Urinary incontinence is one of the most common and bothersome problems facing people as they age. Though it seldom results in serious morbidity, incontinence carries a tremendous psychosocial burden.

There is often a lot of “don’t ask, don’t tell” between doctors and patients around this problem, until it progresses to the point where a patient can no longer ignore it, or a physician can’t help but noticing. Doctors would do well to pay greater attention, especially since there’s growing evidence that a number of safe, easily-obtained nutrients and botanical medicines can give significant improvements with little risk of adverse effects.

Urinary incontinence is technically defined as any involuntary leakage of urine from the bladder. The incidence is staggering. Data from the Agency for Health Care Policy and Research published in 1996, showed that 13 million Americans had incontinence; of these, 85 percent were female. The National Association for Continence, puts the number at 25 million adults in the United States.

More recent consumer research suggests one in every four women over the age of 18 occasionally suffers from episodes of incontinence. Because of embarrassment or a belief that it is an expected symptom of aging, there are many more people suffering without seeking treatment. Given the demographic shift toward increasing numbers of elderly people, incidence will only increase in the coming years.

It is important to recognize that incontinence is a symptom, not a disease, per se. A variety of conditions and traumas can cause incontinence including child birth, anatomical birth defects, enlarged prostate, dementia, neurological diseases, infections, multiple sclerosis, diabetes, injuries or pelvic surgeries (such as prostate surgery or hysterectomy), spinal cord injuries and degenerative changes associated with aging.

It is not uncommon for young women to experience a form of urinary incontinence while pregnant, as the fetus gets larger and exerts extra pressure on the bladder. However, this is usually transient and tends not to become a chronic problem once the child is born.

Types of Urinary Incontinence

Incontinence can reflect a problem anywhere along the urogenital tract, from the ureters down to the urinary sphincter. It is important to try and identify what, specifically, is going on in each case.

For example, incontinence may reflect problems with neurological control of the urethral sphincter. On the other hand, it can also occur if there are problems with signalling between the bladder and the brain. Incontinence can occur when any component of the urinary system is no longer functioning properly.

Urologists generally recognize the following distinct types of incontinence:

Stress incontinence is the result of damage to the pelvic muscles. A person who suffers from stress incontinence will lose urine when there is increased abdominal pressure that causes a shift in the normal anatomic location of the bladder and urethra.

Urge incontinence takes place when an individual has a strong sense of needing to urinate but is unable to make it to the bathroom before urine has leaked out. These people often need to urinate more frequently than others, and are prone to wetting the bed. Urge incontinence is one of the main symptoms of a condition known as overactive bladder (OAB).

Functional incontinence takes place when a person does not realize he or she needs to urinate, or does not know where the toilet is located and cannot make it before urine is leaked. This is most commonly seen in individuals with dementia, Alzheimer’s disease, or poor mobility.

Overflow incontinence takes place when there is too much urine for the bladder to hold so it has to get rid of some involuntarily. Urine will trickle out without any prior warning. This occurs in bladders that have lost all nerve impulses, but is most often seen in men with large prostates causing complete obstruction of the bladder. This can also be brought on by chronic constipation.

Mixed incontinence is common and most often involves a combination of urge and stress incontinence.

Conventionally-trained urologists, internists and family physicians typically treat incontinence with anti-cholinergic drugs to block nerve receptors on the bladder so as to prevent it from contracting at unwanted times. These include Ditropan, Detrol, Vesicare, Enablex, Sanctura, Oxybutinin and Oxytrol.

The most common side effects are dry mouth, constipation, blurry vision and urinary retention, which affect between 20% and 40% of all patients. Most patients learn to live with these side effects as a trade-off to get the benefits of reduced urinary leakage. These same patients would certainly benefit from natural solutions without the added side effect profile.

Helpful Vitamins & Minerals

While not “cures” for incontinence, the following vitamins and minerals can help in improving pelvic and bladder muscle tone, as well as reducing the likelihood of urinary tract infections, which sometimes contribute to incontinence.

Vitamin C, 1,000 mg three times a day, keeps bacteria from growing in urine. Beta-carotene, at doses of 25,000–50,000 IU per day, promotes immune system function and keeps mucous membranes healthy.

Zinc, 30 mg per day, supports immune function. Calcium, 1,000 mg per day, and magnesium, 500 mg per day, taken together, improves control of the muscles used in urination.

Botanicals for Incontinence

The American and European botanical medicine traditions contain a number of valuable individual herbs and formulas for relieving incontinence and other urinary tract problems.

The combination of Rosehips (Rosa spp.), Saw Palmetto (Sabal serrulata syn. Serenoa serrulata), Couch Grass (Agropyron repens syn. Elymus repens), Buchu (Barsoma betulina) and Oats (Avena sativa) is an excellent formula that will tone the bladder sphincter and the bladder smooth muscle itself. It can often stop bladder leakage problems, and strengthens reproductive system ligaments and other connective tissues in women with uterine prolapse, a common contributor to incontinence.

The formula can be easily made by buying tinctures of the individual herbs, all of which are easily obtained at health food stores or herbal pharmacies. Simply combine the five herbs, in equal parts, in a single bottle. Physicians can create the mixture themselves, in bulk amounts, or direct patients to a trained herbal medicine practitioner who can create the formula. Typically, patients with incontinence should take 20–30 drops of the combined tincture thrice daily for six weeks.

Teasel (Dipascus sylvestris) root is another helpful herb. Teach patients to boil one tablespoon of the dried root per cup of water for 10–15 minutes, then drink the tea daily to strengthen and restore tone to overstretched sphincter muscles.

Horsetail (Equisetum arvense) is a valuable herb for incontinence. It can be mixed into a formula with other herbs: two parts Horsetail, one part Agrimony (Agrimonia eupatoria), and one part Sweet Sumac (Rhus glabra).

Plantain (Plantago major) and Marshmallow root (Althaea officinalis) may also be added to teas for their demulcent properties. Soak 1 heaping tablespoon of marshmallow root or plantain in 1 quart of cold water overnight. Strain and drink during the day in addition to other teas.

Antispasmodic herbs such as Black Cohosh (Cimicifuga racemosa), Ginger (Zingiber officinale), Catnip (Nepeta cataria), and Cornsilk (Zea mays) may help when incontinence comes from a hyperactive bladder. This is more frequent with urge incontinence than stress incontinence. We recommend 10–20 drops of Black Cohosh tincture 1–2 times per day for several weeks or as needed. A tea made from the other herbs may be taken freely.

Astringent herbs such as Yarrow (Achillea millefolium), Agrimony (Agrimonia eupatoria) or Lady’s Mantle (Alchemilla vulgaris) can help to tighten up loose connective tissue in the pelvic area.

Saw Palmetto has been shown to reduce non-cancerous prostate enlargement in men, which is a major cause of male incontinence.

All of these herbs may be used in dried form, taken in capsules or brewed into teas. Teas should be made with 1 tablespoon herb per cup of hot water. Steep covered for 5 to 10 minutes for leaf or flowers, 10 to 20 minutes for roots. Patients should drink 2 to 4 cups per day. Many are also available commercially as glycerites (glycerine extracts) or tinctures (alcohol extracts). The dose for tinctures is generally 20–30 drops 2–3 times per day but varies based on patient age and weight.

Cranberry and blueberry extract contains substances that keep bacteria from adhering to the bladder. This may help prevent infections that can make incontinence worse. This can also help deodorize urine.

Homeopathic Help

Homeopathic remedies can also help many patients with incontinence. Usually, the dose is 3 to 5 pellets of a 12X to 30C remedy, every one to four hours, until symptoms improve. The key to selecting remedies is in eliciting from the patient a more detailed description of the specific sensations, timing patterns and physiological context of the incontinence episodes.

• Causticum for stress incontinence, especially with retention from holding the urine and frequent urges to urinate.
• Natrum muriaticum for stress incontinence, vaginal dryness and pain during sex, especially with a history of grief.
• Pareira for retention of urine from an enlarged prostate.
• Sepia for stress incontinence with sudden urge to urinate, especially with prolapsed uterus and vaginitis.
• Zincum when there is frequent slight loss of urine.
• Pulsatilla when the bladder and pelvic floor feel unreliable or weak.

Other Helpful Natural Therapies

Pumpkin Seed Oil has been shown to support normal emptying of the bladder because of its calming effect on the function of bladder muscles. This may lead to a strengthening of the functional-urinary system for men and women.

Passiflora incarnata is an herb rich in alkaloids and flavone glycosides. Recent studies have pointed to the flavonoids as primary constituents responsible for its relaxing and anti-anxiety effects. The effects of Passiflora in earlier studies were believed to be primarily on the nervous system. It is also said to have an anti-spasmodic effect as well.

Cranberry Juice helps to prevent bacteria from clinging to bladder walls and has been shown to reduce symptoms and reoccurrence of urinary tract infections. Cranberry supplements may be a better source due to their higher concentration of active ingredients.

Stephen Siegel, MD, is a board-certified urologist in private practice in Waterbury CT. He earned his MD degree from Vanderbilt University School of Medicine, and undertook his surgical training and urology residency at Yale University. Joanne Cohen is a certified herbalist who has studied with Rosemary Gladstar, Eliot Cowan, and David Dalton. She has a private practice, Sacred Passages, in which she helps people with issues including infertility, anxiety, sexual abuse, and other physical and emotional traumas. Both are contributors to www.herbalist.com, a website designed to provide non-commercial information on botanical medicine and other holistic therapies and to create a community forum between practitioners and the health conscious public.