Incontinence

Overview

Urinary control relies on the finely coordinated activities of the smooth muscle tissue of the urethra and bladder, skeletal muscle, voluntary inhibition, and the autonomic nervous system.

Urinary incontinence can result from anatomic, physiologic, or pathologic (disease) factors. Congenital and acquired disorders of muscle innervation (e.g., ALS, spina bifida, multiple sclerosis) eventually cause inadequate urinary storage or control.

Acute and temporary incontinence are commonly caused by the following:

  • Childbirth
  • Limited mobility
  • Medication side effect
  • Urinary tract infection

Chronic incontinence is commonly caused by these factors:

  • Birth defects
  • Bladder muscle weakness
  • Blocked urethra (due to benign prostate hyperplasia, tumor, etc.)
  • Brain or spinal cord injury
  • Nerve disorders
  • Pelvic floor muscle weakness
  • Vaginal prolapse

Urinary Incontinence: Why Does It Happen?

Types 
Of the several types of urinary incontinence, stress, urge, and mixed incontinence account for more than 90% of cases. Overflow incontinence is more common in people with disorders that affect the nerve supply originating in the upper portion of the spinal cord and older men with benign prostate hyperplasia (BPH). The primary characteristics of these types are as follows:

  • Stress—urine loss during physical activity that increases abdominal pressure (e.g., coughing, sneezing, laughing)
  • Urge—urine loss with urgent need to void and involuntary bladder contraction (also called detrusor instability)
  • Mixed—both stress and urge incontinence
  • Overflow—constant dribbling of urine; bladder never completely empties

Symptoms Quiz: What type of incontinence do you have?

Incidence and Prevalence 
The U.S. Department of Health and Human Services reported in 1996 that approximately 13 million people in the United States suffer from urinary incontinence. The condition is far more prevalent in women than men. In the general population aged 15 to 64 years old, 10-30% of women versus 1.5-5% of men are affected. At least 50% of nursing home residents are affected. Of that number, 70% are women.

Treatment Options

Treatment options for urinary incontinence depend on the type of incontinence as outlined below.

Stress incontinence is urine loss during physical activity that increases abdominal pressure (e.g., coughing, sneezing, laughing). Treatment options include:

  • Injectables
  • Nonsurgical treatments
  • Medications
  • Surgical treatments

Urge incontinence is urine loss with urgent need to void and involuntary bladder contraction (also called detrusor instability). Treatment options include:

  • Nonsurgical treatments
  • Medications
  • Surgical treatments

Overflow incontinence is constant dribbling of urine; bladder never completely empties. Treatment options include:

  • Medications
  • Intermittent Self-Catheterization

Management

There are several things patients can do to help improve continence.

  • Avoid overconsumption of diuretics, antidepressants, antihistamines, and cough-cold preparations.
  • Perform Kegel exercises daily.
  • Practice double voiding (urinate, wait a few seconds, urinate again).
  • Eat fruits, vegetables, and whole grains daily to prevent constipation.
  • Retrain the bladder (urinate only every 3 to 6 hours).
  • Stop smoking (nicotine irritates the bladder).

A number of protective devices are available to help manage accidental urination, including the following:

  • Bed pads
  • Combination pad-pant systems
  • Disposable or reusable adult diapers
  • Full-length absorbent undergarments
  • Male incontinence drip collectors
  • Underwear liners (pads, guards, shields, inserts)

Early reliance on absorbent pads may cause the wearer to accept incontinence rather than seek diagnosis and treatment. These products should be applied correctly and changed often to prevent skin irritation and urinary tract infection.

 

Naturopathic Treatment of Incontinence

Natural medicine may be used to treat urinary incontinence caused by poor muscle tone, hormonal deficiency, or food allergy.

Kegel exercises are the standard and most effective treatment for incontinence caused by poor muscle tone.

In women, lower estrogen levels during menopause can cause urethral tissue to become thinner, less resilient, and less elastic, leading to reduced sphincter control. The addition of phytoestrogens (plant estrogens) to the diet can be helpful for women who experience menopause-related tissue atrophy. Phytoestrogens are compounds found in plants that produce an estrogen-like effect in the body. In most cases, adding phytoestrogens to the diet is safe and easy and the following items may be suggested:

  • Roasted soy nuts
  • Soy milk
  • Soy protein powder
  • Tempeh
  • Textured soy protein
  • Tofu

Soy isoflavones, which are the components of soy with the strongest estrogenic properties, are available in capsule form in health food stores and supermarket nutrition sections. A typical dose is 50–150 mg daily. There are also several phytoestrogenic and progesterone creams that can be applied directly to the genital tissue to support the elasticity as well as reduce vaginal dryness.

From a naturopathic standpoint, incontinence problems that are not the result of neurological damage, poor muscle tone, or hormone deficiencies are may result from irritability or chronic inflammation within the bladder or urethral tissues caused by food sensitivities. Naturopathic physicians and holistic medical doctors often can treat this uncomfortable condition with changes in the diet and the elimination of sensitive and/or inflammatory foods.

Nutrition

  • Eliminate food sensitivities which may cause chronic inflammatory conditions. To determine food sensitivities, use an elimination and challenge diet. While undertaking an elimination/challenge it is important to focus on calming the bladder with soothing urinary tract tonics. These help heal the bladder and related nervous irritation.
  • Eat whole, fresh, unrefined, and unprocessed foods. Include fruits, vegetables, whole grains, soy, beans, seeds, nuts, olive oil, and cold-water fish (salmon, tuna, sardines, halibut, and mackerel).
  • Avoid sugar, dairy products, refined foods, fried foods, junk foods, and caffeine.
  • Drink 50% of your body weight in ounces of water daily (e.g., if you weigh 150 lbs, drink 75 oz of water daily).

Supplements 
The following supplements can provide anti-inflammatory support.

  • Bromelain – Take 400 mg 3 times a day away from meals.
  • Flaxseed oil – Take 1 tablespoon daily.
  • Vitamin C – Take 500 mg 2-3 times daily with meals.
  • Vitamin E – Take 400 IUs daily.

Herbal Medicine 
Herbal medicines usually do not have side effects when used appropriately and at suggested doses. Occasionally, an herb at the prescribed dose causes stomach upset or a headache. This may reflect the purity of the preparation or added ingredients, such as synthetic binders or fillers. For this reason, it is recommended that only high-quality products be used. As with all medications, more is not better and overdosing can lead to serious illness and death.

The following herbs may be used to soothe and heal the urinary tract:

  • Buchu (Barosma betulina) – A soothing diuretic and antiseptic for the urinary system.
  • Cleavers (Galium aparine) – A traditional urinary tonic.
  • Corn silk (Zea Mays) – Has soothing and diuretic properties.
  • Horsetail (Equisetum arvense) – An astringent and mild diuretic with tissue-healing properties.
  • Marshmallow root (Althea officinalis) – Has soothing, demulcent properties. It is best taken as a cold infusion; soak the herb in cold water for several hours, strain, and drink.
  • Usnea (Usnea barbata) – Has soothing and antiseptic properties.

Homeopathy 
A trained homeopathic practitioner is needed to diagnose and prescribe a deep-acting, constitutional remedy. The standard dosage for acute symptom relief is 3 pellets of 30C every 4 hours until symptoms resolve. Lower potencies, such as 6X, 6C, 30X, may be given every 2 to 4 hours. If the right remedy is chosen, symptoms should improve shortly after the second dose. If there is no improvement after 3 doses, a different remedy is given.

The following remedies have been used to treat incontinence:

  • Causticum – Indicated for stress incontinence associated with difficulty urinating.
  • Natrum muriaticum – Indicated for stress incontinence associated with the menopausal symptoms of vaginal dryness, painful intercourse, and a history of emotional grief.
  • Pareira – Indicated for difficulty urinating due to prostate enlargement.
  • Sepia – Indicated for stress incontinence with urgency, especially associated with vaginitis or prolapsed uterus.
  • Zincum – Indicated for difficulty urinating while standing up (must sit to initiate flow) or due to prostate problems.