INCONTINENCE
No one wants to be the woman in a Depends commercial, the lady who can’t enjoy a Kristen Wiig movie or time with her grandkids because she’s wet herself. Embarrassing stains, soiled panties, padded diapers—you only expect this when you’re a baby, or pregnant with one.
But time has other plans. The decades between pregnancy and old age are when you’re likely to leak, bulge, sag or otherwise experience pelvic trouble—and thus the most important time to attend to your bladder and adjacent organs, muscles and ligaments. “Women are shocked when it happens. They hit 50 and say, ‘Oh my gosh, I survived pregnancy, but now this,’ ” says Missy Lavender, founder of the Women’s Health Foundation, a Chicago-based nonprofit that educates women about pelvic health.
SYMPTOMS
About 28% of women age 50 and younger experience urinary leakage, rising to 34% for women older than 50, according to a 2013 NIH review of 22 studies. And 20% to 30% of all women suffer from some degree of pelvic organ prolapse—slippage of the uterus, vagina, bladder or rectum—because the surrounding muscles and ligaments no longer provide enough support. (Likelihood increases with age.) Urinary incontinence can be a symptom of prolapse, though you can have leakage without prolapse and vice versa. Other prolapse symptoms include a feeling of pressure or discomfort in the vagina or pelvis, back pain or painful intercourse.
“Women who have had kids get a double whammy,” says Diana Quinn, N.D., a naturopathic physician and founder of the Hygeia Center for Healing Arts in Ann Arbor, Mich. “First the mechanical and structural changes that happen during labor and delivery, then the diminishing estrogen levels after menopause cause thinning and irritation of the bladder wall.” But even women who have not delivered babies can develop incontinence as well as prolapse, due to gravity, age and hormonal changes. There are surgical options for both problems, including mesh “sling surgery,” but complications are common and results do not always last.
Now—finally—for the encouraging news: Natural approaches—Kegels, physical therapy, acupuncture, dietary changes and herbal remedies—work well both to prevent and treat incontinence. And a pelvic-floor workout program (see “Less Leakage, Better Sex”) also can slow or even improve symptoms of both incontinence and prolapse while making sex more pleasurable, Lavender says.
REMEDIES
Stress incontinence
If you leak when you sneeze, cough, run, jump or lift weights, you have stress incontinence, caused by pressure—“stress”—on the bladder. You’re especially prone if you had a long or difficult vaginal delivery, such as one involving forceps or other interventions that can injure pelvic nerves and muscles.
Being overweight doubles the risk of stress incontinence because the extra poundage puts pressure on the bladder, and losing weight appears to help. In a 2010 Journal of Urology study of women with daily leakage episodes, those who lost 7.5% of their body weight after one year reported a 65% reduction in episodes of stress incontinence.
If you leak urine only when you exercise, you may want to be fitted for a pessary, a small silicone disc that is inserted like a diaphragm and holds the pelvic organs in place (your gynecologist fits and prescribes one). A pessary also can be helpful for women with severe uterine prolapse, pelvic pain or feelings of heaviness or bulging from the vagina, Lavender says.
If stress incontinence interferes with your daily life and you are not a candidate for, or interested in, surgery, what then? First: Kegels. Then, more Kegels. (And by the way, Kegel rhymes with “bagel,” not “legal.”) Kegels work both to prevent and treat stress and urge incontinence by strengthening the pelvic floor, a thick, wide band of muscle that stretches across your pelvis and acts as a hammock, supporting the bladder and uterus.
Kegels can help women who develop stress incontinence because their pelvic floor is too lax. “You know how your arms are no longer taut and toned like they were when you were 18? The same thing is happening to the muscles in your pelvis,” says Melissa Nassaney, M.S., DPT, a pelvic-floor physical therapist at Women & Infants Hospital in Providence, R.I.
You can, and should, do Kegels on your own. However, if you have persistent, bothersome leakage when you laugh, cough or sneeze, or if you are experiencing urinary urgency, you might want to see a specially trained physical therapist, who may use exercises and/or biofeedback to improve your pelvic floor muscle strength and endurance. These techniques may also help reverse symptoms of pelvic organ prolapse, according to a 2010 article published in the American Journal of Obstetrics and Gynecology.
Urge incontinence (overactive bladder)
Are you the type who always sits on the aisle at the movie theater? If you have urge incontinence, also known as an overactive bladder, you get the urge to go, though your bladder is barely filled, and you leak en route to the restroom. (Having frequent urges without the leakage is called urinary frequency and often has the same causes.) Urge incontinence is heavily influenced by dwindling estrogen levels after menopause, and the more babies you’ve delivered, whether vaginally or via Cesarean section, the higher your risk.
A huge percentage of women have mixed incontinence—both stress and urge—and the only reliable way to distinguish between the two is to undergo urodynamic testing at a urology clinic. (It’s also important to rule out other causes, such as urinary tract infections.) Bladder-retraining exercises help for urge incontinence, and there are also several drugs available, but their effectiveness and side effects vary widely, so it pays to explore other options first. Because urge incontinence is often triggered by bladder irritation or inflammation, the following approaches can be helpful:
DIETARY CHANGES
Bladder inflammation is often caused or aggravated by certain beverages and foods, such as coffee and black tea, alcohol, spicy foods and acidic foods like citrus and tomatoes. Eliminating wheat or dairy may help some women. “Identifying food sensitivities can make a big difference,” says Quinn. A blood test as well as an elimination diet can indicate how your immune system responds to certain foods and help you decide which foods or beverages to cut out.
AMINO ACIDS
“The two key ones are L-glutamine and N-acetyl glucosamine,” Quinn says. She also uses the herbs zea mays (cornsilk), uva ursi and marshmallow root. “They are protective of all the mucous membranes in the body and have a particular affinity for irritation and inflammation of the bladder,” she explains. These products and the toning herbs below should be prescribed by a qualified practitioner, such as a naturopathic physician (N.D.) or an osteopathic physician (D.O), who can diagnose your specific problem and determine the right doses and combinations.
TONING HERBS
Herbs such as passionflower and chamaelirium can help tone the pelvic tissue, says Pina LoGiudice, N.D., L.Ac., a naturopathic physician at InnerSource Natural Health in Huntington, N.Y. “Also, an herb called equisetum helps strengthen the whole pelvic floor and helps with nighttime urinary frequency.”
ACUPUNCTURE
“Traditional Chinese Medicine looks at imbalances in the body, and incontinence is an energy-deficiency problem,” says LoGiudice, who is also a licensed acupuncturist. “By stimulating various points you can strengthen a patient’s qi, or energy, so the bladder regains its strength and doesn’t spasm.” LoGiudice recommends weekly treatments for eight to 10 weeks.
PERCUTANEOUS TIBIAL NERVE STIMULATION (PTNS)
Among the most promising treatments for urinary urgency and frequency is this technique in which an acupuncture needle transmits a mild electrical current at the ankle. “We’ve seen surprisingly good results, mainly among women who couldn’t tolerate overactive-bladder medication or didn’t respond to it,” says Roger Goldberg, M.D., director of urogynecology research at the University of Chicago NorthShore University HealthSystem. “The main downside is that the results aren’t permanent,” he adds.
If you have any degree of bladder or other pelvic-area problems, says Quinn, “First consult with your holistic health provider, then get a referral to a physical therapist and a urologist with a big-picture attitude.”
