Alternative Medicine - - News - BY GARY E. LEACH, MD FACS

Look to th­ese tips to ease tell-tale symp­toms of a bad blad­der.

Just as you can call a plum­ber to fix an an­noy­ing, drippy faucet, an in­creas­ing num­ber of adults are re­lieved to learn that blad­der con­trol is­sues are no longer some­thing they have to tol­er­ate. There are drug-free, non­sur­gi­cal al­ter­na­tives to spend­ing $300 a month on di­a­pers. (Who knew that adult di­a­pers would be­come an $8 bil­lion in­dus­try?)

Hav­ing an over­ac­tive or leaky blad­der can be em­bar­rass­ing and life-al­ter­ing, but if you’re suf­fer­ing from this con­di­tion, you’re not alone. An es­ti­mated 42 mil­lion Amer­i­cans suf­fer from over­ac­tive blad­der, and about 38 mil­lion of those are ei­ther un­treated or un­der­treated.

There are four forms of uri­nary in­con­ti­nence:

1. Stress in­con­ti­nence is when you trickle urine as you sneeze, laugh, or cough

2. Urge in­con­ti­nence is when you feel a con­stant urge to uri­nate, and you’re al­ways rush­ing to make it to the bath­room in time

3. Mixed in­con­ti­nence is when you ex­pe­ri­ence a com­bi­na­tion of stress and urge in­con­ti­nence

4. Over­flow in­con­ti­nence is when your blad­der never fully emp­ties. You might ex­pe­ri­ence this as a re­sult of hav­ing di­a­betes. It may also be a side ef­fect of cer­tain drugs (in­clud­ing anti-de­pres­sants) that re­lax the blad­der and make it more dif­fi­cult to empty.

Over­ac­tive blad­ders aren’t just a con­di­tion af­fect­ing the el­derly, although it’s es­ti­mated to af­fect more than one third of peo­ple older than 65. This con­di­tion also af­fects peo­ple in their 20s who have is­sues with bed wet­ting, and women in their 30s and 40s whose mus­cles are weak­ened by child­birth.

While there are at least 10 pre­scrip­tion med­i­ca­tions on the mar­ket for treat­ing urge and mixed in­con­ti­nence, al­most all have side ef­fects in­clud­ing dry mouth, blurred vi­sion, and con­sti­pa­tion. It’s no won­der that nearly 80 per­cent of peo­ple stop tak­ing th­ese med­i­ca­tions within the first year. Bo­tox in­jec­tions di­rectly into the blad­der or a blad­der pace­maker de­vice are more in­va­sive op­tions.


TIPS FOR STAY­ING DRIER, NAT­U­RALLY A lot of peo­ple ask me if there are any vi­ta­mins or nu­tri­tional sup­ple­ments which might re­lieve uri­nary in­con­ti­nence symp­toms. Un­for­tu­nately, there is no sci­en­tific proof that sup­ple­ments can help cure any form of this con­di­tion, but there are strate­gies that work. An over­ac­tive blad­der can af­fect re­la­tion­ships, dis­rupt sleep, and take a heavy toll on qual­ity of life. The fol­low­ing strate­gies are giv­ing peo­ple their lives back:

1. Kegel ex­er­cises. Th­ese pelvic floor ex­er­cises can be about 70-per­cent ef­fec­tive for stress and urge in­con­ti­nence, but about 50 per­cent of women are do­ing them wrong. The best way to im­prove tech­nique is with the help of biofeed­back. With this ap­proach, a sen­sor is in­serted into the vagina. It is con­nected to a ma­chine that en­ables you to see if you are us­ing the right mus­cles. A ben­e­fi­cial side ef­fect of biofeed­back is that it uses some elec­tri­cal stim­u­la­tion which also helps strengthen the mus­cles.

2. Ur­gent PC. This is a low-risk, of­fice­based treat­ment, and the good news is that al­most ev­ery­one with an over­ac­tive blad­der (ex­cept those with car­diac pace­mak­ers) is a good can­di­date for it. You just re­move one shoe and sock. A thin nee­dle is placed near a nerve in your an­kle. A hand­held de­vice is con­nected to the stim­u­la­tor to send gen­tle elec­tri­cal im­pulses to in­di­rectly stim­u­late nerves in the pelvic area re­spon­si­ble for blad­der con­trol. Th­ese im­pulses pro­duce a mild tin­gling that is sim­i­lar to how it feels when your


foot falls asleep. In fact, many pa­tients are so re­laxed that they make phone calls or read dur­ing the treat­ment. Pa­tients re­ceive 30-minute out­pa­tient treat­ments once a week for 12 weeks to de­ter­mine max­i­mum re­sponse. Af­ter that, the im­prove­ments can be sus­tained with monthly treat­ments. It’s about 80-per­cent ef­fec­tive, and the pro­ce­dure is cov­ered by Medi­care. There are no sig­nif­i­cant down­sides or side ef­fects.

3. Mon­i­tor fluid in­take. Don’t re­strict your fluid in­take. If you’re thirsty, by all means drink flu­ids! Al­low­ing your­self to be­come de­hy­drated may lead to more con­cen­trated urine. This can ir­ri­tate your blad­der and ac­tu­ally in­crease your urge to go. De­hy­dra­tion can also cre­ate an ideal en­vi­ron­ment for bac­te­ria, which could cause uri­nary tract in­fec­tions. Just as im­por­tant, don’t drink more wa­ter than is ap­pro­pri­ate for your weight.

4. Get in the habit of timed void­ing. A lot of busy peo­ple try to hold their urine all day. By the time they stop to go to the bath­room, it’s an emer­gency sit­u­a­tion. Try go­ing to the bath­room ev­ery two or three hours, even if you don’t feel the urge. Timed void­ing is help­ful, es­pe­cially if you are deal­ing with urges that of­ten come with­out much warn­ing.

5. Limit cof­fee, tea, and al­co­hol. Th­ese act like di­uret­ics, which can make leak­age worse.

6. Main­tain a healthy weight. Stud­ies show that over­weight women are at greater risk of in­con­ti­nence than women who are at their ideal body weight. That may be be­cause ex­cess weight around your hips and tummy places ex­tra pres­sure on your blad­der, in­creas­ing the urge to go.

7. Get fit. Ex­er­cise is good for more than your heart and weight. Con­sis­tent, mod­er­ate ex­er­cise ben­e­fits your en­tire body, in­clud­ing mus­cles in your pelvic area.

8. Re­duce stress. Anx­i­ety and stress can also in­ten­sify over­ac­tive blad­der symp­toms. FOODS YOU MIGHT WANT TO AVOID Some health­care pro­fes­sion­als be­lieve that di­etary changes may be able to al­ter blad­der con­trol is­sues by de­creas­ing the uri­nary pH so urine is less acidic. My bot­tom-line ad­vice: Keep a food di­ary. Record­ing your blad­der symp­toms can pro­vide you with keen in­sight into their po­ten­tial trig­gers. Jot down your fluid in­take as well as any use of caf­feine, al­co­hol, and ar­ti­fi­cial sweet­en­ers, which have been as­so­ci­ated with over­ac­tive blad­der. Switch to wa­ter if you’re con­cerned about ex­tra calo­ries. If a spe­cific food, bev­er­age, or in­gre­di­ent seems to ir­ri­tate your blad­der, avoid it!

It’s okay to eat low-acid al­ter­na­tive foods in­clud­ing apri­cots, pa­payas, wa­ter­melon, and non-cit­rus herbal tea. Also, make sure you’re con­sum­ing the rec­om­mended amount of di­etary fiber each day. Re­mem­ber that your blad­der and colon are next to one an­other in your body, which means that chronic con­sti­pa­tion can put ex­tra pres­sure on your blad­der. If you aren’t get­ting 25 grams of fiber ev­ery day, con­sider tak­ing a daily sol­u­ble fiber sup­ple­ment.

While there is no cure for an over­ac­tive blad­der, the mea­sures I’ve out­lined can re­duce or elim­i­nate both­er­some symp­toms for most pa­tients. If you can’t re­mem­ber the last time you sat through an en­tire movie with­out get­ting up to go to the bath­room, or you scope out the bath­room lo­ca­tions wher­ever you go—see a pro­fes­sional. Get your over­ac­tive blad­der eval­u­ated and treated.

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