Introduction:

Urinary incontinence is the inability to control urination. It affects more than 13 million people of all ages in the United States. It primarily occurs in women, but is most common among elderly women. The prevalence of urinary incontinence also increases with increasing number of births (among women) and smoking.

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).

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
• Recurrent 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)
• Obesity
• 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 ask questions about any past prostate problems, pregnancy, or hysterectomy, your pattern of urinating, when your urine leakage occurs, and whether you strain or experience discomfort when urinating. You may be asked to cough vigorously to see if it causes urine loss, a sign of stress incontinence.

Your health care 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 is highly effective in more than 80% of patients. Exercise and behavioral therapies are most successful. Common treatments include:

• Exercises: Pelvic floor muscle training and Kegel exercises strengthen muscles that control urination. While increased muscle tone requires long term exercise, squeezing the muscles just before coughing or sneezing provides initial relief.
• Biofeedback: Electronic devices inserted into the vagina or rectum aid in muscle identification for exercise therapy.
• Relaxation techniques may help you go longer without urinating.
• Habit training helps establish regularity of urination.

Several types of drugs are available to help muscle control. Oral and topical estrogen may help with vaginal atrophy. Surgery is also helpful, particularly in women with stress incontinence and for men with an enlarged prostate. Various other options exist as well, such as catheters, urethral plugs, condom catheters, vaginal slings, and absorbent pads or underwear.

Complementary and Alternative Therapies

Alternative therapies mainly involve Kegel exercises, biofeedback, acupuncture, hypnosis, and herbal therapies. Yoga may help as well. Always tell your health care provider about the herbs and supplements you are using.

Nutrition and Supplements

• Cranberries and blueberries contain substances that keep bacteria from adhering to the bladder. This may help prevent infections that can make incontinence worse, while also deodorizing urine.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Eat more high fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
• Avoid refined foods such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy is present) or beans for protein.
• Cut down on foods containing oxalate, such as spinach, rhubarb, beets, nuts, chocolate, black tea, wheat bran, strawberries, and beans.
• Include foods rich in magnesium and low in calcium, such as barley, bran, corn, rye, oats, soy, brown rice, avocado, banana, and potato.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans fatty acids, found in commercially baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise moderately, if tolerated, for at least 30 minutes daily, 5 days a week.

You can address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, D, E, the B vitamins and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Calcium citrate, 500 - 1,000 mg daily, for bone and muscle support.
• Vitamin D, 400 IU daily, for bone and muscle support.
• Magnesium citrate, 200 - 400 mg daily, for muscle support.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
• Omega 3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tbs. of oil 1 - 2 times daily, to help decrease inflammation and improve immunity. Cold water fish, such as salmon or halibut, are good sources. Omega 3's can increase the blood thinning effects of certain medications, including Coumadin. Speak with your doctor.
• L-theanine, 200 mg 1 - 3 times daily, for nervous system support.
• Acetyl-L-carnitine, 500 mg daily, for antioxidant and muscle protective activity.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted. Speak to your doctor about any herbal therapies you are considering using.

The following herbal remedies may provide relief from symptoms:

• Cranberry (Vaccinium macrocarpon) standardized extract, 300 - 400 mg daily, for kidney health. You may also drink 8 - 16 ounces of unsweetened cranberry juice daily.
• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and immune effects. Use caffeine free products. You may also prepare teas from the leaf of this herb.
• St. John's wort (Hypericum perforatum) standardized extract, 300 mg 2 - 3 times per day, for symptoms of urinary incontinence. St. John's wort can interfere with many medications. Check with your health care provider if you are taking prescription medications.
• Saw palmetto (Serenoa repens) standardized extract, 160 mg twice daily, for men with symptoms of prostate-related urinary incontinence.

Homeopathy

Some of the most common remedies used for urinary incontinence are listed below. Usually, the dose is 3 - 5 pellets of a 12X to 30C remedy every 1 - 4 hours until your symptoms get better.

• Causticum for 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
• Pareira for retention of urine from an enlarged prostate
• Sepia for stress incontinence with sudden urge to urinate, especially with prolapsed uterus and vaginitis
• Zincum for stress incontinence, urinary retention from prostate problems, and the inability to urinate while standing

Acupuncture

Acupuncture may help, depending on the cause of the incontinence. Acupuncture may also strengthen the urogenital system. In one study, women who received 4 weekly bladder acupuncture treatments experienced significant improvement in symptoms of urinary incontinence compared to women who received placebo treatments.

Following Up:

Exercise and behavioral therapy can be highly successful. 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 health care provider before taking any medication. For men, regular prostate examinations can detect problems early.

Alternative Names:

Incontinence - urinary