Urinary Stress/Overactive Bladder

Over 13 million American men and women of all ages suffer from incontinence, causing them to leak urine. Urinary incontinence is not a disease, but instead a sign that a problem exists in the urinary tract; it is the result of a variety of anatomic, physiologic, and/or pathologic factors. It is considered an important condition to treat, because it can lead to social isolation, low self-esteem, depression and dependence.

During the filling and storage phase, the bladder stretches so it can hold increasings amount of urine. The bladder of an average person can hold 350 ml to 550 ml of urine. Generally, a person feels like they need to urinate when approximately 200 ml of urine fills up in the bladder. The nervous system tells you that you need to urinate. It also allows the bladder to continue to fill.

The emptying phase requires the detrusor muscle to contract, forcing urine out of the bladder. The sphincter muscle must relax at the same time, so that urine can flow out of the body. Undesired bladder muscle contractions may occur from nervous system (neurological) problems and bladder irritation.

Overactive bladder is a common cause, yielding uncontrolled contractions of the detrusor muscle during bladder filling. These contractions may cause urge urinary incontinence, urgency and frequency. Urge urinary incontinence is one of the most disturbing symptoms of overactive bladder and is characterized by a strong desire to void that is associated with an involuntary loss of urine.

There are three major types of incontinence:

  • Stress – leakage only with increased pressure as in coughing or jumping
  • Urge – leakage due to an overpowering sensation of impending urination
  • Overflow – people with overflow incontinence do not feel the urge to urinate. The bladder never empties normally and remains at least partially full; small amounts of urine are leaked on a nearly continuous basis. Weak bladder muscles — caused by nerve damage from diabetes or other diseases — or a blocked urethra can be responsible.

The term “overactive bladder” describes a wide range of symptoms that include urge urinary incontinence, urgency, and frequency. From a holistic standpoint, most bladder control problems that are not the direct result of neurological damage, poor muscle tone or hormone deficiencies are usually the result of irritability within the bladder or urethral tissues caused by chronic inflammation and/or food allergies.

Urge incontinence may also result from:

  • Bladder cancer
  • Bladder inflammation
  • Bladder outlet obstruction
  • Bladder stones
  • Infection
  • Neurological diseases (such as multiple sclerosis)
  • Neurological injuries (such as spinal cord injury or stroke)

In men, urge incontinence also may be due to:

Although urge incontinence may occur in anyone at any age, it is more common in women and the elderly.

In most cases of urge incontinence, no specific cause can be identified.

 


Signs, symptoms & indicators of Urinary Stress/Overactive Bladder

Symptoms - Urinary  

(Mild) urinary incontinence



 

Urinary urgency



Counter Indicators
Symptoms - Urinary  

Absence of urinary urgency



 

Absence of urinary incontinence




Risk factors for Urinary Stress/Overactive Bladder

Hormones  

Low Estrogen Levels

The cause of urinary stress incontinence in women is usually pelvic relaxation resulting from childbirth and the aging process. These changes become more pronounced following menopause as estrogen deficiency allows atrophy of the genitourinary tissues.



Metabolic  


Nutrients  

EFA (Essential Fatty Acid) Type 3 Requirement

Flax seed oil at 1 Tablespoon per day is sometimes recommended because it can reduce inflammation contributing to an overactive bladder.



Supplements and Medications  

Non-human estrogen use

Researchers have found that hormone pills seem to worsen urinary incontinence, especially the leakage brought on by sneezing, laughing, coughing, or walking.

Women using HRT have more than double the risk of developing this particular type of incontinence, the study concluded, and the risk was especially acute for those taking pills containing estrogen alone as opposed to the combination pill of estrogen and progestin. Those taking estrogen-only pills had a 53% greater chance of developing any type of incontinence by the end of one year than women who were given a placebo. Women given pills containing both hormones experienced a 39% increase in risk.

For those who were already experiencing problems with urinary incontinence, synthetic hormones were found to make it worse. Those taking estrogen faced a nearly 60% higher risk of worsening symptoms over the course of a year;




Urinary Stress/Overactive Bladder suggests the following may be present

Nutrients  

EFA (Essential Fatty Acid) Type 3 Requirement

Flax seed oil at 1 Tablespoon per day is sometimes recommended because it can reduce inflammation contributing to an overactive bladder.




Recommendations for Urinary Stress/Overactive Bladder

Botanical  

Cleavers (Gallium asparine)

Cleavers may provide some benefit as a traditional urinary tonic for an overactive bladder along with other herbal candidates such as marshmallow root, buchu, corn silk, horsetail or usnea lichen.



Diet  

Artificial Sweetener Avoidance

Artificial sweeteners or sugar substitutes such as NutraSweet may increase urinary urgency.



 

Alcohol Avoidance

Alcohol can quickly fill the bladder, usually resulting in frequent urination.



 

Caffeine/Coffee Avoidance

Caffeinated drinks, such as coffee, tea, and cola, may have the effect of causing the bladder to fill more rapidly. These products contain methylxanthines, or diuretics, which can make you urinate.



 

Spicy Foods Avoidance

Spicy and acidic foods may affect your bladder and cause irritation, resulting in increased urgency . Carbonated beverages, citrus juices and fruits, tomatoes and tomato-based products, and chocolate may also contribute to this problem.



Digestion  

Bromelain

Bromelain at 400mg three times per day, separate from meals, may have an anti-inflammatory action in overactive bladder.



Drug  

Conventional Drugs / Information

If synthetic hormones (HRT) are being used in females, it should be remembered that they increase the risk and degree of stress incontinence. Please see the link between the HRT question and Incontinence. It is believed that bioidentical sex hormones do not have this side effect. [JAMA, February 23, 2005]



Lab Tests/Rule-Outs  

Elimination Diet

An elimination diet can deal with both food allergens and food irritants which may be causing the irritable bladder.



 

Test for Food Allergies

Naturopathic physicians and holistic medical doctors report countless success stories of treating this uncomfortable condition with changes in the diet that eliminate sensitive and/or inflammatory foods.



Physical Medicine  

Physical Therapy

Here is one of many sites that will show you how to do Kegel exercises for urinary stress incontinence.



Vitamins  

Vitamin C (Ascorbic Acid)

Vitamin C at 500mg, 2-3 times daily with meals may provide some anti-inflammatory support.



Key

Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended
May have adverse consequences

Glossary

Nervous System

A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.

Diabetes Mellitus

A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Hormones

Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.

Chronic

Usually Chronic illness: Illness extending over a long period of time.

Allergy

Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.

Cancer

Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Multiple Sclerosis

Demyelinating disorder of the central nervous system, causing patches of sclerosis (plaques) in the brain and spinal cord, manifested by loss of normal neurological functions, e.g., muscle weakness, loss of vision, and mood alterations.

Stroke

A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.

Benign

Literally: innocent; not malignant. Often used to refer to cells that are not cancerous.

Hypertrophy

Increase in the size of an organ due to enlargement of its cells; frequently with a corresponding increase in functional capacity.

Prostate

The prostate gland in men that surrounds the neck of the bladder and the urethra and produces a secretion that liquefies coagulated semen.

Menopause

The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.

Estrogen

One of the female sex hormones produced by the ovaries.

Flax

Flax Seed or Flax Oil. Flax oil is nutty-flavored oil that is pressed out of flax seeds and is one of the richest sources of Essential Fatty Acids (especially Omega-3 oil), a vital element for good health. The oil making process removes many of the seed's phytoestrogens which offer several health-related benefits including reducing the risk of cancer and alleviating menopausal symptoms. Many choose to use the whole seed because of its fiber and lignan content. Flaxseed oil is light- and temperature-sensitive and must be stored in the refrigerator.

Tablespoon

(Tbsp) Equivalent to 15cc (15ml).

Acute

An illness or symptom of sudden onset, which generally has a short duration.

Placebo

A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.

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