Mixed incontinence: causes, effects and treatment

Mixed incontinence: causes, effects and treatment

Mixed incontinence is a form of urinary incontinence that combines symptoms of both stress and urge incontinence. This combination can complicate diagnosis and treatment because it involves two distinct mechanisms. This section describes the causes, effects, and treatment options for mixed incontinence.

Causes of mixed incontinence

1. Combination of factors of stress and urge incontinence:

   • Pelvic floor muscle weakness: Weakened pelvic floor muscles, which typically lead to stress incontinence, can also impair overall bladder control and trigger urge incontinence.
   • Overactive bladder: An overactive bladder leading to urge incontinence can further weaken the pelvic floor and worsen stress incontinence through repeated episodes of urinary urgency and incontinence.

2. Neurological disorders:

   • Neurological diseases such as multiple sclerosis or Parkinson's disease can affect both the bladder muscles and the nerves that control the pelvic floor, causing mixed incontinence.

3. Bladder infections and inflammations:

   • Chronic bladder infections or inflammation can irritate the bladder and trigger both urge and strain symptoms.

4. Hormonal changes:

   • Especially in postmenopausal women, hormonal changes can weaken the tissue of the urethra and bladder and contribute to the development of mixed incontinence.

5. Surgical procedures and injuries:

   • Pelvic surgery or injuries can damage both the nerves and muscles responsible for bladder control and lead to mixed incontinence.

Effects of mixed incontinence

1. Social and emotional impacts:

   • Shame and embarrassment: The combination of uncontrolled urine loss during physical exertion and sudden urge to urinate can lead to considerable shame and embarrassment.
   • Stress and anxiety: The unpredictability of symptoms can cause stress and anxiety.

2. Physical effects:

   • Sleep disorders: Nighttime urge to urinate (nocturia) and uncontrolled loss of urine can interrupt sleep and lead to fatigue.
   • Skin irritations: Constant contact with urine can lead to skin irritations and infections.

3. Professional and economic impacts:

   • Reduced ability to work: Frequent toilet visits and concerns about incontinence can affect productivity at work.
   • Cost pressure: Expenses for incontinence products and possible medical treatments can be financially burdensome.

Treatment options for mixed incontinence

1. Behavioral changes:

   • Bladder training:
     • Description: Targeted training to extend the time intervals between toilet visits.
     • Benefits: Can increase bladder capacity and better control urination.
   • Fluid management:
     • Description: Reducing fluid intake at certain times of the day and avoiding caffeine and alcohol.
     • Benefits: Can reduce urinary urgency and improve bladder control.

2. Physiotherapy:

   • Pelvic floor training (Kegel exercises):
     • Description: Regularly tensing and relaxing the pelvic floor muscles strengthens these muscles.
     • Benefits: Can improve bladder and sphincter control and reduce the symptoms of incontinence.

3. Drug treatment:

   • Anticholinergics: These medications relax the bladder muscles and increase bladder capacity.
   • Beta-3 adrenoceptor agonists: These medications help relax the bladder and increase its capacity.
   • Topical estrogens: Local application of estrogen creams or suppositories strengthens the tissues of the urethra and pelvic floor.
   • Duloxetine: An antidepressant that increases sphincter activity and may improve urinary control.

4. Pessaries:

   • Description: Vaginally inserted devices that support the urethra and reduce pressure on the bladder outlet.
   • Advantages: Non-surgical option that often provides immediate relief.

5. Surgical treatment:

   • Sling operations (TVT, TOT): A mesh band is placed under the urethra to support it and prevent urine from leaking out.
   • Bladder augmentation: In severe cases, surgical enlargement of the bladder may be performed to increase its capacity.
   • Injection of bulking agents: Injection of substances around the urethra to thicken it and increase the closure pressure.

6. Neuromodulation:

   • Sacral neuromodulation: An implanted device sends electrical impulses to the sacral nerves to improve bladder control.
   • Tibial nerve stimulation: External electrical stimulation of the tibial nerve can regulate bladder function.

Preventive measures

1. Regular exercise: Regular physical activity contributes to overall health and strengthens the pelvic floor muscles.
2. Healthy diet: A balanced diet helps avoid bladder irritants and promote overall well-being.
3. Fluid intake: Drink enough, but not too much, to avoid overloading the bladder and to regulate the urge to urinate.
4. Avoiding bladder irritants: Reduce or avoid caffeine, alcohol, and spicy foods that can irritate the bladder.

conclusion

Mixed incontinence is a complex form of urinary incontinence that includes symptoms of both stress and urge incontinence. A combination of behavioral changes, physical therapy, medication, and, if necessary, surgical intervention can alleviate symptoms and improve the quality of life of those affected. An individualized and comprehensive diagnosis is crucial for developing appropriate treatment strategies and maintaining long-term bladder function.