Nerve damage after the birth of her second son caused Christine Cornell, 47, an instructor with the Total Control fitness program at Good Samaritan Hospital in Los Angeles, to struggle with urinary incontinence. Another pregnancy made the condition worse.
“As a fitness instructor I wear thinner clothing, and pads aren’t an option,” she notes.
Childbirth isn’t the only thing that can make bladder control difficult.
“Caffeine, carbonated beverages, artificial sweeteners, and spicy and citrus foods can result in more frequent urges to urinate or trouble ‘holding it,’” says Abbey Gaske, MD, a urologist at Good Samaritan.
The National Association for Continence says some 25 million Americans—75% of them women—suffer from urinary incontinence (UI). Despite the numbers, UI is still largely unrecognized as a legitimate health concern. Many women don’t realize that it’s a treatable condition and think that dribbling or leaking are just inconveniences they must live with.
“Urinary incontinence can cause social isolation and low self-esteem, and affect one’s general quality of life. Too many women suffer needlessly,” Gaske says.
Incontinence isn’t just a problem for older women; among elite female athletes, 28% have UI issues. For some women loss of control begins in the teen years and is accentuated, as in Cornell’s case, by pregnancy.
Almost 50% of women in their 40s have some degree of incontinence. By the time of menopause, that percentage creeps upward; researchers now know that going on hormone therapy, which is supposed to improve UI symptoms, might actually increase the incidence.
The stress, lost work days and increased practitioner visits resulting from UI have an effect beyond searching frantically for the nearest restroom. According to a study in the journal Psychosomatics, 30% of women between 18 and 44 who have UI become depressed.
Practitioners recognize several forms of UI. Spasm or contraction of the muscles surrounding the bladder can cause increased urinary frequency and urgency, a condition called overactive bladder. Urge incontinence occurs when urine releases uncontrollably, even when the bladder isn’t full.
Leakage during coughing, sneezing, laughing, jogging—any activity that puts stress on the bladder—results in stress incontinence. The most common type experienced by younger women, stress incontinence often results from the weakening of pelvic muscles after childbirth; these muscles may also lose tone when estrogen levels decrease after menopause. (Incontinence in men usually results from an enlarged prostrate or other medical conditions, pelvic surgery or lower back injuries.)
Pelvic-muscle problems aren’t the only reasons a woman may develop UI. Kidney stones, constipation, surgery involving the bladder or uterus and neurological conditions such as multiple sclerosis may affect continence; so may uterine prolapse, in which the uterus falls out of position.
Damage to bladder control nerves from diabetes, trauma or certain medications—including sleeping pills, tranquilizers, some over-the-counter cold medications and hormone replacement therapy—may contribute to incontinence. In addition, chronic urinary tract infections (UTIs) can lead to continence problems.
Diet and other lifestyle factors play a significant role in UI.
“Diet sodas are a triple whammy. Carbonation, caffeine, and sugar substitutes are all bladder irritants,” cautions Cornell. Coffee, tea, alcohol, nicotine and spicy or acidic foods may contribute to the problem. Being overweight puts extra pressure on the urinary sphincter, resulting in excessive wear and tear that can lead to loss of control. “Each person needs to discover the specific triggers for her body,” Cornell says.
Severe incontinence may require surgery, medication or use of a pessary, a device designed to lift a prolapsed uterus back into place. However, most people can eliminate embarrassment and regain control over their lives with lifestyle adjustments and minimally invasive techniques.
For example, Cornell has found that “tai chi, yoga and Pilates are good ways to stretch and strengthen abdominal and core muscles, which aids control.” Exercise in general is helpful; walking for only 30 minutes a day has been found to reduce UI risk by up to 25%. Kegel exercises, which target muscles in the lower pelvic area, can help reduce incontinence if done consistently.
Keeping a food diary for several weeks can help uncover foods that may be irritating the bladder. If nighttime urination is a problem, limiting fluids after dinner should help. Proper hydration is vital, though, so it’s a good idea to eliminate carbonated and caffeinated beverages and stick with plain water. Consuming a high-fiber diet to avoid constipation and maintaining a healthy weight can also improve bladder control.
Several nutrients and herbs may help ease UI. Evidence suggests that pumpkin seed, long used by Native Americans for bladder health, promotes hormonal changes that help strengthen pelvic-floor muscles. (Pumpkin seed also appears to inhibit enzymes that spur prostate enlargement.) Buchu and cleavers are other herbs used by holistic practitioners for their diuretic properties.
Magnesium, which encourages muscle relaxation, may help control bladder spasms. Bromelain may help ease inflammation related to chronic urinary infections. Natural therapies used in UTI prevention include cranberry, vitamin C and zinc.
Physical therapy can alleviate UI symptoms; some therapists incorporate biofeedback to help patients be aware of, and strengthen, their pelvic muscles. Acupuncture may also be useful. Women who went for acupuncture sessions had a 60% decrease in UI episodes (Journal of Wound, Ostomy and Continence Nursing 11-12/09). Meditation, including deep-breathing and guided-imagery exercises, can help train the brain to control the bladder.
“Change your mindset,” advises Cornell. “Limit ‘just-in-case’ bathroom visits. Try stalling urination to train the body to go longer between breaks.”