What exactly is incontinence?
Urinary incontinence can occur if you have trouble controlling your bladder. You may find that you leak urine when you laugh, cough, or sneeze. In more severe cases, you may feel the sudden urge to go the bathroom but not make it to the toilet in time.
Incontinence is a symptom, not a disease. In many cases, urinary incontinence results from having an overactive bladder. About 33 million Americans deal with an overactive bladder.
The symptoms you experience will depend on the type of incontinence that you have:
- Stress incontinence: You leak urine whenever you do anything that puts pressure on your bladder. This includes coughing, sneezing, exercising, or laughing.
- Urge incontinence (overactive bladder): Your bladder muscles contract and release urine before you’re ready. You’ll feel an urgent need to go, followed by leakage.
- Overflow incontinence: Your bladder is unable to fully empty and becomes too full, which makes you leak.
- Functional incontinence: You have a physical or mental condition that prevents you from feeling the normal urge to go, or from getting to the bathroom before it’s too late.
- Total incontinence: Your bladder can’t store anything, so you constantly pass urine.
- Mixed incontinence: You’re experiencing symptoms of two or more types of incontinence, usually stress and urge incontinence.
Incontinence can be chronic or transient. Chronic incontinence occurs over the long-term. Transient incontinence goes away after you treat the cause.
What is mixed incontinence?
Mixed incontinence is usually a combination of urge and stress incontinence. Women are more likely than men to have incontinence in general. About 45 percent of women report having incontinence, and about 14 percent have mixed incontinence.
What are the symptoms of mixed incontinence?
People who have mixed incontinence typically experience the symptoms of both stress and urge incontinence.
For example, you may leak while:
These symptoms are usually indicative of stress incontinence.
You may also feel a sudden urge to go, and then leak. This is typically characteristic of urge incontinence.
Oftentimes, one set of symptoms is worse than the other.
What causes mixed incontinence and
who is at risk?
Mixed incontinence is usually caused by a combination of the same factors that cause stress and urge incontinence.
Stress incontinence is caused by weakness in the pelvic floor muscles that support the bladder and weakness in the muscles that control urine release. As a result, your urethra — the tube urine passes through out of your bladder — can’t stay closed.
Stress incontinence can happen because of:
- surgery or radiation to the vagina (women), rectum, or prostate (men)
- injury to the pelvis
Urge incontinence happens when the muscles in your bladder wall contract too much.
It can be caused by:
- urinary tract infection (UTI)
- conditions affecting the nervous system
How is mixed incontinence diagnosed?
Your doctor will start by asking about your symptoms:
- When do you feel the urge to go?
- How often do you leak?
- What are you usually doing when you leak?
Keeping a diary of your bathroom habits and leakage can help you answer your doctor’s questions.
To diagnose mixed incontinence, your doctor might give you one or more of these tests:
- Urine test: Your doctor will check for a UTI.
- Neurological exam: This will allow your doctor to detect any nerve problems.
- Stress test: Your doctor will determine whether you lose any urine while coughing.
- Post-void residual volume: Your doctor will measure how much urine is left in your bladder after you urinate.
- Cystoscopy or urethroscopy: This allows your doctor to look inside your bladder and urethra for any structural problems.
How is mixed incontinence treated?
These treatments can help with the symptoms of both stress and urge incontinence:
Exercise and training
Pelvic muscle exercises (Kegels): You squeeze and relax the muscles you use to hold in and release urine. Over time, these muscles will strengthen and keep your urethra closed.
Bladder training: You go to the bathroom at set periods of time, such as every 45 minutes. Gradually, you increase the amount of time between bathroom visits. This helps strengthen your bladder muscles.
Your doctor may prescribe one of the following to calm overactive bladder muscles:
Injections of botulinum toxin (Botox) into your bladder can also calm overactive bladder muscles.
In more severe cases of incontinence, one of the following may be necessary:
- Pessary: This is inserted into the vagina to support the vaginal walls. This can prevent the bladder from collapsing downward on the vagina.
- Urethral inserts: These are inserted inside the urethra to help prevent leakage.
- Pelvic floor stimulation: An electric current is sent to the pelvic floor muscles that can affect the emptying of your bladder. This stimulation causes the muscles to contract, which may improve the closure of the urethra.
- Injections: A bulking material is injected into the area around the urethra to keep it closed and prevent urine from leaking.
- Surgery: In rare instances, a sling procedure may be necessary. Your doctor will create a hammock out of tissue from your own body or man-made material to support the urethra and prevent leakage.
What is transient incontinence?
Transient means temporary. This type of incontinence is caused by a medical condition. It should get better once the problem has been treated.
What are the symptoms?
If you have transient incontinence, an underlying medical condition prevents you from getting to the bathroom or feeling the urge to go. As a result, you leak urine.
What causes it and who is at risk?
You may be at risk for transient incontinence if you experience one of the following conditions:
- excess urine production
- thinning and shrinking of the tissues in the vagina (vaginal atrophy)
- stool impaction
Certain medicines may result in incontinence. This includes some:
- blood pressure reducing drugs
- pain relievers
How is it diagnosed and treated?
Your doctor will first ask about your symptoms and review any medications that you may be taking.
If you don’t have an underlying medical condition, such as Parkinson’s disease, your doctor will collect a urine sample to test for a UTI.
If incontinence isn’t a side effect of one of your medications and you don’t have a UTI, your doctor may test for certain underlying medical conditions.
Once your doctor determines the cause of your incontinence, they will work with you to develop an individualized treatment plan. Treating the root cause can alleviate your symptoms.
What is total incontinence?
Total incontinence is characterized by constant urine leakage. This type of incontinence is rare.
What are the symptoms?
Some people will leak small amounts of urine, and other will leak larger amounts. In both cases, the leakage will be constant.
What causes it and who is at risk?
Total incontinence may be caused by:
- a structural problem with your bladder
- pelvic surgery that damages your bladder
- spinal cord injury or disease like multiple sclerosis, which prevents nerve signals from passing between your bladder and brain
- a fistula, or a hole between the bladder and vagina (in women)
How is it diagnosed and treated?
Your doctor will first assess your symptoms and determine whether the leakage is constant. If what you’re experiencing is total incontinence, your doctor may recommend surgery to fix a fistula or damage to your bladder.
In some cases, your doctor may recommend that you use a catheter. This is a thin tube that’s placed into your urethra to empty your bladder.
Wearing sanitary pads or other absorbent products can help pull in any wetness and hide odors.
What happens next
Your outlook depends on what’s causing your incontinence. Mixed incontinence is treatable with lifestyle changes, medicine, and surgery. Transient incontinence will usually go away once you treat the problem the underlying condition. Some causes of total incontinence, such as a fistula, can be treated.
If your symptoms worsen or persist, consult your doctor. They can assess your treatment plan and, if needed, make new recommendations.
How to prevent incontinence
Incontinence isn’t always preventable, but certain lifestyle changes may help alleviate urinary urgency and leakage.
Tips and tricks
- Limit fluids. Drink only small amounts of fluid at a time. Stop drinking two hours before bedtime. Avoid caffeinated soda, alcohol, and coffee, which make you go more often.
- Eat more fiber. Eat more fresh fruits, vegetables, and whole grains to prevent constipation, which can cause urine incontinence.
- Avoid foods that irritate your bladder. Stay away from citrus fruits and other acidic foods, as well as from spicy foods and artificial sweeteners.
- Maintain a healthy weight. Being overweight puts extra pressure on your bladder.