Overactive Bladder and Urinary Incontinence

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Urinary incontinence is a widespread problem–nearly half of the elderly female population (13 million women over age 70), suffer from it. It is an embarrassing problem in which woman experience involuntary leakage of urine at some point in life.  Symptoms include urgency with or without incontinence, frequency, and nocturia. These symptoms may occur alone or in combination. Incontinence can occur with chronic health problems, and is often associated with poor overall health, declining quality of life, social issues (isolation), and mental health concerns.

Newer prescription drugs (mainly oxybutynin) are helpful in treating this bothersome and frequently embarrassing condition, but the drugs do have side effects. Another option is bladder suspension surgery. This surgery can be successful but may also lead to urination difficulties.  Others conventional therapies include adult diapers.

There are numerous reasons why patients fail to seek treatment for overactive bladder.  Some feel embarrassed, some fear surgery, others believe the misperception that the problem is untreatable or a normal part of aging.  There is concern with some patients that the problem will trigger admission into a nursing home or personal-care facility.

TYPES

URGE INCONTINENCE – The most common form of incontinence.  It is characterized by a sudden urge and loss of urine with polyuria.  It usually occurs when the detrusor muscle becomes weak as a result of central nervous system disease (i.e. Alzheimer’s, Parkinson’s, or stroke). 

OVERFLOW INCONTINENCE – The second-most common form of incontinence.  It results when the outflow of the bladder is blocked by structures distal to the bladder (i.e. men with enlarged prostate). Urinary pressure builds in the bladder until it exceeds the ability the ability of the bladder muscles to contain it, causing leakage.

STESS INCONTINENCE – Stress incontinence occurs when laxity of the muscles of the pelvic floor loss of urinary sphincter muscle function, and/or failure of urethral closure fails to prevent urine from leaking from the bladder.  Surgery is a common cause of stress incontinence, however long-term use of antihistamines can also lend toward development of this problem.

CAUSES

Like constipation or diarrhea, incontinence is a symptom rather than a disease. The most common form is stress incontinence which causes urine loss when sneezing, coughing or lifting heavy objects. Involuntary leakage of urine can evolve as a malfunction in any part of the urinary tract, from the kidneys to the pelvic muscles controlling release.

Pregnant women or men with enlarged prostate glands may also experience some incontinence. In some cases, certain drugs may cause incontinence as a side-effect. Another type of incontinence, irritable bladder, is basically an overactive bladder that contracts involuntarily.  Symptoms of incontinence may also be present in women with urinary tract infections, and extended use of antihistamine drugs (non-sedating or sedating).

DIET

The “Golden Rule” in dietary approaches is to eliminate late night drinks. Avoid salty and spicy foods. Acidic diets, including foods like citrus fruits, coffee, tea and soft drinks (especially with aspartame) can be a bladder irritant. Eat foods rich in vitamin A (apricots, asparagus, beet greens, broccoli, carrots, collards, peaches, pumpkin, sweet potatoes, and yellow squash). Maintaining a more alkaline diet (plant-based) will contribute to long-term benefits.

Excessive consumption of water does not lead to incontinence, but it may be best to refrain from drinking liquids after six o’clock in the evening.  Reduce or avoid caffeine because it can cause the bladder to be more spastic. Caffeine also has a diuretic effect causing you to void more often. Alcohol also causes a diuretic effect and irritates the bladder.

EXERCISE

Weak pelvic muscles can be a factor in incontinence, and pelvic exercises can strengthen the muscles in that area. An effective treatment is called the Kegel exercise. The Kegel is a convenient exercise that someone can do just about anywhere at anytime. It is nothing more than contracting the muscles in the pelvic area. To experience how this feels, try stopping your urine midstream. When you’re familiar with how it feels, you can simply draw up your vaginal muscles, hold, then release. Women should try to hold the muscle for 10 seconds and repeat the exercise 40-50 times a day.

For general improvement, biofeedback can help. Biofeedback is actually a form of meditation used by eastern healers for many years.

CONVENTIONAL TREATMENTS

Conventional treatments for incontinence include pelvic floor exercises, surgery, and medications.  Surgical treatments success rates vary, but is generally accepted that it is less than 50 percent. The most effective drugs are oxybutynin and tolterodine.  They have success rates of decreasing urinary episodes up to 70 percent and a cure rate of 20 percent. Some bothersome side effects may preclude continued use.  Biofeedback has been utilized for some patients with limited success. Hypnosis and acupuncture have also been utilized.

SUPPLEMENTAL PROTOCOL

  1. MAGNESIUM (HYDROXIDE) and CALCIUM
    Magnesium and calcium may be the natural solution because of the positive effect these minerals have on all muscles in the body. They aid in controlling bladder spasms. A deficiency of these vital nutrients causes incontinence and urinary frequency. Dosage: Magnesium 350-500 mg daily; Calcium 1,000-1,500 mg daily.
  2. PROBIOTIC SUPPORT
    Because
    Candida or yeast may be a prime factor in loss of urinary control, taking maintenance doses of acidophilus capsules or powder (2-3 times a day) may regulate bowel flora and help decrease the long-term problem.
  3. UVA URSI
    Uva Ursi is a safe and effective herb used to increase urinary flow and decrease frequency. Dosage: As directed on package.
  4. SAW PALMETTO
    Saw Palmetto may help if part of the problem is an enlarged prostate gland exerting pressure on the bladder. Dosage: As directed on package.
  5. HORSETAIL
    Horsetail is an excellent urinary tonic in reducing incontinence. Dosage: 10 drops of the tincture or 300 mg of the capsule twice daily.
  6. CHINESE HERBAL FORMULA
    In some controlled studies, up to 77 percent of patients had some resolution of incontinence when supplementing with a combination of Chinese herbs.  Some of the herbs used includes ASTRAGALUS, ANGELICA, LICORICE (
    Glycyrrhiza), and GINSENG.  Dosage: As directed.
  7. FREE-FORM AMINO ACID COMPLEX
    Free-form amino acid complex helps to strengthen the bladder muscle. Use a product made from a vegetable source. Dosage: Use as directed on label.
  8. BIOFEEDBACK and ACUPUNCTURE
    Biofeedback has been utilized for individuals who exhibit features of both stress and urge incontinence. A study done on 190 elderly patients concluded that 50% had a reduction in frequency.  Accupuncture has been extensively studied as a treatment for urge and stress incontinence, and also showed a 50% improvement in some studies.
  9.  ST JOHN’S WORT
    St. John’s wort has been found to inhibit contraction of the bladder, implying a possible treatment for urge incontinence. Dosage: 300-600 mg daily.
  10. VITAMIN A and VITAMIN E
    These antioxidant vitamins aid in normalizing bladder muscle function. Use the d-alpha-tocopherol form of vitamin E. Dosage: 200-400 IU daily.
  11. HOMEOPATHY
    A combination of 30C potency homeopathic agents has been shown to improve this condition. Some of the most effective products include
    Causticum, Nux vomica, Pulsatilla, and Sepia. Dosage: Use twice a day, see a qualified homeopath.
  12. MULTI-VITAMIN/MINERAL FORMULA
    Supplementing with a potent multi-vitamin/mineral formula aids in relieving stress by supplying needed nutrients. Dosage: As directed.
  13. BLACK COHOSH and SOY
    Since low estrogen levels adversely affect the nerves and blood circulation to the pelvic area, phytoestrogenic herbs may improve blood circulation. Dosage: As directed.
  14. ZINC
    This mineral helps improve bladder function and enhances the immune system. Dosage: 35-75 mg daily.
  15. POTASSIUM
    Potassium supplementation aids in balancing sodium and potassium in the body. Dosage: 99 mg daily.
  16. BROMELAIN
    A natural plant anti-inflammatory, bromelain may decrease the body’s inflammatory response. Dosage: 2-4 capsules daily.
  17. DEVIL’S CLAW
    Devil’s claw is reputed to strengthen the bladder. Dosage: As directed.

 

Balach, PA, Balch, JF. Prescription for Nutritional Healing, Third edition. Penguin-Putman, NY. 2000.

Cherniack, EP. Biofeedback and Other Therapies for the Treatment of Urinary Incontinence in The Elderly. Alternative Medicine Review, Sept. 2006. 11(3): 224-229.                                         

Cremonia, T. Causes and Treatments for Incontinence. Natural Pharmacy, August 1999. P. 21.

Gaby, A. Biofeedback and Other Therapies for the Treatment of Urinary Incontinence in the Elderly. Alternative Medicine Review, Sept. 2006. 11 (3): 224-229.

Stengler, M. Laugh Without Leaking. Alive #266, December 2004. Pp. 56-57.

Wick, JY. Overactive Bladder: Putting the Patient in Control. Pharmacy Times, June 2006. 72(6): 25-26.

Wood, RL, Hood, EH. Management of Urinary Incontinence. Drug Topics, June 17, 2002. Pp. 53-60.

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