What is Mixed Urinary Incontinence?
There are several types of urinary incontinence. Mixed incontinence is one of these and it is just what it sounds like, a mixture of both stress urinary incontinence and urge urinary incontinence. So, it means that if you leak when you cough, when you sneeze, when you laugh, or when you exercise AND you might have a leak when you have the urgency to go to the bathroom. You leak with activity (stress urinary incontinence) and you leak when you get the urgency (urge urinary incontinence) to go but cannot make it quick enough, if you do both of these things that is mixed urinary incontinence.
What causes mixed urinary incontinence?
The things that cause mixed urinary incontinence are very similar to what's causing stress urinary incontinence and urge urinary incontinence because mixed urinary incontinence is a mixture of the two. The bottom line is that you do not have very good neuromuscular control of your pelvic floor. At least not as good as it should be. There are two situations that arise when your pelvic floor muscles are not as healthy as they should be. First, your pelvic floor muscle contraction, or Kegel, is not strong enough. That means that you cannot stop the leakage with laughing, sneezing, coughing, or exercise, AND your pelvic floor muscles are not strong enough to prevent leakage when you have an urge leaving you with urine leaks on the way to the bathroom. Second, if you are able to contract your pelvic floor muscles you may not be able to relax and release your pelvic floor muscles. This can prevent you from having a proper pelvic floor contraction when you cough, sneeze, laugh, or exercise, AND leave you with an insufficient Kegel to overcome the urge that comes from your bladder spasming. Overall, this poor control of your pelvic floor muscles really causes mixed urinary incontinence. Additional contributing factors can include shrinking your bladder too much because you have given into that urgency, and you have gone to the bathroom too frequently over the day, or you have gone to the bathroom too frequently at night.
How do we treat mixed urinary incontinence?
Mixed urinary incontinence can be treated really effectively through Pelvic Floor Physical Therapy. As mentioned above, mixed urinary incontinence indicates that you have poor control of your pelvic floor muscles. During Pelvic Floor Physical Therapy, we are going to teach you how to properly do a pelvic floor contraction and release. We will also teach you to properly use your stomach, low back, and the pelvic floor muscles because these need to be in the right ratio of strength and flexibility to contract and release your pelvic floor. When you have good neuromuscular control of your pelvic floor you shouldn’t leak urine at all; whether it be with urgency or with exercise, coughing, laughing, or sneezing.
You have to know how to properly coordinate your pelvic floor contraction with your breathing. You should not have to squeeze your legs or your bottom together. If you have to squeeze your butt or your legs together when you have urgency, or need to make it to the bathroom, that's an indication that you do have a little bit of urinary incontinence. A Pelvic Floor Physical Therapist is going to take you through a variety of exercises and techniques to make sure that you can properly Kegel, with coordination of your breathing, and without clenching your gluteal muscles. We will also teach you how to properly release the that Kegel. You have to be able to contract your pelvic floor muscles, all your muscles below the bladder, and release them.
What makes your mixed urinary incontinence worse?
There are some things that will make your mixed urinary incontinence worse. The thing that almost all people with mixed urinary incontinence do is empty their bladder too frequently. This seems like a good strategy initially because if your bladder is empty you can't have leaks, but the reality is even when you have a complete void, you retain some urine. Additionally, by emptying your bladder too frequently, you shrink the size of your bladder, which leads to a worsening of your symptoms. You end up in a cycle of smaller bladder leading to shorter duration between trips to the bathroom, and a shorter duration between trips to the bathroom allowing your bladder to shrink.
With mixed urinary incontinence, your problems can be really tricky because you could be leaking if you don't go quickly enough and it's hard to know when you really need to empty your bladder or not. Another issue people face when dealing with mixed urinary incontinence is larger truncal obesity or larger mass around your stomach definitely makes the stress incontinence component of mixed incontinence worse. Smoking makes mixed urinary incontinence (as well as stress and urge incontinence) worse because it causes the coordination of your breathing and the contraction of your of your pelvic floor to become uncoordinated. Last is weakness of your hips because of their coordination with the pelvic floor muscles. Every case is unique, so if you have questions about your mixed urinary incontinence, you really need to see someone to get your questions answered.
How does Mixed Urinary Incontinence affect quality of life?
If you are suffering from mixed urinary incontinence, you know the toll it can take on your life. Mixed urinary incontinence can dramatically reduce your quality of life. If you are experiencing mixed urinary incontinence, you know it is no fun. You're probably having to empty your bladder too frequently, you're probably having quite a few leaks. Mixed Urinary incontinence is a large indicator that you have poor control of your pelvic floor muscles. When you're having both stress and urge urinary incontinence, we really want to get it treated and not just with medication because medication is really just masking the fact that you don't have good control over your pelvic floor muscles. Once you regain control of your pelvic floor muscles with pelvic floor physical therapy, you shouldn’t need medication anymore and life will be better. You won't have to find the bathroom every 15-30 minutes, you won't have to know every stop along the way, you won’t need to use urinary incontinence products anymore. A little bit of time and energy, maybe a little bit of money up front, will save you tons of time, energy, and money down the road and you will Love Your Life!
Insurance, including Medicare, pays for physical therapy; even if you're younger and have a co-payment or have to pay out-of-pocket, it's really going to save you money in the long run because incontinence products are really expensive so go see your pelvic floor physical therapist, learn how to do a proper Kegel, learn how to get your muscles strong. It is probably going to take 8 weeks or less, as long as you don't have any pain.
Whether you are a woman, a man, pregnant, or an older adult, the treatment for mixed urinary incontinence is fairly straightforward. Stop waiting, get treatment started today and Love Your Life!
-FYZICAL Therapy & Balance Centers of Oklahoma City
FYZICAL Therapy & Balance Centers of Oklahoma City provide world class orthopedic rehabilitation to our patients. Our physical therapists specialize in orthopedic rehabilitation, balance and falls prevention, and Pelvic Health. Our practitioners take a patient-centered individualized approach that focuses on your pelvic health needs. If you are unsure about your pelvic health, or you want to see the FYZICAL Difference for yourself, schedule a free consultation today.