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Restoring
Natural Bladder Control
By Lane
Lenard, Ph.D.
Urinary incontinence (UI)
is a common disorder affecting at least 10 million
people in the United States. Women are especially
prone to UI – half of all women experience
incontinence at some point in their lives, and for
one in three UI is a chronic condition. Incontinence
is more prevalent among adults 60 years of age or
older, affecting more than 15 percent of older adults
who live at home, and up to 60 percent of people
living in nursing homes. UI is one of the most common
reasons for nursing home admission.
For many, the fear of losing
control of such a basic bodily function is so stressful
and distressing that fewer than half of those with
incontinence feel comfortable discussing their symptoms
with their doctor. Commenting on the severity of
the problem, Dr. Seth Landefeld, geriatrics chief
at the University of California, San Francisco, notes
that, “We as a society need to get over our
discomfort with this subject so that incontinence
sufferers receive the compassion, acceptance, and
care they need, and our aging population can take
steps to prevent incontinence in the future.”
Women's
Secret Burden
While the statistics are striking, the toll incontinence
takes on one’s quality of life can be devastating,
especially for women. Initially, most women find that
occasional leaks can be controlled by wearing specially
designed pads. But as the condition worsens, larger
pads, or pads with greater absorptive capacity, may
be needed. And while pads are usually effective for
controlling leakage they do little to alleviate the
other ways that UI influences daily life.
For example,
one must learn to be constantly “tuned in” to
the slightest signal from the bladder that it is time
to go. And even simple tasks, such as going out to
the store, require advance planning to pinpoint the
location of nearby bathrooms for frequent emergency
visits when the bladder is too full. Women also need
to be particularly cautious about standing up quickly
after sitting, especially when consuming liquids, and
dark clothes are the preferred fashion choice because
they are less prone to reveal dampness.
For many women, despite all
the restrictions that UI imposes on their lives,
the social stigma imposed by the disorder is the
most overwhelming aspect of incontinence. The dread
of a small cough or laugh triggering a “leak” during
a social or business situation robs women of the
pleasure such events offer and causes many women
to limit or even avoid social activities all together.
And at home, women may begin to avoid sex with their
partners out of fear of embarrassment during intercourse.
If not addressed, incontinence can lead to isolation
and inactivity, allowing depression to take over
and sadly, leading to further isolation and deepening
depression.
Types
of Urinary Incontinence
While UI in men is primarily associated with prostate
enlargement, women are affected by three major types
of urinary incontinence: stress incontinence, urge
incontinence, and overactive bladder. Many women have
a combination of two or three of these, which is referred
to as mixed incontinence. To understand the types of
incontinence, and their underlying causes, we must
briefly review the bladder and its muscles.
The balloon-like bladder (Fig.
1) stores urine after delivery from the kidneys (not
shown). The bladder is surrounded by a muscular wall.
Normally, leakage from the bladder is prevented by
sphincter muscles that keep the urethra – the
tube that carries urine from the bladder out of the
body – shut at either end. When we urinate,
the bladder muscle contracts and the two sphincters
relax, so that urine is squeezed out through the
urethra. Incontinence occurs when the bladder muscle
contracts suddenly – and inappropriately – and/or
the sphincters are too weak to hold back the urine.
-
Stress
Incontinence is typically associated
with coughing, laughing, exercise, or other movements
that put pressure on the bladder. It commonly
occurs as a result of physical changes following
pregnancy, childbirth, and menopause that weaken
the sphincters.
-
Urge
Incontinence occurs if you suddenly
and uncontrollably lose urine for no apparent
reason after feeling the need or urge to urinate.
Typically, you feel a slight urge to urinate,
and suddenly, possibly before you can get to
the toilet, you lose control. Inappropriate contractions,
or spasms, of the bladder muscle, even when there
is only a small amount of urine in the bladder,
are a common cause of urge incontinence. These
spasms may be triggered by abnormal nerve signals.
-
Overactive
Bladder is a result of the bladder muscle
squeezing at the wrong time without warning and
too frequently. Symptoms include high urinary
frequency (eight or more times per day and two
or more times per night); urinary urgency (the
sudden, strong need to urinate immediately);
and urge incontinence.
-
Overflow
Incontinence occurs primarily in older
men with prostate enlargement. The enlarged prostate
squeezes the urethra, which prevents the bladder
from emptying completely. Overflow incontinence
usually takes the form of dribbling, resulting
in an inability to urinate voluntarily, overdistending
the bladder and reducing the flow of urine.
Controlling
Incontinence
Incidence of incontinence tends to increase with age
for a variety of reasons, including: a reduction in
the capacity of the bladder, leading to greater frequency
of urination; weakening of urinary sphincter muscles;
and decreased bladder muscle tone. In men, the prostate
often enlarges with age.
Women with UI learn to cut
down on, or even eliminate certain foods and beverages
that act as diuretics to stimulate urination, such
as coffee, tea, or anything else with caffeine; alcohol;
citrus fruits and juices; and spicy or acidic foods.
Certain drugs, especially those prescribed for high
blood pressure or edema (swelling), act as powerful
diuretics and should be avoided if possible (in consultation
with a doctor).
Of course, staying properly
hydrated can become another problem that requires
attention and a delicate balance. While taking steps
to avoid excess intake of liquids of any kind, women
also have to avoid becoming dehydrated, which can
lead to constipation, among other serious conditions.
Exercise, vital for maintaining health in later years,
can also trigger additional loss of urine, further
complicating life for those with UI.
While special exercises known
as Kegels can be helpful in reducing certain types
of UI, they require dedication and patience, since
it can take several weeks before they manifest any
benefit.
Incontinence
Drugs
Pharmaceutical companies have developed a number of
drugs designed to ease the symptoms of UI, although
none is completely effective, and disturbing side effects
are often a problem.
-
Anticholinergics: Muscle
tone, including the muscles that control bladder
contractions, is largely under the control of the
neurotransmitter acetylcholine (ACh). Thus, drugs
that interfere with the actions of ACh – known
as anticholinergics – can sometimes be of
help, especially for urge incontinence and overactive
bladder because they relax the bladder muscle.
According to drug company research, these drugs
inhibit involuntary bladder contractions, increase
bladder capacity, and delay the initial urge to
void. Marketed anticholinergic drugs indicated
for urge incontinence include Ditropan® and
Oxytrol® (oxybutynin); Detrol® (tolterodine);
and Levabid® and Cystospaz® (hyoscyamine).
-
Antispasmodics: These
drugs, which also have anticholinergic properties,
are designed to help relax the bladder muscle in
patients with urge incontinence and also sometimes
help with overactive bladder. The most common antispasmodics
are Urispas® (flavoxate) and Bentyl® (dicyclomine).
Although these drugs have been used for years,
their effectiveness is questionable. The newest
antispasmodic drugs, Sanctura® (trospium chloride)
and Enablex® (darifenacin), also work by interfering
with the actions of ACh.
-
Alpha-adrenergic
agonists: Unlike anticholinergic
drugs, which are designed to weaken bladder muscles,
alpha-adrenergic agonists are intended to strengthen
the smooth muscle that controls the sphincters
at either end of the urethra. The most common
drugs in this class include ephedrine and pseudoephedrine,
which are commonly found in over-the-counter
decongestants and appetite suppressants. Although
these drugs may be helpful for some women with
mild stress incontinence, their side effects – agitation,
insomnia, and anxiety – can be disturbing.
They are also not suitable for people with heart
disease, high blood pressure, glaucoma, diabetes,
or hyperthyroidism.
Problems
with ACh Drugs
The major problem with drugs that affect ACh activity
is that this neurotransmitter has actions, not just
in the bladder muscle, but all over the body, in nearly
all muscles, as well as in the brain. Common side effects
include dry mouth, dry eyes, headache, constipation,
rapid heart rate, glaucoma, muscle weakness, dizziness,
drowsiness, and restlessness.
A recent study by a US Navy
neurologist confirmed that these drugs can cause
serious mental problems in some older people, including
loss of memory and hallucinations. At a recent meeting
of the American Academy of Neurology, neurologist
Dr. Jack Tsao described one 73-year-old woman who
began hallucinating conversations with dead relatives
shortly after starting on a common incontinence drug.
The hallucinations ceased when she stopped taking
the drug.
Dr. Tsao and colleagues then
systematically evaluated 870 older Catholic priests,
nuns, and brothers for nearly 8 years. Almost 80
percent of the participants were taking anticholinergic
drugs, including the incontinence drugs Ditropan
and Detrol, for high blood pressure, asthma, Parkinson’s
disease, as well as UI. The incontinence drugs were
among the most potent and most frequently taken of
all the anticholinergics in the study.
They found that those who were
taking the drugs had a 50 percent faster rate of
cognitive decline than those who were not taking
them. “It may be better to use diapers and
be able to think clearly than the other way around,” noted
Dr. Tsao.
Natural
Support for Enhanced Bladder Control
With the population rapidly graying, the National Institutes
of Health (NIH) has urged scientists to find better
ways of preventing incontinence and removing the stigma
so that more people will seek help.
One such approach may be FloControl™,
a new, advanced herbal formula designed to address
urinary incontinence and restore normal control over
bladder functions. FloControl is a proprietary blend
of traditional Chinese herbs that have long been
known to enhance urinary function (see box
listing herbs and their traditional indications).
By restoring bladder strength
and muscle tone, FloControl reduces both stress and
urge incontinence. And in men, FloControl has been
shown to enhance muscle tone to reduce dribbling
and restore normal urinary performance.
References
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Chinese Herbal Medicine – Materia Medica, Eastland
Press, Seattle, Washington
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Beneficial effect of Corni Fructus, a constituent of
Hachimi-jio-gan, on advanced glycation end-product-mediated
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Pharm Bull. 2007 Mar;30(3):520-6.
5. Lee WK, Kao ST, Liu IM, Cheng JT. Increase of insulin
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6. Luo Q, Yan J, Zhang S. Isolation and purification
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