Incontinence

According to the American Urological Association, an estimated 17 million American adults-primarily women-have some form of incontinence. Estimated is the operative word here. No one knows the exact number because so many people with bladder-control problems are too embarrassed to talk about them.

The word incontinence refers to loss of bladder or bowel control. (For information on bowel control problems, or fecal incontinence, see "Fecal Incontinence: A Case of Disobedient Bowels:") Urinary incontinence takes several forms.

Stress incontinence. Certain muscles support your bladder and urine tube (urethra), holding these structures in their proper positions. If these pelvic-floor muscles weaken, anything that puts pressure on your abdomen can cause you to involuntarily release some urine.

Urge incontinence. When you have urge incontinence, something causes your bladder muscles to contract, and you suddenly feel the need to relieve yourself.

Onlineremediesed incontinence. As the name suggests, this is a combination of stress and urge incontinence. You suddenly feel the need to urinate, and your muscles aren't strong enough to prevent it.

Overfiow incontinence. This condition usually affects middle-age men with enlarged prostates. Your prostate is pinching your urethra, which makes your bladder feel full and creates a weak urine stream.

Medication-related incontinence. Many blood pressure drugs can impair the function of your bladder and urethral muscles.

In its various forms, urinary incontinence can affect just about anyone of any age, but definitely women more than men. Among men, the leading risk factor for loss of bladder control is an enlarged prostate. Women, on the other hand, have a number of risk factors to contend with, including pregnancy and childbirth, overweight, smoking, infections, weakening pelvic-floor muscles due to aging, and any neurological disease that damages the nerves needed for bladder control. Pelvic trauma and radiation therapy can also contribute to incontinence.

If you have urinary incontinence, you should discuss your condition with your doctor. There may be an underlying health problem causing your loss of bladder control. If that's the case, you really need to get a diagnosis and begin treatment.

More than likely, though, your incontinence is not a symptom of another condition. So once your doctor determines what type of incontinence you have, you can use a combination of mainstream and alternative therapies to treat it. Here's what experts say can help.

Best Choices

Nutrition

Avoid the irritators. Steer clear of foods and beverages that can irritate your bladder. They include dairy products, spicy foods, foods containing artificial sweeteners such as aspartame, citrus fruits and juices, alcohol, and caffeinated beverages. "I've cured several cases of stress incontinence just by telling women to stop drinking coffee," says Christiane Northrup, M.D., founder of the Women to Women health center in Yarmouth, Maine, and past president of the American Holistic Medical Association.

Exercise

Flex your PC. Back in 1948, urologist Arnold Kegel, M.D., theorized that strengthening the pelvic-floor muscles might help the urethral sphincter stay closed. He developed a specific set of exercises to condition the pubococcygeus (PC) muscle, which plays an important role in bladder control.

As a treatment for urinary incontinence, Kegel exercises have been shown to significantly improve bladder control in 50 to 90 percent of women.

To do Kegels properly, you must first identify your PC muscle. It's the one you flex to stop urinating in midstream. Try this a few times to make sure you're working the right muscle. But don't get in the habit of interrupting urination. It's not good for your bladder.

Once you've located your PC, practice contracting and releasing it. Hold each contraction for 10 seconds, then relax for 10 seconds. Do 10 repetitions four times a day for 8 weeks. If you don't notice any improvement after 8 weeks, consult your doctor. You may not be working the right muscle.

Biofeedback

Retrain your muscles. If you have urge incontinence, you may benefit from biofeed­back training. At the University of Alabama at Birmingham, researchers taught 197 women with urge incontinence to use vaginally inserted biofeedback devices. The devices allowed the women to view graphic displays of their bladder and urethral muscle activity. By the end of the study, 74 percent of the women using biofeedback reported substantial decreases in incontinence. And biofeedback treatment produced no side effects, as incontinence drugs can.

Social Support

Get help from a trusted source. If you're too embarrassed to discuss incontinence with anyone, even your doctor, you may feel isolated and alone. But you can get help discreetly, from the National Association for Continence (NAFC). This organization provides information, advice, and support for people with bladder-control problems. You can contact the NAFC by writing to P. O. Box 8310, Spartanburg, SC 29305-8310.

Herbal Medicine

Fight leakage with phytos. Mainstream doctors often prescribe estrogen replacement for postmenopausal incontinence. The hormone boosts blood flow to your bladder and urethral muscles, which helps strengthen them. You can get similar benefits from naturally occurring compounds called phytoestrogens, supplied by the herb black cohosh. Herbalist Susun Weed, of Woodstock, New York, who specializes in women's health, recommends taking 10 drops of black cohosh tincture once or twice a day in water or juice.

Home Remedies

Plan your toilet time. To treat urge incontinence, some experts recommend that you ignore the impulse to relieve yourself. Instead, try to urinate at about the same time every day. You can start by going to the bathroom every 30 to 60 minutes if necessary-but over the next several months, gradually extend the time between "pit stops:" Eventually, you may be able to wait 3 to 4 hours between bathroom visits. According to researchers at the Medical College of Virginia in Richmond, this type of bladder retraining cut accidents in half among 123 women with incontinence.

Take a seat-twice. If you're a man with over flow incontinence, sit down when you urinate. Stay on the toilet until you feel finished, then stand up and sit down again. You may be able to eliminate more urine this way.

Dress loosely. Tight clothes can aggravate stress incontinence by putting pressure on your lower abdomen. Women should avoid wearing girdles, corsets, and tight exercise outfits.

Drink more. When you have incontinence, you may be tempted to avoid fluids for fear that you'll have an accident. In fact, dehydration makes your urine more concentrated, which can irritate your bladder and aggravate your bladder-control problem, says Andrew T. Weil, M.D., director of the program in integrative medicine at the University of Arizona College of Medicine in Tucson.

Keep a diary. For a week or two, write down the number of times each day that you urinate, the number of times you experience leakage or feel a sudden urge to urinate, the approximate amount of urine you leak, and your fluid intake. By tracking these factors, you may notice a pattern in your incontinence. For example, you may realize that you have leakage every time you drink coffee. In that case, cutting back on coffee may help you avoid accidents. Your doctor can also use this information in deciding how best to treat your condition.

Other Good Choices

Homeopathy

Count on Causticum. For stress incontinence, homeopaths often prescribe Causticum, says homeopath Dana Ullman. For overflow incontinence associated with an enlarged prostate, he recommends Sabal serrulata. Consult a homeopath for a dosage that best suits your needs.

Chinese Medicine

Fortify with herbs. To treat incontinence, Efrem Korngold, O.M.D., L.Ac., prescribes a number of strengthening and astringent herbs. These include lotus seed, astragalus seed, rehmannia root, dioscorea root, and cornus fruit.

Press points to prevent it. Stimulating certain points on your arms and legs may help prevent urine leakage. Apply firm, steady finger pressure to each of the following points for 3 minutes.

• Lung 9, located on the thumb side of your inner forearm in the hollow between your wrist bone and wrist crease
• Kidney 7, located on your inner leg, two thumb-widths above your anklebone
• Spleen 6, located four finger-widths above your inner anklebone on the back inner border of your shinbone

Over-The-Counter Drugs

Discover a new use for decongestants. Decongestants may help relieve stress incontinence by increasing urethral constriction, which inhibits urine flow, says Patrick Culligan, M.D., of the Evanston Continence Center in Illinois. For the same reason, these drugs can aggravate overflow incontinence.

If you have stress incontinence, Dr. Culligan suggests taking 30 to 60 milligrams of pseudoephedrine (Sudafed) four times a day. If you are unsure of the equivalent number of tablets or capsules, ask your pharmacist.

Avoid using pseudoephedrine after dinner, because it can keep you wide awake if taken too close to bedtime.

Medical Measures

Various kinds of urine retention devices have been recommended to patients by many generations of physicians. Today, little cups made from rubber, foam, or plastic serve the same purpose, but far more efficiently. They fit over the urethral opening and physically block leakage. While these retention devices are effective, many women find them uncomfortable.

For stress, urge, or mixed incontinence, mainstream M.D.'s often prescribe supplemental estrogen in pill or cream form or as a ring inserted in the vagina. The hormone strengthens the bladder and urethral muscles by improving blood circulation to them.

For stress incontinence, doctors may opt to prescribe a drug similar to over-the­counter decongestants to increase urethral resistance to urine flow. For urge incontinence, they sometimes prescribe a number of drugs that reduce involuntary bladder muscle contractions, such as oxybutynin (Ditropan) and tolterodine (Detrol). All of these medications are effective but produce many side effects. They may cause dry mouth and eyes, blurred vision, nausea, constipation, drowsiness, and confusion. Some women who can't tolerate the side effects simply stop taking the drugs.

Your doctor might also recommend injections of collagen, a natural protein. As a last resort, you can have surgery to help reinforce your pelvic-floor muscles, providing extra support for your bladder and urethra.