This is the embarrassing problem of loss of bladder control causing leakage of urine. There are three main types of urinary incontinence – ‘stress’, ‘urge’ and ‘overflow’.

• Stress incontinence is when a small amount of urine loss occurs following a rise in intra-abdominal pressure, such as with coughing, sneezing, laughing or exercising. It is caused by a weakness of the sphincter and pelvic floor muscles which normally keep the bladder outlet closed. This muscle weakness and shrinkage may result from trauma during childbirth, estrogen depletion at the menopause, aging, disuse, obesity and chronic constipation.
• Urge incontinence is characterised by a sudden urge to urinate followed by an involuntary loss of a significant amount of urine if a toilet cannot be reached in time. In other words, when you’ve got to go, you’ve really got to go. The lifestyle of the urge incontinence sufferer can become quite limited as they are afraid to go anywhere where a toilet is not close at hand. Even a trip to an unfamiliar shopping center can be incredibly stressful. The urge may be triggered by movement, cold weather, running water or just the thought of urination. Urge incontinence results from an unstable or overactive bladder which contracts inappropriately. The cause of this instability is usually unknown (possibly developing from poor bladder habits and frequent bladder emptying), but may be due to a neurological disorder, obstruction of the bladder outlet (e.g. from prostate enlargement or narrowing of the urethra), or bladder pathology such as stones or infection.
• Overflow incontinence is an intermittent dribbling urinary leakage. It occurs secondary to chronic retention of urine which results from bladder outlet obstruction or poor contraction of the bladder muscle. The patient may also complain of incomplete urination or of having to strain to void.

Urinary incontinence may be precipitated by urinary tract infections, vaginal/urethral atrophy (see Vaginal Dryness/Atrophic Vaginitis), impaired mobility in the elderly, head injury, dementia, depression and various drugs including diuretics, anti-depressants, some blood pressure-lowering drugs, major tranquillizers, drugs used in Parkinson’s disease, caffeine and alcohol. Obviously, if you are suffering incontinence you should have a thorough assessment by your doctor.

Treatment and general recommendations

• Pelvic floor exercises are the basis of treating stress incontinence and some types of urge incontinence. These are exercises to tone up the muscles that form the floor of the pelvis and support the bladder (not exercises you do whilst lying on the floor!). To find out where your pelvic floor muscles are, the next time you go to the toilet try to stop the flow of urine mid-flow. The muscles you contract to do this are your pelvic floor muscles. Stopping the flow of urine midstream is only a test and should not be done repeatedly as it may lead to bladder instability. Alternatively, women can place one or two fingers in the vagina and try to contract their muscles to grip the fingers. If you are still unsure what to do, pretend that you need to urinate urgently and can’t get to a toilet, or pretend you need to pass wind and try to ‘hold it in’. Once you have learnt how to contract your pelvic floor muscles you are ready to begin an exercise program.
• Pull up and contract your muscles for four seconds and then relax for six seconds. Repeat this until your muscles are starting to fatigue. You may only be able to manage three or four to begin with. Note that your abdominal and buttock muscles should be relaxed. Do these exercises several times per day. As the pelvic floor muscles strengthen you should aim for about ten at a time repeated ten to twenty times each day! You can do these exercises anytime anywhere and no one will ever know! The most difficult thing is remembering to do them. One of our patients sticks yellow “Post-It” notes everywhere such as inside cupboard doors, on the fridge and on the dashboard of the car, as reminders. As an added bonus, toning up your pelvic floor muscles will improve your sexual response and allow you to reach orgasm more easily. Many physiotherapists can be of assistance in learning pelvic floor exercises and, if necessary, can use electrotherapy to strengthen pelvic floor muscles.
• Urge incontinence will often respond to bladder retraining. Initially, a diary is kept of the times of urination and volume voided on each occasion. Bladder retraining then aims to delay the interval between voiding, and the volume of urine passed is subsequently progressively increased. To help in delaying urination, mental distraction techniques such as putting pressure on the perineum or concentrating on breathing, together with pelvic floor exercises, biofeedback or hypnotherapy may be required.
• If you are overweight, weight loss can certainly improve stress incontinence, and restricting an excessive fluid intake will help relieve urge incontinence.
• Smoking should be avoided, as nicotine irritates the bladder and a smoker’s cough will aggravate stress incontinence.
• Walking aids, bedside commodes or non-spill urinals can be helpful for those with poor mobility and lack of dexterity. Incontinence aids such as absorbent pads and pants, urodomes and catheters may be required.
• Use of a compounded cream containing natural estrogen – as discussed in “Hormone Replacement – The Real Truth”.

Diet

• Include often – high fibre foods like fruits and vegetables, wholegrains and legumes to avoid constipation.
• Minimize coffee, alcohol and refined sugars.
• Some people find that specific foods cause incontinence. Keeping a food chart may help to identify such foods. Common culprits include tomatoes, chocolate, chilli peppers and spicy foods. Eliminate suspected foods one at a time for at least three days to see if there is any improvement.

Recommended books

• “Magnesium – The Miracle Mineral”. This book discusses magnesium as being essential for hundreds of chemical reactions that take place in the body every second, with recent findings also indicating that it offers a wide range of important health-promoting benefits. See page 9 for these benefits.

Orthodox medical treatment

This depends very much on the type and cause of incontinence. Special testing called urodynamic studies are frequently recommended to accurately identify the cause of the problem, and can be organised by your doctor. Drugs which may be prescribed include propantheline, imipramine, terodiline, prazosin and bethanechol. When other measures fail, surgical treatments are frequently effective, particularly for stress incontinence. Alternatively, non-surgical treatments for stress incontinence are available, such as a flexible intravaginal device called a ‘Bladder Neck Support Prosthesis’ which can be fitted for you by a Gynecologist or Urologist. Once correctly fitted, women can learn to insert and remove the device as required; it will provide immediate results.

Recommended supplements for urinary incontinence

• Magnesium Tablets or Powder
  Take 2 tablets twice daily or 1 teaspoon daily- Magnesium may assist to regulate nerve supply to the bladder.

The above statements have not been evaluated by the FDA and are not intended to diagnose, treat or cure any disease.