It's one of those topics that no one likes to talk about. Urinary incontinence, involuntary leaking of urine, can cause embarrassment, interfere with daily life and intimacy, and diminish quality of life and self-esteem.

More than 13 million Americans—most of them women—cope with the disorder. Many people turn to prescription drugs and surgery to help, but there are many natural approaches that work—without the side effects or dangers of drugs and surgery.

Incontinence occurs for many reasons. In women, it can result from thinning urethral tissue after menopause. Some studies show an increased rate of incontinence due to vaginal childbirth, which can damage or stretch the pelvic floor muscles. Other studies show that the rate of incontinence is no different in women who have not given birth vaginally.

Additional risk factors: Pelvic surgeries... prolonged straining due to chronic constipation... repetitive heavy lifting...obesity...urinary tract infections...smoking and lung disease (with chronic cough)...some diseases, including multiple sclerosis, diabetes and Parkinson's disease...stroke...spinal cord injury...and a number of medications, including muscle relaxants.

Men, too, are affected by all types of incontinence. In addition to many of the factors above, prostate problems and nerve damage also can cause incontinence in men.

Natural Approaches

I spoke with one of my colleagues, Tori Hudson, ND, from Portland, Oregon, about the most effective approaches to treating incontinence in women and men. Dr. Hudson is the author of Women's Encyclopedia of Natural Medicine (McGraw-Hill). These natural approaches and supplements treat all types of incontinence. Patients should experiment to find the approach that works best for them.

  • Lifestyle changes. Lifestyle changes may resolve your incontinence. Example: Losing weight-excess weight can press on the bladder, creating the urge to urinate. Other changes: Resolve constipation problems, and avoid medications that contribute to incontinence, such as diuretics, as well as caffeine (even decaffeinated drinks affect some people). Carbonated drinks, tea, citrus juices and artificial sweeteners also can aggravate the condition.
  • Exercise your muscles. Even patients who don't have incontinence should regularly do Kegel exercises to strengthen the muscles of the pelvic floor. While mainly associated with women, Kegel exercises also can help men strengthen their pubococcygeus muscle. Studies show that in women with stress incontinence caused by bladder pressure from laughing or coughing, the faithful practice of Kegel exercises achieves a 40% to 60% reduction of the problem.

How to do Kegel exercises: Both men and women can locate their muscles the same way-by stopping the flow when urinating. To do Kegels, contract the muscles for a count of 10, release for 10, and then contract for 10. Repeat five to 10 times in a row, three times a day any time-while waiting for a red light to change...lying in bed...sitting at your desk.

A more advanced technique: For men and women who have difficulty isolating the right pelvic muscles, biofeedback, involving electrical stimulation of the pelvic muscles, can help. Sensors are placed near the pelvis. When a patient contracts the correct muscles, he/she can see the result on a computer screen and thus be trained to recognize and exercise those muscles.

An alternative for women: Cone-shaped weights are inserted into the vagina. This is for women with mild-to-moderate incontinence who have some pelvic floor strength (they must be able to hold the cones in place). Cones come in 20-to 100-gram weights. Insert the lightest for 15 to 30 minutes while going about daily activities. Weights are gradually increased as holding them becomes easier.

  • Bladder training. Usually performed along with Kegel exercises, bladder training helps patients learn to hold urine longer. When they need to urinate, they hold their urine for five minutes before using the bathroom. When that gets easier, they hold it for 10 minutes, eventually building up to using the bathroom every three to four hours. Another technique: Scheduled bathroom trips. Patients first use the bathroom every hour and then gradually extend the time between visits.
  • Eliminate certain foods. Food sensitivities can cause or worsen urinary incontinence, possibly by irritating the nervous system and bladder. One of my patients eliminated dairy from her diet, and it greatly improved her incontinence. Another eliminated orange juice with success. Other common sensitivities include wheat...other glutenous grains, such as (common food preservatives).. and sugar substitutes.

What to do: For about a month, investigate your potential food sensitivities by recording what you eat and drink. Make note of days when urine leakage is worst. If you notice a pattern, eliminate a possible problem food for several days. If you are sensitive to that food, you should see improvement within two to three days.

Consider Supplements

Several supplements have proven successful for treating incontinence in men and women. Begin by trying one supplement at a time for two months before deciding whether it helps.

  • BetterWOMAN or BetterMAN. These high-quality blends of more than a dozen Chinese herbs reduce all types of incontinence. In one study, women with incontinence took 400-mg capsules twice a day for 60 days. They reported a 70% decrease in urinary urgency and a 73% decrease in urinary frequency. Follow instructions on the label (888-686-2698, www. for both products).
  • Uriplex. Made of pumpkin seed extract, this herbal formula is believed to strengthen the pelvic muscles and help maintain bladder function. At least one study showed it to be about 60% successful in decreasing all types of incontinence. Available only through physicians (natural or otherwise), Uriplex is made by Integrative Therapeutics (800-931-1709, www. Follow the instructions on the label.
  • Vaginal estrogen suppositories or creams. These more conventional treatments also work—and I often recommend them to female patients. Available by prescription, these suppositories and creams can improve vaginal muscle tone and help support the bladder.

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