder diary, or ultrasound to help specify what type of incontinence you have and why.
How can we treat mixed incontinence?
You might notice that fear of leaking urine, or the feeling of being busting to wee, has impacted your everyday activities. You might only go to certain events where you know a toilet is close by, or you might have completely restricted your fluid intake due to fear of leaking. You aren’t alone!
We’ve got good news, like urge and stress incontinence – mixed incontinence can also be managed (in most cases) with some simple lifestyle changes, bladder retraining and pelvic floor muscle exercises. However, treatment doesn’t happen overnight, so the first steps to treating mixed incontinence is to manage the leaks appropriately. This allows you to stay active and confident whilst treating the cause. You can find which Poise® pad or liner is best for your type of leaking here
Treatment involves targeting the type of incontinence that is most predominant in your presentation of symptoms. Do you leak more with activity? Then focus on treating the stress incontinence first. You can find more specific information on stress incontinence
Are you most bothered by an urgent need to wee all the time and sometimes leak on the way to the toilet? Then focus on urge incontinence strategies first. You can find more specific information on urge incontinence
Treatment that covers both types of incontinence:
- Pelvic floor muscle training (recommend for a minimum of 12 weeks. You can find a 12-week strength training program here)
- Weight loss (If BMI >30)
- Managing fluid intake (if drinking too much or too little)
- Treating chronic constipation
There are some strategies specific to urgency that are important to include:
- Bladder retraining. This is a behavioural retraining method which gradually increases the time between toilet visits and teaches ways to supress the urge sensation.
- Tibial Nerve TENS (Transcutaneous Electrical Stimulation). This is a form of Neuromodulation that involves putting electrical stimulation pads onto the inner ankle. This treatment looks to target the messaging along the nerves to the bladder. A physiotherapist, urologist or urogynaecologist can perform this treatment for you.
Other management options include medication targeted at reducing bladder overactivity, Botox to the bladder wall and surgical intervention as a last line.
This content is general and nature and not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek advice from a qualified health care professional with any questions regarding your concerns.
FAQSWhat is the most common type of incontinence?
Stress incontinence is the most common type of incontinence (leaking when you are physical exerting yourself). However mixed incontinence has been documented to occur in approximately 30-50% of all urinary incontinence cases.When should you consider surgery for incontinence?
Surgery is more likely to be a consideration for you if:
- You have completed longer than 3-6 months of regular pelvic floor muscle training and lifestyle changes and continue to experience symptoms that impact your quality of life.
- You have severe stress urinary incontinence.
- Already require surgery for other pelvic conditions (I.e., End stage prolapse)
This is a last line management option for incontinence and should be a conversation with your healthcare provider.
National continence helpline (1800 33 00 66 FREE CALL) – you can speak to a continence nurse for free advice and information.
Continence Foundation of Australia (continence.org.au) – Free information on bladder and bowel conditions in both Women and Men, including information in other languages
Jean Hailes for Women’s Health (https://www.jeanhailes.org.au/health-a-z/bladder-bowel) – Free information targeted at improving Women’s Health across Australia throughout the lifespan.
Urinary incontinence and pelvic organ prolapse in women: management NICE guideline [NG123]02 April 2019
Written for Poise by Caitlin Dunsford. Caitlin is a practicing Physiotherapist, with special interest and further training in Women's Health and Continence.