Mixed Urinary Incontinence

Urinary incontinence is the involuntary leakage of urine, causing symptoms of wide-ranging severity and often significantly affecting patients' quality of life. The International Urogynecological Association (IUGA), the International Incontinence Society (ICS), and the American Urological Association (AUA) have divided urinary incontinence into 3 main classifications. See StatPearls' companion reference, "Urinary Incontinence," for more information.  Stress incontinence is the involuntary loss of urine with increased intraabdominal pressure or physical exertion (eg, coughing, sneezing, jumping, lifting, laughing, straining, exercising). Urge incontinence is the involuntary loss of urine preceded by a sudden and severe desire to pass urine. See StatPearls' companion references, "Urge Incontinence" and "Stress Incontinence," for more detailed information on these respective conditions. Mixed urinary incontinence (MUI) is a combination of stress and urge incontinence and may take on the pathophysiology of both. MUI is particularly prevalent in women older than 65, affecting >37% of older female patients, and often necessitates significant lifestyle changes due to its impact on both physical and psychosocial well-being.  Although incontinence is not itself a terminal disease, a meta-analysis of 6 studies with a total of 1,656 individuals indicated that urinary incontinence contributes to overall mortality, at least in nursing home residents, where it increases the death rate by 20%. However, urinary incontinence more often affects other aspects of the patient's health and quality of life. Health conditions associated with MUI include skin, perineal, and vaginal infections (eg, cellulitis and yeast), as well as an increased risk of falls and fractures from excess trips to the bathroom. The incidence of falls in postmenopausal women with urinary urgency and urge incontinence is twice that of comparatively aged women without such urinary symptoms. Additionally, quality of life is significantly affected as incontinence causes depression, anxiety, embarrassment, limitation of social interactions, increased isolation, work issues, sleep deprivation due to nocturia, and loss of self-esteem in those affected. Sexual dysfunction is also common in incontinent patients, as up to 33% will have coital incontinence (ie, leakage during sexual activity). Consequently, the fear of coital incontinence tremendously affects sexual enjoyment in many patients. MUI also places a substantially increased burden on family caregivers as well as nursing facilities. Up to 10% of all nursing home admissions in the United States are solely due to urinary incontinence.  A careful clinical history is usually sufficient to identify the type of the patient's incontinence; however, noninvasive diagnostic evaluations, including urinalysis, postvoid residual urine volume, and a pelvic examination in women, should be utilized to help clarify the clinical characteristics and etiology. Many behavioral, medical, and surgical techniques are available to improve lifestyles due to incontinence. The initial treatment for incontinence typically begins with a conservative lifestyle approach and various nonsurgical measures, including Kegel exercises, caffeine avoidance, vaginal estrogen in women, physical therapy, and oral medications. For conditions unresponsive to such conservative therapies, consideration of more invasive therapies may be indicated.