Treatment of Mixed Urinary Incontinence

Mixed urinary incontinence is the term used for incontinence problems that arise from more than one source. It is not generally defined as a distinct medical condition, but is rather the simultaneous presence of two or more medical conditions in one individual. Treatment for mixed urinary incontinence is therefore a matter of diagnosing and treating each of the underlying ailments.

Understanding and Treating the Underlying Causes

• If you have incontinence problems, it is important to realize that your symptoms may be the result of a number of different urinary ailments.

  Urge incontinence is characterized by an abrupt, immediate need to urinate, followed by involuntary urination. The length of time between the urge to urinate and involuntary release can be as short as a few seconds, and the cycle of urge and release typically continues 24 hours a day. Causes of the ailment include urinary tract infection, bowel problems, bladder irritation, stroke, multiple sclerosis and Parkinson's disease.

  Stress incontinence is characterized by a weakened urinary bladder sphincter, leading to loss of bladder control during common activities like exercising, laughing, sneezing, coughing or lifting heavy objects. It can result from removal of the prostate gland in men, or from pregnancy, childbirth or menopause in women.

  Overflow incontinence is characterized by constant or frequent urine flow, usually in small releases or dribbles. It can result from bladder damage, urethra obstruction, prostate problems or diabetes complications.

  Gross total incontinence is characterized by lack of storage capacity in the bladder, leading to periodic uncontrolled release of large amounts of urine or constant leaking. It can result from injury to the urinary system or spinal cord, or from genetic defect.

  Functional incontinence results from simple inability to reach a toilet in time. It may stem from mental impairment or the advance of physical conditions like arthritis.

  If your doctor diagnoses you with more than one of these conditions, you have mixed urinary incontinence. Once this conclusion is reached, treatment will be tailored to address your specific underlying problems.

General Incontinence Treatments

• Apart from the specifics of your ailment, your doctor will likely follow certain commonly accepted treatment guidelines. As a general rule, she will begin treatment with the least invasive method possible. Potential starting options include behavioral techniques such as bladder training, fluid and diet management, and regular scheduling of toilet trips. Physical therapy may also be used, with options including electrical stimulation or direct exercise of the pelvic floor muscles.

  Potential drug treatments for incontinence include bladder-calming compounds like solifenacin (Vesicare) and tolterodine (Detrol), and topical estrogen. Imipramine (Tofranil) is specifically suitable for mixed stress and urge incontinence.

  Certain devices have been developed for incontinence in women. Urethral inserts act as temporary sponges to soak up urine before it leaks out. Pessaries are stiff inserted rings that help support the bladder through the vagina.

Additional Therapies and Surgery

• Your doctor may also use additional therapies, including radiofrequency therapy, sacral nerve stimulation or injection of bulking materials that help close the urethra. Surgery may also be indicated when other methods have failed. Consult your doctor or urologist for a full list of treatment options available for your specific condition.