“I laughed so hard I peed my pants,” is a common expression that usually brings a smile. But if you’ve actually experienced urinary incontinence, as millions of women have, it isn’t so funny.
The most common cause of leakage is stress incontinence, which occurs when laughter, coughing, sneezing, or exertion puts pressure on the bladder and supporting muscles. Pregnancy, childbirth, hormonal changes, weight gain, and aging can weaken the muscles in the pelvic floor and the sphincter (the muscle that opens and closes at the neck of the bladder) to the point they’re not always able to hold back urine.
Urge incontinence, or overactive bladder, is characterized by involuntary contractions of the bladder muscles, frequent urination, and the feeling that you need to go right now. It is linked with a number of underlying causes, including medication side effects, nerve damage, infection, stroke, Parkinson’s, and multiple sclerosis. Many women have symptoms of both types of incontinence.
Lifestyle Change Make a Real Difference
Urinary incontinence is a distressing problem, and nobody wants to suffer embarrassing accidents or be dependent on absorbent pads. The good news is that lifestyle changes can make a big difference.
Cut back on fluids, especially alcohol and caffeine, and drink less before bedtime. Weight loss is a proven strategy for stress incontinence, as demonstrated by studies of bariatric surgery. Bladder training, which involves going to the bathroom on a regular schedule (every two to four hours or so, whether you need to or not), improves control.
Get a handle on constipation, smoking, chronic cough, and other conditions that worsen symptoms. And talk to your doctor if you’re taking diuretics, muscle relaxants, sleeping pills, antidepressants, alpha-blockers, or narcotic painkillers. All these meds list incontinence as a side effect.
As you know, the best way to strengthen any muscle is exercise. When it comes to bladder control, regular practice of pelvic floor exercises, or Kegels, tones these supporting muscles and is a proven method of reducing and preventing incontinence. Kegels seem easy, but many women don’t do them correctly—or remember to do them at all. Biofeedback can help you learn to isolate the proper muscles, and getting into the habit of doing them during specific activities such as driving or brushing your teeth improves compliance.
Pessaries, devices placed in the vagina to provide bladder support, are also safe and effective for stress incontinence. The FDA has approved Impressa, an over-the-counter product that doesn’t require a doctor’s visit for special fitting. In a study involving women of all ages with this problem, 85 percent of them had a 70 percent or greater reduction in urinary incontinence and dramatic improvements in quality of life while using this product.
Drugs and Surgery for Incontinence
Urinary incontinence is a fertile market for Big Pharma. Although there are no medications for stress incontinence, a number of drugs target overactive bladder. Unfortunately, these drugs are only modestly effective, and they have serious side effects. Fewer than half of patients stay on them longer than six months.
Most of these meds are anticholinergics. They inhibit involuntary bladder muscle contractions by blocking acetylcholine, a neurotransmitter active in nerve cells throughout the body. Anticholinergics are notorious for their adverse effects of constipation, dry mouth, vision changes, dizziness, confusion, and memory loss. And when taken for prolonged periods, they are associated with increased risk of dementia.
Botox is also used for urge incontinence. Injected directly into the bladder, it causes temporary paralysis of some of the muscles, allowing the bladder to relax and store more urine.
Another option is electrical stimulation, which sends mild electrical currents to stimulate and stabilize nerves and muscles involved in urination. Treatments range from implanted devices that stimulate the sacral nerve in the lower back to home units placed in the vagina.
Women with severe stress incontinence may opt for surgery. The most common type is a “sling” procedure, which involves the creation of a sling from tissue or synthetic mesh to support the neck of the bladder and/or the urethra (the tube that carries urine from the bladder out of the body). These procedures often relieve symptoms. However, painful complications such as tissue erosion and organ perforation are not uncommon with mesh slings, and tens of thousands of complaints have been filed with the FDA and the court systems.
Like all drugs and surgeries, these should be used only as a last resort.
When All Else Fails to Treat Incontinence...
If you’re still having problems after giving lifestyle changes a serious try, consider the following treatments, which you probably won’t hear about from your conventional physician.
Acupuncture has been used to treat urinary incontinence for thousands of years, and recent studies support its effectiveness, especially for urge incontinence.
Supplements that have been shown in clinical trials to reduce leakage, urgency, and frequency include Go-Less, a combo of pumpkin seed extract and soy isoflavones, and BetterWoman, a blend of Chinese herbs. You can find both of these online and at health food stores.
Cranberry extracts help stave off urinary tract infections, which irritate the bladder and often increase the urge to urinate.
Estrogen helps keep pelvic tissues healthy, and hormonal declines following menopause increase risk of vaginal atrophy, urinary tract infections, incontinence, and pelvic floor disorders. Boosting hormone levels with topical bioidentical estrogen is a safe and effective therapy, especially for reducing vaginal atrophy but also symptoms of overactive bladder and stress incontinence.
I’ll close with what is likely the most effective treatment of all: stem cell therapy. Treatment with your own stem cells, concentrated and returned to the body, stimulate repair of muscles, nerves, and other tissues, and early clinical trials demonstrate benefits in both women and men.