Mixed incontinence

Mixed incontinence is a form of urinary incontinence in which urination occurs both under stress and through hyperactivity of the bladder wall muscles or hypersensitivity of the bladder itself. This form is particularly distressing for patients, as they are virtually helplessly exposed to the urge to urinate. Even the renunciation of any physical activity would still lead to urination due to the urge incontinence. The therapy consists of simultaneous medication and training of the pelvic floor muscles. This topic might also be of interest to you: Bedwetting in adults – what is behind it?

Reflex Incontinence

In reflex incontinence, dyssynergic effects occur between the muscles that empty the bladder and the muscles that close it. Logically, the muscles that close the bladder (the “sphincter muscles”) should relax when the bladder wall muscles contract to expel urine from the bladder. In reflex incontinence, however, the interaction of these two muscle groups no longer works: both muscle groups contract simultaneously, resulting in an increase in pressure in the bladder with a strong stretching of the bladder wall.

Since the accumulated urine cannot escape through the obstructed urethra, it accumulates back into the kidneys and causes damage to them in the long term. The stretching of the bladder wall leads to severe pain, as it contains nerve fibres that signal the body to empty the bladder. However, this is not possible because the bladder is blocked by the sphincter muscles.

In addition to the severe pain, the kidneys are also damaged. The aim must therefore be to empty the bladder immediately in order to relieve the patient’s pain and protect the kidneys. There are various methods for this, but in acute cases, a long, sterile needle is simply inserted through the abdominal wall into the bladder and the excess urine is sucked out.

This provides immediate relief of the symptoms. However, this cannot be a permanent solution, as the micturition behaviour is permanently disturbed and at the same time, the opposite muscle behaviour can occur. In this case, the bladder wall muscles as well as the closure muscles relax and the urine runs out of the bladder unhindered – this is called urinary incontinence.Reflex incontinence is caused by spinal damage to the nerve roots height S2 – S4.

This is the name given to the nerve bundles that emerge between the second and fourth sacral vertebrae, i.e. in the lower back just above the coccyx. Such damage can be caused by an accident, an incarceration due to incorrect lifting, but also by viruses. Neurological tests and an anamnesis interview, during which the symptoms are precisely determined, provide information about the type of damage.