Mixed urinary incontinence: causes, symptoms, and treatment options to stop leaking

You sneeze and leak a little. Then later, out of nowhere, you get a sudden urge to go — only to leak before you get to the bathroom. Does this double whammy sound familiar? It’s called mixed urinary incontinence, and it’s more common than you might think. Around 20 to 30 percent of women experience these symptoms. It can happen in men, too, but people with female anatomy are twice as likely to experience it. 

Mixed incontinence symptoms can make social or active situations feel stressful. You might need to plan ahead to ensure easy bathroom access or avoid certain activities.

But there’s a lot you can do to treat and prevent mixed urinary incontinence. “Targeted exercises and physical therapy, as well as a few lifestyle tweaks, can make a big difference,” says Brittney Sellers PT, DPT, a pelvic floor physical therapist with Hinge Health. 

Unfortunately, not enough people know about them. According to Hinge Health’s 2024 State of Musculoskeletal Care report, 47% of survey respondents with pelvic issues said they did not know that specialized physical therapy could help their symptoms.

Here’s what you need to know about mixed urinary incontinence, and how to prevent and treat it with lifestyle changes, exercises, and tips from Hinge Health physical therapists who specialize in pelvic floor disorders.

What is mixed incontinence?

Mixed incontinence is a combination of two kinds of incontinence.

• Stress incontinence, where physical stress on your bladder (like coughing or sneezing) causes you to leak urine 

• Urge incontinence, where you suddenly feel an overwhelming urge to go and may leak urine before you get to the bathroom 

Mixed incontinence can significantly impact your quality of life. “People can become very self-conscious. They may start to become more isolated because they worry about it happening in front of other people,” says Dr. Sellers. “But there are many things you can do to manage symptoms, reduce leaking and urgency, and regain confidence.”

Causes of mixed urinary incontinence

Mixed urinary incontinence can be due to a combination of factors like pelvic floor muscle weakness, bladder sensitivity, neurological issues, hormonal shifts, or complications from certain surgeries. Here are some of the most common causes. 

• Pelvic floor muscle impairments. Pelvic floor muscles help support your bladder and control when you urinate. Sometimes these muscles can become less coordinated or experience changes in strength, which can make it harder to hold urine, especially when you’re on your way to the bathroom. It’s common for pelvic floor function to change after vaginal birth, C-section, perimenopause, menopause, or pelvic surgery. Everyday factors like frequent coughing or heavy lifting can also influence how these muscles work. “Pelvic floor changes are a normal part of life and can affect anyone — no matter how you gave birth, or even if you’ve never had a baby,” says Dr. Sellers.

• Overactive bladder (OAB). Overactive bladder is the urge to empty your bladder, even when it’s not full. People with OAB may notice they need to urinate more often, and some may experience leaking. "An overactive bladder is more sensitive than usual, so urges to go can happen suddenly or in response to things that wouldn’t normally be a problem," says Dr. Sellers. Many older adults (about 30% of men and 40% of women) experience overactive bladder.

• Hormonal changes. During perimenopause and menopause, shifts in hormone levels can lead to mixed incontinence. “There are estrogen receptors throughout the body, including in the urinary tract,” explains Dr. Sellers. As estrogen levels decrease, urinary tract tissues can become thinner, drier, and less elastic, which can contribute to urinary problems.

• Post-surgical complications. About a third of people experience incontinence after prostate surgery, though it often improves in a few months. Incontinence can also occur after hysterectomy. 

• Neurological conditions. Parkinson’s, multiple sclerosis, or stroke can cause nerve damage that leads to mixed incontinence.

Symptoms of mixed urinary incontinence

Mixed urinary incontinence can cause a range of symptoms, including leaking during physical activity or sex, sudden urges to pee, frequent nighttime trips to the bathroom, occasional unexpected leaks, and feeling like you need to stay close to a toilet throughout the day. Here’s what you may notice:

• You leak urine when you sneeze, cough, laugh, exercise, or during sex

• You have sudden, intense urges to urinate which are sometimes followed by leaks

• You wake up more than once at night to urinate

• Daytime fatigue due to interrupted sleep

• Occasional leaks without an obvious cause 

• Frequent urination and avoidance of activities without easy access to a toilet

These exercises work together to help manage mixed incontinence in several ways. Standing Kegels with quick flicks or squeezes help calm your bladder and can give you extra time to reach the bathroom. Abdominal bracing and side lying leg raises build strength in your core, hips, and pelvic floor, providing better support to reduce leaks. Diaphragmatic breathing improves pelvic floor coordination for better bladder control, and Kegel squats help you practice engaging these muscles as you make your way to the restroom.

Practicing these exercises regularly can help manage mixed incontinence by strengthening and improving coordination of your pelvic floor, core, and hip muscles. This added support and muscle control can make it easier to prevent leaks during sudden urges and physical activities.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for mixed incontinence 

Treatment for mixed incontinence may include pelvic floor physical therapy (including Kegels and other exercises), bladder training, vaginal estrogen, medications, electrical stimulation, and, in some cases, surgery. Here’s what to expect with each approach: 

• Pelvic floor physical therapy. Pelvic floor muscle training teaches you how to strengthen and coordinate the muscles that control urine leakage. It is the first-line treatment for this type of incontinence, explains Dr. Sellers. This can include Kegel exercises as well as other targeted movements like squats, core strengthening, and diaphragmatic breathing (see exercises above). Research shows it can significantly improve symptoms and quality of life. 

• Bladder training. This helps you reduce how often you need to go to the bathroom by gradually teaching your bladder to hold more urine. This approach has two main parts: following a bathroom schedule and using strategies such as Kegel exercises to manage sudden urges.

• Vaginal estrogen. If your symptoms are due to perimenopause or menopause, your doctor may prescribe vaginal estrogen (applied topically) to help with your mixed incontinence. Vaginal estrogen can help restore the health of the tissues in your urinary tract and vagina, making them thicker, more elastic, and better able to function. This can ease both stress and urge leaks by improving support and function in the pelvic area.

• Medications. If you still notice symptoms after trying pelvic floor physical therapy and bladder training, your doctor may discuss medication as another option. Medications can help your bladder hold more urine, increase the tone of the muscles around the urethra, and reduce both urgency and leaks.

• Electrical stimulation. A physical therapist may recommend gentle electrical stimulation as part of your treatment for mixed incontinence. This therapy is provided in person using specialized equipment that delivers mild, controlled pulses — usually through a small probe placed in the vagina or anus, or with electrodes near the pelvic area. These gentle pulses help activate and strengthen your pelvic floor muscles and improve coordination, which can reduce symptoms. Research suggests it can support symptom improvement. “It can help the nerves and muscles in that area work together more smoothly,” explains Dr. Sellers.

• Surgery. If you’re still experiencing symptoms after trying other approaches, there are a few surgical options your provider may discuss with you. Some procedures are designed to support the pelvic organs if they’ve changed position, such as with pelvic organ prolapse. Others, like urethral sling or bladder neck support procedures, can help reduce leakage during activities. In certain situations, a small device may be implanted under the skin, typically in the lower back or ankle area, to stimulate the nerves involved in bladder control. Your provider will work with you to find an approach that fits your needs and goals.

Physical therapy for mixed incontinence

Physical therapy is a key treatment for mixed urinary incontinence, focusing on targeted exercises, and techniques that aim to improve pelvic floor function, support the bladder and urethra, and foster better communication between your pelvic floor and surrounding muscles for symptom relief, explains Dr. Brittney Sellers, PT, DPT, a pelvic floor physical therapist with Hinge Health. This may include pelvic floor exercises (such as Kegels), core and hip-strengthening movements, and breathing exercises — all designed to help you regain confidence and reduce leaks.

A physical therapist can assess your symptoms and movement patterns to create an exercise plan tailored to your needs. They can also support you with bladder training and urge suppression techniques, recommend lifestyle changes — such as adjusting fluid intake and bathroom habits — to help reduce your symptoms, and offer practical tips for managing mixed incontinence in daily life.

You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit. Some exercises they may recommend can be found above.

When to see a doctor

It’s a good idea to see a healthcare provider if you have symptoms of mixed incontinence, since it can impact your sleep and overall quality of life. They can help identify the factors contributing to your symptoms and recommend treatment options. You can also connect directly with a pelvic floor physical therapist, who is specially trained to help manage incontinence and improve your pelvic health.

If you notice any of the following symptoms, see a healthcare provider right away, as they may indicate a more serious medical issue:

• Blood in your urine

• Painful urination

• Fever

• A feeling like you can’t empty your bladder fully

PT tip: Keep things moving

Constipation can worsen mixed incontinence, says Dr. Sellers. Constipation can cause your colon to become enlarged and put pressure on your bladder. “If you find that you have to strain for bowel movements, or you poop less than every three days, you may be constipated,” she explains. “You can help manage constipation by drinking plenty of water, eating fiber-rich foods, and staying active.”

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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