Urinary Incontinence

Urinary incontinence is the inability to control urination. It affects more than 13 million people of all ages in the United States. It is more common in the elderly and women.

Incontinence is classified as either stress incontinence (caused by coughing laughing sneezing) urge incontinence (losing urine when suddenly feeling the urge to urinate) overflow incontinence (continually leaking urine) functional incontinence (in people with a brain injury) or transient incontinence (temporary incontinence). Treatment is highly effective in more than 80 percent of cases. Exercise and behavioral therapies are most successful.

Signs and Symptoms

• Not being able to hold your urine until you get to a bathroom
• Frequent and unusual urges to urinate

What Causes It?

• Stretched pelvic muscles from pregnancy and childbirth
• Low estrogen levels in women
• Enlarged prostate in men
• Side effects of certain medications
• Urinary tract infections (UTIs)
• Frequent constipation
• Damage to or diseases of the brain or spinal cord (for example dementia spinal cord injury multiple sclerosis stroke)
• Weakened muscles that control urination (urethral sphincter and pelvic-floor muscles)

What to Expect at Your Provider's Office

Your health care provider will give you a physical examination and may ask you some questions about your past prostate problems pregnancy hysterectomy your pattern of urinating when your urine leakage occurs and whether you strain or experience discomfort when you urinate. You may be asked to cough vigorously to see if it causes urine loss a sign of stress incontinence.

Your provider may suggest urine tests to detect infection urinary stones diabetes and other underlying causes. A pelvic ultrasound may be performed to examine your bladder kidneys and urethra.

Treatment Options

Treatment Plan

Several types of drugs are available to help muscle control. However many of them have unacceptable side effects. Kegel exercises can strengthen muscles that control urination. There are electronic biofeedback devices that can be inserted into the vagina or rectum to aid muscle identification for exercise therapy. Relaxation exercises may help you to go longer without urinating. Catheters urethral plugs condom catheters and absorbent pads or underwear can be used. Surgery may be helpful especially for women with stress incontinence or men with an enlarged prostate.

Drug Therapies

Prescription

• Antibiotics—for UI from urinary tract infections or sexually transmitted diseases
• Anticholinergics—relieve symptoms of UI but have high instances of intolerable side effects
• Cholinergics—relieve symptoms of UI but have intolerable side effects
• Sympathomimetics—for stress incontinence; various side effects
• Hormone replacement therapy—for stress incontinence; various potentially serious side effects

Over the Counter

N/A

Complementary and Alternative Therapies

Alternative therapies mainly involve Kegel exercises biofeedback and preventing any conditions that worsen incontinence. Yoga may help as well.

Nutrition

• Eliminate caffeine alcohol sweetener substitutes simple sugars.
• Cranberries and blueberries contain substances that keep bacteria from adhering to the bladder. This may help prevent infections that can make incontinence worse and helps deodorize urine.
• Vitamin C (1 000 mg three times a day) keeps bacteria from growing in urine.
• Beta-carotene (25 000 to 50 000 IU per day) helps your immune system function properly and keeps mucous membranes healthy.
• Zinc (30 mg per day) supports immune function.
• Calcium (1 000 mg per day) and magnesium (500 mg per day) taken together may improve control of the muscles used in urination.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers; 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

Urinary astringents tone and heal the urinary tract and can be taken long-term at 1 cup per day or 30 drops tincture per day.

• Horsetail (Equisetum arvense) helps connective tissue integrity.
• Plantain (Plantago major) is an astringent and demulcent.

Marshmallow root (Althea officinalis) is a urinary demulcent best used alone in a cold infusion. Soak 1 heaping tbsp. of marshmallow root in 1 qt. of cold water overnight. Strain and drink during the day in addition to other teas.

Homeopathy

Some of the most common remedies used for urinary incontinence are listed below. Usually the dose is 12X to 30C every one to four hours until your symptoms get better.

• Causticumfor stress incontinence especially with retention from holding the urine and frequent urges to urinate
• Natrum muriaticum for stress incontinence vaginal dryness and pain during sex especially with a history of grief
• Pareirafor retention of urine from an enlarged prostate
• Sepia for stress incontinence with sudden urge to urinate especially with prolapsed uterus and vaginitis
• Zincumfor stress incontinence urinary retention from prostate problems unable to urinate standing

Acupuncture

May help depending on cause of the incontinence

Following Up

Exercise and behavioral therapy are highly successful when closely adhered to. You may need close monitoring by your health care provider and support from someone close to you to stay committed to these lifestyle changes.

Special Considerations

If you are pregnant consult with your provider before taking any medication. For men regular prostate examinations can detect problems early.

Supporting Research

Bartram T. Encyclopedia of Herbal Medicine. Dorset England: Grace Publishers; 1995:247.

Blumenthal M ed. The Complete German Commission E Monographs. Boston Mass: Integrative Medicine Communications; 1998:432.

Dambro MR. Griffith's 5 Minute Clinical Consult: Baltimore Md: Williams & Wilkins; 1998.

Fauci AS Braunwald E Isselbacher KJ et al eds. Harrison's Principles of Internal Medicine. 14th ed. New York NY: McGraw-Hill; 1998:1466–1468.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany Calif: Hahnemann Clinic Publishing; 1993:111–113 258–261 286 402.

Olshevsky M Noy S Zwang M et al. Manual of Natural Therapy. New York NY: Facts on File Inc; 1989.

Thom DH Van den Eeden SK Brown JS. Evaluation of parturition and other reproductive variable as risk factors for urinary incontinence. Obstet Gynecol. 1997;90:983–989.

Ullman D. The Consumer's Guide to Homeopathy. New York NY: The Putnam Publishing Group; 1995.

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The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.