Mixed Incontinence

Introduction

Mixed incontinence occurs when both stress incontinence and DI occur simultaneously. Patients may present with symptoms of both types of incontinence. These patients present both a diagnostic and therapeutic dilemma. The prevalence of mixed incontinence is more common than most practitioners realize. A detailed history will reveal symptoms of SUI with urine loss associated with cough, sneeze, or other increase in Valsalva pressure, as well as urinary urgency, frequency, and concomitant incontinence. The coexistence of these 2 conditions may be brought about by many causes. Patients with stress incontinence often preemptively urinate to avoid a full bladder and subsequent urine loss, thereby conditioning the bladder to habituate to a low functional capacity. This may promote premature signaling of bladder fullness and result in frequent urge symptoms.

Patients may have DI that is precipitated by coughing or laughing. Patients may have indolent involuntary bladder contractions that only manifest with the additional pressure of a cough, sneeze, or laugh. The cause is often difficult to ascertain, but the diagnosis should be confirmed with urodynamic studies that can assist in identifying the cause of urine loss.

Treatment

For mixed incontinence, treatment should be based on the patient’s worst symptoms. Often patients can prioritize their symptoms, stating that one component impacts their life more than the other. By having the patient separate the symptoms, a practical management plan with realistic expectations can be devised. A great disservice can be done by operating on a patient to restore bladder neck support and remove stress symptoms, when the patient’s main concern is daily urge incontinence while she is at work. Conservative measures should be tried first, and if symptoms do not improve surgical measures can be entertained to target alleviation of the stress component. However, there is a 50-60% chance that urge symptoms may resolve after a midurethral sling is performed. Occasionally the involuntary contractions are alleviated by restoration of bladder support and vaginal anatomy.

 

Provided by ArmMed Media
Revision date: July 7, 2011
Last revised: by Dave R. Roger, M.D.