Urinary Incontinence

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 innervations (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:

• Bladder muscle weakness

• Blocked urethra (due to benign prostate hyperplasia, tumor, etc.)

• Brain or spinal cord injury

• Nerve disorders

• Pelvic floor muscle weakness

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

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.

A physical examination includes a neruologic status evaluation and examination of the abdomen, rectum, genitals, and pelvis. The cough stress test, in which the patient coughs forcefully while the doctor observes the urethra, allows observation of urine loss.

Instantaneous leakage with coughing indicates a diagnosis of stress incontinence.

Leakage that is delayed or persistent after the cough indicates urge incontinence.

The physical examination also helps the doctor identify medical conditions that may be the cause of incontinence. For instance, poor reflexes or sensory responses may indicate a neurological disorder.

Urinalysis

Examination of the urine may identify medical conditions associated with urinary incontinence, such as the following:

• Bacteriuria — presence of bacteria in urine; indicates infection

• Glycosuria — excess glucose in urine; may indicate diabetes

• Hematuria — blood in urine; may indicate kidney disease

• Proteinuria — excess protein in urine; may indicate kidney disease, cardiac disease, blood disease

• Pyuria — presence of pus in urine; indicates infection

Specialized Testing

If incontinence persists after diagnosis and treatment, additional testing may be needed. Urologists perform urodynamic, endoscopic, and imaging tests to obtain a more extensive evaluation of the lower urinary tract to determine a new treatment plan.

Postvoid residual volume (PRV)

This procedure requires catheterization or pelvic ultrasound. The patient voids just before the PRV is measured. This initial void should be observed for hesitancy, straining, or interrupted flow. A PRV less than 50 mL indicates adequate bladder emptying. Repeated measurements of 100 to 200 mL or higher represent inadequate bladder emptying. The clinical setting and the patient's readiness to void may affect the test result; therefore, repeated measurements may be necessary.

Urodynamic Testing

Cystometry may be used to measure the anatomic and functional status of the bladder and urethra. The cystometer is an instrument that measures the pressure and capacity of the bladder; thus evaluating the function of the detrusor muscle.

Simple cystometry detects abnormal detrusor compliance, but abdominal pressure is not included and the results must be evaluated with caution.

The multichannel, or subtracted, cystometrogram simultaneously measures intra-abdominal, total bladder, and true detrusor pressures. This allows involuntary detrusor contractions to be distinguished from increased intra-abdominal pressure. The voiding cystometrogram detects outlet obstruction in patients who are able to void.

Uroflowmetry identifies abnormal voiding patterns. Urethral pressure profilometry measures the resting and dynamic pressures in the urethra.

Endoscopic Tests

Cystoscopy may be performed when urodynamic testing fails to duplicate symptoms, when the patient experiences new symptoms (e.g., cystitis, pain), or when urinalysis reveals a disease process (e.g., menaturia, pyuria). Cystoscopy identifies the presence of bladder lesions (e.g., cysts) and foreign bodies.

Imaging Tests

X-rays and ultrasound may be used to evaluate anatomic conditions associated with urinary incontinence. Imaging of the lower urinary tract before, during, and after voiding is helpful in examining the anatomy of the urinary bladder and urethra

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 of Urinary Incontinence

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 ½ 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.

The above opinionated views and information serves to educated and informed consumer .  The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. .It should not replaced professional advise and consultation.A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions