Diagnosis of Mixed Incontinence continued...
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 cystoscopy, which examines the inside of the bladder and urethra with a small scope called a cytoscope.
Treatment for Mixed Incontinence
Treatment for mixed incontinence will require a combination of approaches used to relieve both stress incontinence and urge incontinence. There is no single treatment that works for everyone. The treatments you and your doctor choose will depend on the severity of your incontinence as well as your lifestyle and preferences.
These treatments may include:
Behavior Modification: If your diary shows a pattern of urination, your doctor may recommend that you use the bathroom at regular intervals to minimize leaking. Doing Kegel exercises regularly can help strengthen muscles that are involved in urine control. To learn how to do Kegel exercises, go to the bathroom and urinate. Halfway through, try to stop the stream of urine. This will help you identify the muscles you need to contract for Kegel exercises. Once you identify the muscles, do not practice while urinating. Do the exercises for about five minutes a day as you go about your day. After a few weeks to a month you should start to notice some improvement.
Medications: For the urge incontinence component of mixed incontinence, doctors may prescribe a medication called an anticholinergic to help relax bladder muscles to prevent spasms. Alternatively, your doctor may change a medication you are taking, such as high blood pressure medications that increase urine output and can contribute to incontinence.
Biofeedback: This technique can help you regain control over muscles that contract when you urinate by helping you better become aware of your body's functioning.
Neuromodulation: For urge incontinence that does not respond to behavioral modification or medications, your doctor may recommend neuromodulation, a therapy that involves using a device to stimulate nerves to the bladder. If a trial of the device shows it is helpful, the device is surgically implanted.