Mixed Urinary Incontinence Affects 10% of Women Over 30

By  //  April 8, 2012

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UROGYNECOLGY

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Often there is more than one reason for the unexpected and unwanted leakage of urine. Mixed urinary incontinence is a combination of both stress and urge incontinence, and, when not recognized and treated as having both causes, effective management can be ineffective and become very frustrating.

Urge incontinence is where you know all the bathrooms around, but often just seem to not make it in time. Stress is not caused by people stressing you out, but rather the pressure of exercise, coughing or the ultimate, jumping on a trampoline. There are numerous reasons for a woman to be incontinent of urine, and more than one kind of incontinence is frequently responsible for leakage.

Prevalence in Women

The occurrence of any urine leakage at least once over the course of a year ranges from 25 to 45 percent of women. Infrequent leakage should not be a major concern, however, urinary incontinence is fairly common and weekly urine leakage is reported in ten percent of women aged 30 to 79 years.  In some people it can severely diminish their quality of life and there is no need to just tolerate it.

The prevalence of incontinence increases with age, which means it is more common when you get older, however it also can happen in very young adults. The severity of incontinence, measured by how often you have to go and how much or how little you empty with a visit, also increases with age.

Urinary incontinence is caused by stress incontinence in about half of women with incontinence, with combined stress and urge, also called mixed incontinence, next common, and urge incontinence least common.

Frequency

In a recent study, one third of women aged 54 to 79 years, who reported urine leakage once monthly at baseline progressed to leaking at least once a week over a two-year follow-up. Daily incontinence was reported in 12 percent of US women between the ages of 60 and 64 years, and in 21 percent of women 85 years and older

Daily incontinence or leakage a couple times a week, or just the fact that you never know what to expect can severely influence quality of life.

Influence of Stress and Age

In general, urinary incontinence is caused by stress incontinence in about half of women with incontinence, with combined stress and urge, also called mixed incontinence, next common, and urge incontinence least common. These estimates change with age, with urge incontinence more common in the elderly.

Testing & Treatment

Mixed urinary incontinence makes adequate treatment more challenging, because both the stress as well as the urge incontinence must be recognized and treated. If not diagnosed as a mixed cause incontinence, treatment will probably be ineffective.

A thorough history with focused physical exam and specific diagnostic testing is imperative to accurately identify the etiology or, in the case of mixed incontinence, etiologies of incontinence.

Urodynamic testing (bladder filling and trying to mimic what causes the leak) and cystoscopy (examining the bladder through a scope) in the office can aid in making a correct diagnosis. Once an accurate diagnosis has been made, treatment specific to the etiologies can be discussed and initiated.

Appropriate treatment of mixed incontinence consists of two stages. Whether the stress or the urge component of the mixed incontinence is treated first depends on the severity of each. Each patient needs a customized approach depending on the diagnostic testing.

In stress incontinence, the urethral area closest to the bladder stays open. Treating the stress incontinence closes “the open door” from bladder to urethra (the tube through which urine gets expelled), and treating bladder spasms/urgency addresses the overactive bladder.

Looking for Relief?

Once mixed incontinence has been recognized, appropriate staged treatment specific to cause can solve incontinence problems that had appeared to be unresponsive to therapy for years.

Urinary incontinence can appear to be pretty complicated, but once the reason has been determined, can often be treated very effectively. Often small changes can make a big difference.

Quality of life can improve significantly with treatment for urinary incontinence. Talk with your healthcare provider about your incontinence.

Marja Sprock, MD FACOG at Central Florida UroGynecology in Rockledge is a board certified OB/GYN with fellowship training in urogynecology and special expertise in cosmetic gynecology. She is an expert in the diagnosis and treatment of urinary urgency, frequency and loss, as well as G-spot enhancement and other cosmetic urogynecologic  surgeries. For more information log on to cfurogyn.com or call 321-806-3929.

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