STEP 0. DO NOTHING
As the majority of cases of urge incontinence are idiopathic, that is, they have no known cause, even after extensive testing, spare yourself the health risks of invasive tests.
STEP 1. COLLECT INFORMATION
- It is estimated that 34 million Americans deal with overactive bladder, defined as an urgent and frequent need to urinate, or urinating more than 10 times in 24 hours. Most are older than 40, and one-third to one-half are men.
- Urge incontinence comes on so quickly and so powerfully that there is no time to get to a toilet, even if you are standing right next to one! For some women, even the thought or sight of a toilet causes leakage.
- There are many causes of urge incontinence. Invasive diagnostic tests requiring catheterizations are best refused, however, as the results are often inconclusive. In general – unless there is a known cause such as an enlarged prostate, a bladder infection, vaginal yeast overgrowth, interstitial cystitis, fibromyalgia, or multiple sclerosis – urge incontinence/overactive bladder is thought to be caused by abnormal nerve signals to the bladder, which initiate spastic muscle contractions and an often uncontrollable need to urinate, even when the bladder is not full.
- A bladder diary lists the times of day you urinate (including leaks), the amount of urine you void, what you drink and eat and when, and medicines you took. Over a period of a week or two, patterns emerge that can help you retrain your bladder.
“About 30% of women [with overactive bladders] get better simply by understanding what’s happening and thinking about it.”
STEP 2. ENGAGE THE ENERGY
- A powerful visualization coupled with a physical trigger can put you in control of your bladder, fast. Choose an image, visualize it repeatedly, then use it to help prevent leaks and urgency. If you visualize for even two minutes a day, you will get results faster than if you take drugs. If you use the physical trigger while you visualize, eventually it, alone, will be enough to control your urge incontinence, you won’t need the visualization any more. Sitting alone, in a tranquil environment (a bathtub is fine), close your eyes and imagine vividly, using all your senses: see the scene, taste it, smell it, feel its texture, listen to it. As in a dream, you can create whatever you want. Take many quiet sessions to make your visualization real; don’t try to do it all at once. Create your own visualization or try one of these.
- Visualize the nerve message between your bladder and your brain as a stream of water; in your imagination, install dams and locks to slow it down. When you visualize, squeeze your fist in a slow rhythm.
- Visualize the nerve pathway as a road; set up gates or toll booths all along it, starting at the bladder and working your way up to the brain. When you visualize this, gently bite your lower lip.
- Imagine a large, strong hand gently pushing up between your legs and comforting you. When you do so, smile.
- Homeopathic remedies for urge incontinence include:
- Belladonna: if there are chronic spasms
- Eupatorium pur.: bladder always feels full
- Sulphura: urge is sudden and intense
- Nux vomica: urge accompanied by pain
- Uranium nitricum: burning pain
- Biofeedback using electrical or pressure-sensing devices can increase awareness of the bladder, foiling urge incontinence. It is so well-studied, and so effective in relieving incontinence, that Medicare covers the cost.
Everyone who is incontinent has weak muscles. Those with stress incontinence “deny the problem, pay little attention to bladder signals, and are surprised when a slight physical exertion forces urine out. The urge patient, on the other hand, is preoccupied with bladder signals … and rushes to the toilet at the first signals. … the brain learns to stop inhibiting the reflexive contractions of the bladder …”
Leslie Talcott, director Perineometer Research Institute
STEP 3. NOURISH AND TONIFY
- Retrain your bladder to relieve urge incontinence. Since the bladder is only half full when urge begins, countering the urge to urinate, and gradually lengthening the time between visits to the toilet can work wonders. With practice, the threshold of urge is raised and the nerves no longer signal so frequently.
- Food additives such as MSG, potassium sorbate, aspartame, and food colorings aggravate urge incontinence.
- Vitamin B12 deficiency – common among vegetarians and epidemic among vegans – can mimic MS, including causing uncontrollable bladder spasms or urge incontinence. Vitamin B12, in its usable form, is available only from milk, eggs, fish, and meat.
- Including at least 25 grams of real fiber from whole grains, beans, and nuts in the daily diet may significantly ease urinary overactivity and urge incontinence.
STEP 4. STIMULATE/SEDATE
- For men with overactive bladders, herbalist Terry Willard uses a tea of parsley leaf, corn silk, and dandelion leaf to reduce urine acidity and bladder irritability. When needed, he adds wild yam root to soothe or valerian to calm.
- To counter the heat and reduce the inflammation that underlies an overactive bladder, herbalists in India suggest infusions of soothing herbs like marshmallow root (Althea off.), plantain leaf (Plantago species), or mullein leaf (Verbascum thapsus). For those with severe problems, 1-4 tablespoons of powdered turmeric (Cucurma longa) are added to the daily quart of infusion.
- Saw palmetto berries, in tincture or tea, relax the smooth muscle in the bladder neck and help reduce overactivity.
- Herbal nurse Martha Libster reminds us of the usefulness of Chinese ephedra (ma huang) – to reduce mucus surface swelling and relax spastic muscles – when treating an overactive bladder.
- Acupuncture can bring significant relief from urgency, urge incontinence, and overactive bladder say researchers at the Oregon Department of Health and Science University. Four weekly bladder-specific acupuncture treatments improved bladder capacity, reduced urgency and frequency, and improved the quality of life as well as drug or behavioral therapies.
- If you can’t get the knack of doing pelvic floor exercises (Kegels), don’t despair. Physical therapists, personal trainers for your bladder, can help you with these critically important exercises.
STEP 5A. USE SUPPLEMENTS
- A deficiency of magnesium triggers muscles spasms and incontinence. Supplements of 200-600mg daily may help.
- Vegans and vegetarians bothered by overactive bladders probably lack vitamin B12 – a critical nutrient found only in animal foods. Supplements or, better yet, a healthier diet that includes organic dairy and meat, are indicated. You may wish to be tested for methylmalonic acid level, a better indicator of deficiency than tests for vitamin B12 itself.
STEP 5B. USE DRUGS
- Some drugs – such as “water pills” and tranquilizers – cause or aggravate an overactive bladder. Instead, use herbal diuretics such as corn silk, burdock root, and dandelion; they calm the bladder. Tranquilize with bladder friendly St.Joan’s wort (Hypericum perforatum) tincture, a dropperful 3-6 times a day, or motherwort (Leonurus cardiaca) tincture, 15 drops 4-8 times a day.
- Antimuscrinic or anticholerinergic drugs relax the bladder’s detrusor muscle, extending the time between urge and voiding. They are especially useful for those dealing with traumatic incontinence, but are often suggested as a bridge to control leakage from urge incontinence while lifestyle changes take effect. I wonder how useful this is, as antimuscrinic drugs can take up to three months to be effective, and “side effects may be nearly as troublesome as the incontinence itself.”
- Detrol (tolterodine), Ditropan (oxybutynin), Enablex (darifenacin), Sanctura (trospium chloride), and Vesicare (solifenacin), can calm an overactive bladder, but dry the mouth and the eyes and cause memory impairment as well as constipation and heart arrhythmias. In one study, three-quarters of those taking 4mg of tolterodine and 0.4mg of tamsulosin, and two-thirds of those taking the placebo, reported improvement after three months.
- Although lack of estrogen does not cause incontinence, topical vaginal estrogen cream is a fairly safe, and very easy, way for older women to calm a hyperactive bladder.
- Tofranil (imipramine) is an antidepressant that is used in conjunction with an antimuscrinic to tighten the urinary sphincter and relax spasming bladder muscles. Dizziness, drowsiness, and low blood pressure are side effects more frequent in those over 60.
STEP 6. BREAK AND ENTER
- In Europe, injections into the lining of the bladder block the nerve impulse that triggers overactive bladder. This is not yet approved in the USA. But injections of Botox are. The effects – significant increase in bladder capacity before urgency – mimic bladder retraining but only last 6-12 months.
- Surgical implantation of a sacral neuromodulator can relax bladder muscles and relieve overpowering urges to urinate. This is obviously a last resort.
Legal Disclaimer: This content is not intended to replace conventional medical treatment. Any suggestions made and all herbs listed are not intended to diagnose, treat, cure or prevent any disease, condition or symptom. Personal directions and use should be provided by a clinical herbalist or other qualified healthcare practitioner with a specific formula for you. All material in this article is provided for general information purposes only and should not be considered medical advice or consultation. Contact a reputable healthcare practitioner if you are in need of medical care. Exercise self-empowerment by seeking a second opinion.