What is Stress, Urge and Mixed Incontinence?

As a pelvic health physical therapist, I work with many patients who have questions about bladder health. One question they seem to have in common is: how should they manage urinary incontinence symptoms? When I initially meet with patients, they are frequently surprised to learn the different types of incontinence and causes. Let’s talk about the different types and treatments for urinary incontinence.

Here’s a quick snapshot of how I answer those questions:

Defining Urinary Incontinence

Urinary incontinence is the involuntary loss of urine and has different presentations and treatment approaches.

One common cause is from pregnancy-related changes, regardless of mode of delivery. Vaginal delivery may result in tearing of the Pelvic floor muscles or vaginal tissue with overstretching of the pelvic nerves, however, postural changes and the weight of the baby that result from being pregnant can also create these changes (yes, even with a cesarean delivery).

Stress Urinary Incontinence

  • What: Stress urinary incontinence (SUI) occurs when intraabdominal pressure increases, and lessens the pelvic floor muscles’ ability to support the bladder.
  • Cause: Stress urinary incontinence leaks are typically the result of weak or uncoordinated pelvic floor and abdominal muscles or structural deficits, such as urethral hypermobility or lack of ligament or fascial support.
  • Symptoms: Classic leakage for stress urinary incontinence occurs with coughing, sneezing, laughing (sometimes called “giggle incontinence”), jumping on a trampoline, lifting heavy items or other impact or vigorous exercise.
  • Treatments: Treatments for stress incontinence can address pelvic floor and abdominal muscle weakness:
    • Lifestyle changes: It can help to avoid bladder irritants like caffeine, citrus or alcohol. Further, some people don’t realize that drinking water is good for the bladder, since it helps avoid dehydration.
    • Pelvic health physical therapy: I recommend working with a physical therapist to strengthen the pelvic floor area through methods like bladder training and pelvic floor exercises like Kegels

Urge Urinary Incontinence

  • What: Urge urinary incontinence (UUI) is the strong urge to urinate resulting in accidental loss of urine. This is due to abnormal nerve signaling between the bladder and the pelvic floor muscles.
  • Cause: Ideally, the bladder and pelvic floor muscles work together so that the bladder relaxes and fills with urine, while the pelvic floor muscles maintain a certain amount of tone to prevent leakage. However, urge incontinence is caused when your bladder contracts and your pelvic floor muscles inappropriately relax, which causes urine to leak.
  • Symptoms: To understand urge incontinence symptoms, it’s important to know that patients may have a history of bladder or urinary tract infections, however this is not always the case.
  • Burning during urination or pain in the pelvic region is not a symptom of urge urinary incontinence. Instead, the burning or pain could be due to urinary urgency frequency syndrome, painful bladder syndrome (also known as interstitial cystitis) or a urinary tract infection, which should be ruled out by a physician.

    Also, Urinary frequency is not always a symptom of urge incontinence. UUI is diagnosed when there is a loss of urine that occurs with an urge, not necessarily a frequent loss of urine.

  • Treatments: Always consult with your OB/GYN, urologist or urogynecologist for proper treatments for your body. In general, treatments for urge incontinence aim to correct the disruptive signaling in the pelvic nerves and can include:
    • Lifestyle changes: As mentioned above, drinking water is also recommended for urge urinary incontinence. Having more dilute urine also means that it will be less of an irritant to your bladder.
    • Electrical Stimulation: You and your doctor can also explore different types of stimulation devices or procedures that help achieve normal nerve function.

What’s the Difference?

The difference between stress incontinence vs urge incontinence is that movements like jumping or running might trigger stress incontinence due to a weak or uncoordinated pelvic floor, while urge incontinence might occur at any time, when the bladder muscles inappropriately contract and cause involuntary leakage.

What is Mixed Incontinence?

  • What: Mixed urinary incontinence (MUI) is when a person has both stress urinary incontinence and urge incontinence symptoms (these types are explained above).
  • Cause: It can be caused by giving birth or other increased pressures on the bladder, or even by damages to nerves or muscles that control the pelvic area. Although, sometimes, there is no apparent cause.
  • Symptoms: Mixed incontinence symptoms can include symptoms from a combination of each category – stress and urge urinary incontinence. Common symptoms can include urinary leakage on the way to the bathroom, increased urinary urge with certain triggers (such as putting your key in the door and anticipating urinating), and leakage during exercise. Due to the fear of leakage, some women may go to the restroom multiple times per day. Stress and urge urinary incontinence may not occur at the same time but rather at different points throughout the day.

These different types of incontinence sometimes make my patients feel embarrassed, since the leaks are unexpected. They aren’t alone in those feelings – for the one in three women who experience bladder leaks, a Poise® survey found that three-fifths of those women said they're embarrassed by them (60%).1 That’s a stigma we need to shatter!

As a pelvic health physical therapist, I want to encourage women to talk openly about their leaks with their doctors so that they can find the right treatments and solutions for their optimal health.

How to Manage Leaks and Hygiene

When discussing different types of incontinence, my goal with patients is to identify the best treatments, therapy, and/or products that can keep them comfortable, fresh and free despite leaks.

One point I always make with my clients is the importance of protecting their hygiene when managing leaks using products designed to keep their skin moisture-free to prevent irritation. It’s easy to find solutions designed for fast-absorbing protection throughout their day, like Poise® Ultra Thin pads, at local retailers.

Information is empowering and can provide the confidence needed to talk openly about leaks. I always recommend talking to your OB/GYN, urologist, or urogynecologist if you have questions about incontinence.

With a few brief questions, a medical professional can find proper solutions, treatments, and referrals to ensure your comfort and health.

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Author Summary: Dr. Heather Jeffcoat, DPT, Pelvic Health Physical Therapist is the founder of Fusion Wellness & Femina Physical Therapy (FeminaPT.com). Her work focuses on pelvic and sexual health education for all, and she lectures internationally on Female Sexual Dysfunction and chronic pelvic pain. She is also the author of Sex Without Pain: A Self Treatment Guide to the Sex Life You Deserve.

Sources:

  • 1A 10-minute online survey was fielded on February 1, 2021 through February 8, 2021, in the United States among a nationally representative sample of 1,173 women 25+, including an additional oversample of 202 new moms**, at the 95% confidence level and with a margin of error of ±/-3%.
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