Nearly 25 million Americans suffer from symptoms of urinary incontinence, the inability to control urination. There are several types of incontinence, including stress incontinence, which is the leakage of urine caused by coughing, sneezing, or other movements that put pressure on the bladder; and urge incontinence — the loss of urine suddenly after feeling the need to urinate.

Many people have symptoms of both stress incontinence and urge incontinence. This combination is often referred to as mixed incontinence. Many studies show that mixed incontinence is a more common type of incontinence in older women.

Symptoms of Mixed Incontinence

Because mixed incontinence is typically a combination of stress and urge incontinence, it shares symptoms of both. You may have mixed incontinence if you experience the following symptoms:

• Leaking urine when you sneeze, cough, laugh, do jarring exercise, or lift something heavy.
• Leaking urine after a sudden urge to urinate, urinating while you sleep, after drinking a small amount of water, or when you touch water or hear it running.

Causes of Mixed Incontinence

Mixed incontinence also shares the causes of both stress incontinence and urge incontinence.

Stress incontinence often results when childbirth, pregnancy, sneezing, coughing, or other factors lead to weakened muscles that support and control the bladder or increase pressure on the bladder, causing urine to leak.

Urge incontinence is caused by involuntary actions of the bladder muscles. These may occur because of damage to nerves of the bladder, the nervous system, or muscles themselves. Such damage may be caused by certain surgeries or diseases such as multiple sclerosis, Parkinson’s disease, diabetes, stroke, or an injury.

Other medical conditions, such as thyroid problems and uncontrolled diabetes, can worsen symptoms of incontinence, as can certain medications such as diuretics.

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Diagnosis of Mixed Incontinence

If you have problems with incontinence, it’s important to speak with your doctor, who can diagnose the type of incontinence you have and devise a treatment plan. Your doctor may have you keep a diary for a day or more as a record of when you urinate — purposely or not. You should note the times you use the toilet and the amount of urine (your doctor may have you use a special measuring pan that fits in the toilet seat) and when you leak. You may also record fluid intake.

Your diary entries along with answers to your doctor’s questions will help make the diagnosis. These questions may include:

• How often do you go to the bathroom?
• When you get to the bathroom, do you have trouble starting or stopping the flow of urine?
• Do you leak urine constantly or only during certain activities?
• Do you leak urine before you get to the bathroom?
• Do you experience pain or burning when you urinate?
• Do you get frequent urinary tract infections?
• Have you had a back injury?
• Do you have a medical condition such as Parkinson’s or multiple sclerosis that could interfere with bladder function?

Your doctor may also perform a physical examination and look for signs of damage to the nerves that supply the bladder and rectum. Depending on the findings of the examination your doctor may refer you to a neurologist (a doctor who specializes in diagnosing and treating diseases of the nervous system) or perform tests.

These may include:

• Bladder stress test Your doctor checks to see if you lose urine when coughing. This could indicate stress incontinence.
• Catheterization. After having you empty your bladder, the doctor inserts a catheter to see if more urine comes out, meaning you are unable to empty your bladder completely.
• Urinalysis and urine culture. Lab technicians check your urine for infection, other abnormalities, or evidence of kidney stones.
• Ultrasound. An imaging test is performed to visualize inner organs such as the bladder, kidneys, and ureters.

If the diagnosis is still not clear, your doctor may order urodynamic testing. This can help provide information on bladder contractions, bladder pressure, urine flow, nerve signals, and leakage.

Another test used to confirm a diagnosis is cystocopy, which examines the inside of the bladder and urethra with a small scope called a cytoscope.

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