Mixed Incontinence

Mixed urinary incontinence:

  • Urinary incontinence (UI) is a symptom that can affect women of all ages, with a wide range of severity and impact on quality of life. It is common but not normal. 
  • Mixed urinary incontinence is a combination of stress urinary incontinence and urgency urinary incontinence.
  • Mixed urinary incontinence is defined as involuntary loss of urine associated with urgency and also with effort or physical exertion or on sneezing or coughing.
  • There are many barriers to seeking advice/treatment for symptoms of UI. We also know that many women are not able to contract their pelvic floor muscles effectively, so if a woman reports symptoms please refer for further assessment.

Main presenting features:

  • Leakage of urine on effort or exertion or on sneezing or coughing.

As well as

  • A sudden, intense need to empty the bladder which is often difficult to delay. 
  • The urge sensation may be linked to specific triggers, for example arriving home (latch-key urgency), a change of position or the sound of running water.
  • An associated increase in urinary frequency or nocturia.
  • For more information on stress or urgency urinary incontinence please see the separate information sheets for each condition.


Your assessment before referral:

  • Urine dipstick screening to detect the presence of blood, glucose, protein, leucocytes and nitrites in the urine. 
  • Vaginal examination to identify evidence of pelvic organ prolapse or pelvic mass. May also include pelvic floor muscle assessment, if within your scope of practice.
  • Where appropriate the use of OAB drugs and/or topical oestrogen should be discussed.

Physiotherapy management:

If you feel that your patient has mixed urinary incontinence refer her to physiotherapy. The physiotherapist will complete a detailed assessment, following which she will work with your patient with the aim of resolving or reducing her symptoms. This may include:

  • Advice on an individualised pelvic floor muscle exercise programme
  • Advice on fluid intake (following completion/analysis of a bladder diary)
  • Education on daily activities, general exercise, diet, weight loss and smoking cessation 
  • Referral to the community continence services, for further tests or assessment of containment products, if required

If conservative management fails the physiotherapist may discuss referral to the urological/gynaecological consultant. Where appropriate the use of OAB drugs and/or topical oestrogen should be discussed.

Referrals to consultant-led services:

If your patient describes any of the following symptoms they should be referred urgently, following locally-agreed pathways, to the appropriate consultant-led service.

  • Microscopic haematuria in women aged 50 years and older
  • Visible haematuria
  • Recurrent or persisting UTI associated with haematuria in women aged 40 years and older
  • Suspected malignant mass arising from the urinary tract

Further indications for consideration for referral to a consultant-led service include:

  • Persisting bladder or urethral pain
  • Clinically benign pelvic masses
  • Associated faecal incontinence
  • Suspected neurological disease
  • Symptoms of voiding difficulty
  • Suspected urogenital fistulae
  • Previous continence surgery
  • Previous pelvic cancer surgery
  • Previous pelvic radiation therapy
Select font size
Site colour