Incontinence help, medications, supplements, herbs, vitamins, role of diet, food and pelvic floor exercises
November 2 2016 by
Ray Sahelian, M.D.

Urinary incontinence is common in women, but is under-reported and under-treated.  Urine storage and emptying is a complex coordination between the bladder and urethra, and disturbances in the system due to childbirth, aging, or other medical conditions can lead to this condition. Around 20% to 40% of adults have overactive bladder symptoms (urgency with frequency and/or urge incontinence - 'overactive bladder syndrome. Anticholinergic drugs are common treatment options for urinary incontinence. Women with urinary incontinence have close to double the risk of major depression as women without urinary incontinence. The risk of urge and stress incontinence does not seem to be increased with total hysterectomy.
   The more weight a woman puts on after her teen years, the more likely she is to develop urinary incontinence in her middle and older years. Improved urinary continence is one of the benefits that overweight and obese women can expect to experience with weight loss. The New England Journal of Medicine, January 29, 2009.

Food and diet
Women who consume a lot of calories or favor saturated fat over "good" fats may have an increased risk, regardless of their body weight. Excess weight, particularly in the abdomen, is a risk factor. American Journal of Epidemiology, online April 25, 2010.

Diet and Lifestyle Changes as Urinary Incontinence Treatment
In overweight, prediabetic women, intensive lifestyle intervention for diabetes prevention results in a lower risk of urinary incontinence compared with metformin treatment or standard lifestyle advice. Type 2 diabetes increases the risk of urinary incontinence by 50% in women. Researchers investigated the effects of diet and exercise compared to metformin only on incontinence risk among 1957 overweight women at high risk for diabetes. The subjects, who had an average BMI of 35 and age of 50 years, were participating in the Diabetes Prevention Program, a randomized, controlled multicenter trial. During the trial, which lasted a mean of 3 years, women in the intensive lifestyle group lost an average of 3.4 kilograms, compared with 1.5 kg for those on metformin and a gain of 0.5 kg in the placebo group. Among women in the intensive lifestyle intervention group, 15% developed diabetes, compared with 24% of those on metformin and 30% of those on placebo.  At the close of the study, 38% of the women in the lifestyle intervention group had stress or urge incontinence, compared to 48% of women on metformin and 45% of those on placebo. The differences were strongest for stress incontinence, seen in 31% of the intensive lifestyle intervention group, 39% of those on metformin, and 36% of those on placebo. Most of the difference in rates of incontinence was attributable to weight loss. Diabetes Care 2006.

Pelvic floor exercise
Our review confirms that pelvic floor muscle exercise is particularly beneficial in the treatment of urinary stress incontinence in females. Studies have shown up to 70% improvement in symptoms of stress incontinence following appropriately performed pelvic floor exercise. This improvement is evident across all age groups. There is evidence that women perform better with exercise regimes supervised by specialist physiotherapists or continence nurses, as opposed to unsupervised or leaflet-based care. There is evidence for the widespread recommendation that pelvic floor muscle exercise helps women with all types of urinary incontinence. However, the treatment is most beneficial in women with stress urinary incontinence alone, and who participate in a supervised pelvic floor muscle training program for at least three months. Maturitas. 2010. Pelvic floor exercise for urinary incontinence: A systematic literature review. Price N, Dawood R, Jackson SR. Department of Obstetrics and Gynaecology, John Radcliffe Hospital, UK.

Types of Urinary Incontinence
The two main types of incontinence in women, stress urinary incontinence and urge urinary incontinence, can be evaluated by history and simple clinical assessment available to most primary care physicians. There is a wide range of therapeutic options, but the recent proliferation of new drug treatments and surgical devices for urinary incontinence have had mixed results; direct-to-consumer advertising has increased public awareness of the problem of urinary incontinence, but many new products are being introduced without long-term evaluation of their safety and efficacy.

Cause of urinary incontinence
There are several causes including past pregnancies, diabetes, chronic insomnia, and poor overall health. Being overweight is another cause of urinary incontinence. Losing weight can improve symptoms. Women who have incontinence during pregnancy are more likely than other women to have the problem after giving birth as well. See also fecal incontinence information.

Urinary Incontinence cause
Urinary incontinence differs somewhat among age groups. Incontinence experienced by younger adults tends to begin suddenly, and it often resolves quickly with little or no treatment. Also, when younger adults experience incontinence, they usually maintain control without leakage for most of their episodes of urination. Older adults are often more frequently and severely affected. In addition, incontinence is less likely to resolve quickly or without treatment in older adults. Several changes occur with age that affect the person's ability to control urination. The maximum amount of urine that the bladder can hold (bladder capacity) declines. A person's ability to postpone urination after feeling a need to urinate also decreases with age. The rate of urine flow out of the bladder and through the urethra slows. At any age, sporadic contractions of bladder wall muscles occur regardless of need or appropriate opportunity to urinate; most contractions are blocked by normal spinal cord and brain controls at younger ages, but the number that are not blocked increases with age. The amount of urine remaining in the bladder after urination is finished (residual urine) also increases with age. In women, the urethra shortens and its lining becomes thinner as the level of estrogen declines during menopause; these changes decrease the ability of the urinary sphincter to close tightly. In men, the prostate gland enlarges, sometimes impeding the flow of urine through the urethra. Although all of these age-related changes increase the odds that incontinence will occur, it usually only occurs when another factor is in place, for example, when the person has a medical disorder. Many disorders can impair or disrupt the ability to control urination.
   A bladder infection is the most common cause of acute urinary incontinence. Several reversible factors can contribute to incontinence. Examples include conditions that result in confusion (a severe infection such as pneumonia) or impaired mobility (a leg or hip fracture). Other causes include excess intake of alcohol or beverages that contain caffeine and conditions that can result in irritation of the bladder or urethra, such as atrophic vaginitis or severe constipation. Persistent urinary incontinence may be caused by brain disorders such as stroke, diseases that affect the nerves leading to and from the bladder, conditions in the lower urinary tract, and conditions that impair mental function or mobility.
   Women who undergo hysterectomy are at increased risk of developing stress urinary incontinence sometimes severe enough to require surgery.

Overactive bladder cause
For people with overactive bladder problems, cutting fluid intake can substantially improve symptoms. An overactive bladder causes a person to urinate frequently, often urgently. There may or may not be some leakage because of the urgency. Bladder infections, bladder cancer and bladder stones can produce the same symptoms so these conditions should be ruled out before a diagnosis of overactive bladder can be made.

Stress Urinary Incontinence
Stress incontinence is when urine leaks because of sudden pressure on your lower stomach muscles, such as when you cough, laugh, lift something or exercise. Stress incontinence usually occurs when the pelvic muscles are weakened, for example by childbirth or surgery. Stress incontinence is common in women. The common reason for the pelvic floor muscles to become weakened is childbirth. Stress incontinence is common in women who have had several children. It is also more common with increasing age as the muscles become weaker, and in women who are obese.
   Stress urinary incontinence, the most common type of urinary incontinence, is a significant problem for millions of women, many of whom remain untreated for years, sometimes for life. One reason for this is the lack of effective pharmacologic therapy for stress incontinence. A new agent, duloxetine, which inhibits serotonin-norepinephrine re-uptake in these pathways, is now in clinical trials and appears to be the first effective pharmacologic therapy for stress incontinence. Alpha adrenergics, such as phenylpropanolamine and midodrine, and beta adrenergics, such as clenbuterol, are also used in "off-label" therapy for stress incontinence. A meta-analysis of 15 randomised studies with female patients with stress incontinence who received a- and b-adrenergics as part of their therapy, failed to detect efficacy compared to placebo.
   Natural stress Incontinence treatment: Strengthening the pelvic floor muscles is the usual first treatment for stress incontinence. Many cases of stress incontinence can be cured or much improved by strengthening the pelvic floor muscles. The pelvic floor muscles are a group of muscles that wrap around the underside of the bladder and rectum. Exercises to strengthen these muscles are the usual first treatment for stress incontinence. Ask your doctor to refer you to a urinary continence advisor or physiotherapist to help with this.

Urge Urinary Incontinence
This is the condition characterized by the involuntary loss of urine accompanied by a strong desire to void. Urge incontinence is often due to detrusor instability, although the instability of the detrusor bladder muscle cannot be demonstrated clinically but through cystometry. Sensory urge incontinence is the involuntary loss of urine associated with urgency and a strong desire to void urine immediately due to the hypersensitivity of the bladder and urethral sensory receptors. The mainstay treatment for this common form of incontinence is conservative treatment. There are two forms of conservative treatment: behavioral techniques and pharmacotherapy. The urge urinary incontinence is most successfully treated by a drug therapy. Anticholinergic drugs and anticholinergic antispasmodic drugs are the primary pharmacologic treatment for this condition, although the usefulness of this agent has been limited by a lack of selectivity for the bladder, which gives rise to frequent, bothersome side effect (dry mouth, constipation, blurred vision, etc.) For these reasons, tolterodine was developed as the first antimuscarinic agent specifically targeted for the treatment of the urge urinary incontinence. This agent has demonstrated a bladder-selective profile in vivo, leading to a more pronounced and longer lasting effect on the bladder than on salivation in humans.

J Fam Pract. 2014. The pharmacologic management of idiopathic overactive bladder in primary care. Urgency urinary incontinence is 1 of the symptoms commonly experienced by persons with idiopathic (ie, nonneurogenic) OAB. Overactive bladder is a symptom complex characterized by urgency (the sudden, compelling desire to void that is difficult to defer), with or without urgency urinary incontinence, often associated with frequency (8 or more micturitions during a 24-hour period), and nocturia. The etiology of OAB is multifactorial and thought to be due to detrusor overactivity and altered bladder afferent nerve activity. Risk factors for OAB include advancing age, obesity, and diabetes.

Urinary Incontinence Treatment
Treatment for urinary incontinence depends on what's causing the problem and what type of incontinence you have. If your urinary incontinence is caused by a medical problem, the incontinence will go away when the problem is treated. Kegel exercises and bladder training help some types of incontinence. Medicine and surgery are other options.
   Active women are less likely to develop urinary incontinence as they age. Exercising could reduce incontinence risk by strengthening the pelvic floor muscles. The association between exercise and lower incontinence risk is strongest for stress urinary incontinence, in which a person leaks urine due to stresses such as sneezing, coughing or lifting a heavy object.

Weight-loss surgery appears to have an additional side benefit -- it may improve urinary incontinence symptoms in women.

For women with bladder incontinence who haven't been helped by medications or other therapies, Botox injections may help control leakage better than an implanted nerve stimulation device.

Incontinence drug side effects - cognitive and memory problems
Commonly used incontinence drugs cause memory problems in some older people. Dr. Jack Tsao evaluated a large group of older 870 older Catholic priests, nuns and brothers to see if he could measure an effect of these and other medications that affect acetylcholine, a chemical messenger that shuttles signals through the brain and the rest of the nervous system. The drugs block some nerve impulses, such as spasms of the bladder. Nearly 80 percent of the study participants took one or more of a class of drugs called anticholinergics, including drugs for high blood pressure, asthma, Parkinson's disease and incontinence drugs such as Detrol and Ditropan. The people who took the drugs had a 50 percent faster rate of cognitive decline compared to those who didn't take any. The incontinence drugs were among the most potent and were the most frequently taken of all the anticholinergics in the study. Dr. Jack Tsao believes these incontinence drugs are causing the cognitive deficits.
   Confusion and memory impairment were added to prescribing information for Detrol in 2006.

Botulinum for Urinary Incontinence

Injections of Botox, or botulinum toxin-type A, appear useful in the treatment of drug-resistant urinary incontinence due to traumatic spinal cord injury. Thirty seven patients with drug-resistant urinary incontinence received botulinum injections into the detrusor muscle, which controls bladder function. Overall, incontinence was abolished in 82 percent of patients and detrusor overactivity was stopped in 76 percent. In all, 86 percent of patients were able to stop or reduce drug therapy and a similar proportion showed an increase in quality-of-life scores. The mean duration of symptomatic improvement was 9 months, and 12 patients had a mean of 14 months of improvement. BJU International 2006.

Estrogen, Progestin, and Urinary Incontinence
Within a few months of starting estrogen plus progestin hormone replacement therapy (HRT), there is an elevated risk of urge and stress incontinence in postmenopausal women. More than 40 percent of postmenopausal women suffer from urinary incontinence. In stress incontinence, the bladder tends to leak urine when movement puts pressure on it -- during exercise, for example, or when a person laughs or coughs. Urge incontinence is marked by an overwhelming and frequent urge to urinate. Using data from the HERS study, which stands for Heart Estrogen/progestin Replacement Study, Dr. Jody Steinauer, from the University of California at San Francisco, and colleagues assessed the occurrence of urinary incontinence in roughly 1,200 women who reported no episodes of incontinence in the week prior to starting HRT or placebo. The subjects were followed for about 4 years. During this time, 64 percent of HRT-treated women reported weekly incontinence compared with 49 percent of those given placebo -- a statistically significant difference. This difference was noted at 4 months and persisted for the full study period, independent of age. Treatment with HRT increased the risk of urge and stress incontinence by 50 percent and 70 percent, respectively. The excess risks of weekly urge and stress incontinence attributed to HRT were 12 percent and 16 percent, respectively. The current study supports findings from previous randomized trials suggesting that HRT can either trigger or worsen urinary incontinence in postmenopausal women. Interestingly, these results contradict physiologic data suggesting that HRT might actually improve incontinence, the researchers say. Obstetrics and Gynecology 2005.

Urinary Incontinence and Pregnancy
the risk of having stress urinary incontinence many years following first childbirth is significantly increased in those women with an onset of stress urinary incontinence symptoms following first delivery or during first pregnancy compared with those women who do not experience initial symptoms

Urinary Incontinence Product Supply
A wide variety of products are available for managing the leakage of urine. The choice of a specific product depends on several factors, including the amount of urine loss, the pattern of urine loss, ease of use, cost, comfort, odor control ability, and durability. Some men and women try to use sanitary napkins or mini pads to manage urine leakage. However, these incontinence products do not handle urine very well. Disposable inserts are available that resemble a sanitary napkin or mini pad, but they are much more absorbent and have a waterproof backing. These inserts are meant to be worn inside your underwear. Some companies make reusable, washable cloth liners or pads that are held in place by waterproof pants.

Urinary Incontinence in Children
Children who have soiling problems are more likely than their peers to have a range of behavioral and emotional difficulties. Fecal incontinence in older children is often related to constipation but it's likely that a complex mix of dietary, genetic, biological and psychological factors also come into play.

Dietary supplements
Are there herbs that can help urinary incontinence? I have an overactive bladder and donít want to take convention medication. Do you have any herbal formulas that might be good for this condition?
   There may be, I'm just not aware of supplements that have been tested well in humans as urinary incontinence treatment. Urinary incontinence and Stress Incontinence are widespread, but little herbal research is available.

I am interested to know if there is an herb that would help with night time problems urinating for women. Since saw palmetto is good for men, what about women?
    I doubt saw palmetto would help incontinence in women since this herb works mostly with prostate tissue.

Iím looking for treatment for overactive bladder for a 15 year old girl.
    I have not studied the topic of overactive bladder in young female adults in terms of a natural treatment.