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The Bladder - Urinary Incontinence
an article by Susun S. Weed

Stir the heat in your pelvis or it will leak out, dear one,” Grandmother Growth admonishes. “Clench your pelvic floor muscles; then release! Again, and again, and again. Reclaim your power. Speak your anger instead of pissing it away. Stand tall and clench those pelvic floor muscles - again - and again.

“Be at ease, sweet daughter,” Grandmother Growth soothes. “Let your pelvis be at peace. Say ‘no’ out loud so your bladder doesn’t have to scream it. Create your own safety; protect yourself. I am here to help you. I will hold your hand.”

Step 0 . Do Nothing
“To determine which type of incontinence a patient has, a doctor must perform lengthy and exhaustive tests.”1
Avoid the expensive tests needed for a diagnosis of incontinence. You know if you leak, and when. If not, keep a diary. Answer the questions below, and, for safety sake rule out infection or bleeding with a simple, non-invasive urine test. Then try the Wise Woman remedies gathered here. Specialists concur that at least 80% of those with incontinence can regain near normal bladder control with life-style changes such as these.2

Step 1. Collect Information
“There’s no distinct structure around the female urethra. Age weakens all the pelvic tissues. So, as you get older, the ‘gasket’ doesn’t work as well. It’s a design flaw.” [Overheard at a medical conference]

Incontinence affects 10-35% of women globally, including at least 30 million American women.3 Americans spend over$17 billion a year on incontinence pads and treatments.4

Urinary incontinence means leakage of urine. There are several different types of incontinence, and the cause may be as different as muscle weakness or muscle spasms.

Stress incontinence is the most common form of incontinence, affecting half of those who leak. Weakness of the pelvic floor muscles allows leaking when there is pressure, such as from coughing, sneezing, laughing, exercising, or bending. Herbs and pelvic floor exercises strengthen weak muscles, whether from heredity, childbearing, age, or surgery.

Urge incontinence or overactive bladder is less-well understood. It may be caused by muscle or nerve spasms, inflammation, chronic low-level bladder infections, an enlarged prostate, a fibroid tumor, uncontrolled diabetes, a stroke, even circulatory or neurological problems. The voiding urge is so intense, it is impossible to prevent accidents. Herbs and exercises can relax tension in the nerves and muscles of the bladder, eliminate infection and counter prostate swelling.

Overflow incontinence is a worst-case for men with very enlarged prostates or anyone with uncontrolled diabetes. Leakage is constant, even after voiding. In addition to exercises and anti-inflammatory herbs, drugs may be needed.

Functional incontinence is experienced by those with problems such as Alzheimer’s, dementia, multiple sclerosis, or paralysis, who are physically unable to get to the toilet in time or who fail to get or recognize voiding signals. It may also result from pelvic surgery or any injury to pelvic nerves or muscles. Pelvic floor exercises and nerve-nourishing herbs (oatstraw, passion flower, skullcap) complement drugs that can sometimes help.

Transient incontinence is usually triggered by a drug or infection and is relieved when the irritant is removed.

Is incontinence linked to age? In men, probably. In women, probably not. Some incontinence is experience by 57% of postmenopausal women and 47% of those under 50.5

Does childbearing cause incontinence? No. A study comparing over a thousand pairs of postmenopausal sisters - one of whom had given birth vaginally and one of whom had never given birth - found strong concordance within the sister pairs: their stage and type of prolapse was similar, and there was little difference in the incidence, type, or severity of incontinence.6

Does more weight cause incontinence? Weight makes no significant difference in the likelihood of incontinence.7,8 But if you are incontinent, the more you weigh, the worse it will be. Being diabetic increases risk by as much as 70%.9,10

Does your heritage contribute to incontinence? Probably. There is growing consensus that our genes predispose us to incontinence and prolapses, with Caucasian women being more likely than African American or Asian women to have both.11

The Women’s Health Initiative found over 66% of 161,861 women aged 50-79 leaked in a given year. The strongest risk factors were age less than 20 at first birth, breastfeeding regardless of duration, and hysterectomy before the age of 40.12

“More money is spent on menstrual pads for incontinence than for menstruation.”13

Step 2. Engage the Energy

*Low-intensity behavioral training works as well as surgery - without side effects or complications - in relieving both stress and urge incontinence.14 Six weekly 20-minute sessions help everyone reduce accidents by at least 50%; a third become completely dry after keeping a diary of voids and leaks, learning Kegel exercises, and training themselves to wait longer and longer between voiding.

* If your incontinence leaves you feeling ashamed and embarrassed and reluctant to be social, remember, you are not alone. And there are treatments. A dose of 10-20 drops of calming motherwort tincture may make it easier to take action.

* Timed urination - voiding regularly on a schedule - helps elderly, frail, or forgetful people get to the toilet before it’s too late.

* Functional magnetic stimulation of the pelvic floor muscles, delivered by means of a special chair, is used in Holland as a safe, effective treatment against stress and urge incontinence. After two 20-minute treatments per week for eight weeks, 58% of the women had less leakage, and three were completely dry.15

* Homeopathic remedies for bladder problems cover fourteen pages in my Homeopathic Clinical Repertory. I have listed some here:
*Achillea mill.: when there is chronic incontinence
*Juniper. com.: to ease bladder heaviness, especially in age
*Rhus aromatica or Agrimony: to relieve constant dribbling
*Nux vomica: if there is pain in the bladder
*Thuja or Claviceps pur.: to strengthen the bladder
*Uranium nitricum: if there is burning pain on voiding

“The detrusor muscle is comparable to the bulbous end of the baster, reflexively contracting when nerves fire in the muscle. In order for the urinary system to function in a controlled way, the muscles must be strong, the nerves must be in good order, and the bladder itself must be in good physical condition.”16

Step 3. Nourish and Tonify

* Nourish the bladder with apricots, blueberries, brown rice, beans, celery, corn, cranberries, lentils, miso, parsley, and prunes.
Seaweeds nourish and heal the muscles, nerves, and mucosa of the entire urinary system: the kidneys, ureters, bladder, and urethra. Kelps such as wakame, kombu, alaria, and nereocystis (bull whip), eaten in quantity, are most effective. Sprinkling seaweed on food and taking pills of seaweed is far less effective.

* Nourish and strengthen bladder muscles with 2-4 cups of comfrey or nettle leaf infusion daily; add a pinch of silica-rich horsetail for even more effect. Soothe bladder mucosa with a dropperful (1-3 times a day) of tincture of burdock root/seed, cleavers herb, or marshmallow root; use teas of corn silk, plantain seed, or mullein. Dandelion root/leaf tea or tincture tones and tightens bladder sphincters, while regular use of small (5-19 drop) doses of the tincture of passion flower, oatstraw, or skullcap strengthens the nerves of the bladder.

* A review of randomized trials comparing pelvic floor exercises/Kegels with no treatment or a sham treatment, found that women who did Kegels (at least 40 a day for three or more months) were all, unlike those receiving other treatments, able to control or cure stress, urge, and mixed incontinence.17 And women who were coached got the best results of all. Dr. Kegel advised five clenches on awakening, abed, five more when up, then five every half-hour throughout the day.

* Avoid bladder irritants. Food additives, preservatives, artificial sweeteners, coffee, alcohol, pepper, curry, black tea, tomatoes, citrus, parsley juice, and soda pop are common culprits, but you may have individual triggers.18

* If incontinence makes you reluctant to be passionately sexual for fear you’ll wet the bed, invest in a waterproof pad, please!

* Yellow dock root gently aids bowel movements, helping to prevent pressure on the pelvic floor from constipation. Tea of the root is too bitter for most, who prefer a dropperful of the tincture.

* Yoga, Pilates, weight lifting, and tai chi build core strength and tone up tiny muscles in the pelvis that help you stay in control.

Step 4. Stimulate/Sedate
Tinctures of strong herbs - such as damiana leaf (Turnera ulmifolia), kava kava, uva ursi leaf, black haw or cramp bark - in doses ranging from 1-8 droppersful a day, have been used more or less successfully to counter incontinence.

Step 5 . Use Drugs
A wide range of drugs - diuretics, sedatives, antidepressants, antihistamines, calcium channel blockers, and alpha-blockers - can cause or worsen incontinence.19
If your doctor says hormone replacement (ERT or HRT) can prevent or relieve incontinence, s/he’s wrong. HRT increases the risk that a healthy woman will become incontinent, and makes the symptoms worse in women who already are.20

The Women’s Health Initiative randomly assigned more than 27,000 postmenopausal women to take either hormones or placebos. The incidence, frequency, and severity of all types of incontinence (defined as having “ever leaked even a very small amount of urine involuntarily”) increased significantly in women taking ERT or HRT.21,22,23 The results were the same in all racial and ethnic groups24, and were not linked to prior incontinence; longer use increased risk.

In HERS (Hormone and Estrogen Replacement Study), half of the women who took HRT developed incontinence, compared to a third of those who took the placebo. After only one year, the risk of weekly episodes of incontinence was three times greater among hormone users; after four years it was five time higher.25
Drugs have side effects. Research them carefully before use. After 3-4 months, go without to see if you still need the drug.

Step 6. Break and Enter
“In addition to being risky, surgery can cause significant discomfort - and it isn’t always effective [in treating urinary incontinence].”26
Mild electrical shocks, delivered in a clinic or at home with a prescription device, can relieve both urge and stress incontinence.27 The current provokes involuntary muscle contractions, which, over a period of months of daily treatments, has the same effect as Kegels: strengthening of the bladder’s muscles and nerves.
FDA-approved Urgent PC Neuromodulation looks like acupuncture. A needle inserted near the ankle stimulates a bladder-controlling nerve that goes up the leg to the pelvis. Twelve 30-minute sessions reduced leakage by at least half for most participants.28

1. “Many effective treatments for urinary incontinence,” HealthNews, Aug 2006.
2. Urinary incontinence treatments that work,” J.Vapnek MD, Bottom Line Health, 2007.
3. Stem cells muscle in on bladder control, New Scientist, Dec 2004.
4. “Incontinence and women: usually curable, often ignored,” Leah Thayer, Women’s Health Network News, Sept/Oct 2002.
5. “Regain Control,” Sarah Toland, Delicious Living, Jan 2005.
6. “Kegels hold up as urinary continence treatment,” Harvard Women’s Health Watch, May 2006.
7. “Pelvic organ prolapse can run in the family, Harvard Women’s Health Watch, May 2007.
8. International Urogynecology Journal, Oct 2006.
9. (2) HealthNews, Aug 2006.
10. bid, HealthNews, Aug 2006.
11. “Pelvic organ prolapse,” Buchsbaum et al., Obstetrics & Gynecology, Dec 2006; 108:1388-93.
12. “Prevalence and associated risk factors of urinary incontinence: results from the Women’s Health Initiative,” WHI Investigator Group, Abstracts: Twelfth Annual Meeting of NAMS.
13. Nicolette Horbach MD, past president, American Urogynecologic Society, associate clinical professor of Ob/Gyn.
14 “Simpler solutions for incontinence,” HealthNews, Sept 2002.
15. “Magnetic chair, spinal nerve stimulation help incontinence,” BJU International, March 2004.
16. Winnifred B. Cutler, PhD, Hysterectomy: Before & After, Harper Perennial, 1990.
17. (7) Harvard Women’s Health Watch, May 2006.
18. “‘Gotta go, gotta go?’ Tips to help control overactive bladder,” Environmental Nutrition, Aug 2003.
19. “When nature calls too often,” The Johns Hopkins Medical Letter, Nov 2006.
20. Hormones can worsen and cause incontinence, HealthFacts, March 2005.
21. “Urinary Incontinence — One More Purported Benefit of Hormone Therapy Disproved,” New England Journal of Medicine’s Journal Watch, April 15, 2005.
22. “The Prevalence and Associated Risk Factors of Urinary Incontinence: Results From the Women’s Health Initiative,” Abstracts: Twelfth Annual Meeting of NAMS.
23. “Hormone Therapy Increases the Risk of Urinary Incontinence,” National Women’s Health Network, July/Aug 2005.
24. JAMA, Feb 23, 2005; 293:935-9048.
25. “Urinary incontinence risk increased with hormone therapy,” presented at American College of Obstetricians and Gynecologists conference, April 2003.
26. “Stem cells muscle in on bladder control,” New Scientist, Dec 2004.
27. “Oopsie daisy,” Ranit Mishori MD, AARP, July/Aug 2006.
28. Ibid, AARP, 2006.

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.

Susun Weed
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Vibrant, passionate, and involved, Susun Weed has garnered an international reputation for her groundbreaking lectures, teachings, and writings on health and nutrition. She challenges conventional medical approaches with humor, insight, and her vast encyclopedic knowledge of herbal medicine. Unabashedly pro-woman, her animated and enthusiastic lectures are engaging and often profoundly provocative.

Susun is one of America's best-known authorities on herbal medicine and natural approaches to women's health. Her four best-selling books are recommended by expert herbalists and well-known physicians and are used and cherished by millions of women around the world. Learn more at www.susunweed.comSusun Weed’s books include:

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