More than 13 million US adults, most of them women, suffer the embarrassment and annoyance of urinary incontinence. But this problem is not inevitable or untreatable. In a recent clinical trial, an exciting new herbal remedy called BetterWOMAN® achieved significant reductions in urinary incontinence, urgency, and frequency in study participants.
Once out of diapers, we take for granted the ability to control our urination. For decades, the flow starts and stops on command. We can ignore the urge for hours if necessary, and we are absolutely dry between bathroom visits. Some women—only a small minority—have a problem with suddenly voiding while laughing or coughing.
And then, perhaps after bearing a child or a few children, or maybe as we begin to approach menopause, we have a problem. We may find ourselves leaking, or suddenly having to go right now but being unable to make it to the bathroom in the few seconds before the bladder releases. The problem is definitely more severe with advancing age: large numbers of perimenopausal women suffer from urinary incontinence, with one study finding “25% wearing protection or changing undergarments on several days per week.”1 In more extreme cases, diapers become a necessity.
According to the National Institutes of Health, 13 million adults suffer from urinary incontinence2, an embarrassing, annoying inability to keep urine safely in the bladder until—and only until—you want it to leave. Over eight and one-half million of these sufferers are women, who are twice as likely as men to “leak.”3 Although physicians offer various treatments for incontinence and other urinary problems—exercises, drugs, surgery—these therapies are not effective for millions of women. And many women, too embarrassed to discuss their problem with family members or physicians, never seek treatment.4 Even for those who do seek help, the results are not always positive. Indeed, many women try a medication or two, stop taking the drugs because they do not solve the problem or have unpleasant side effects, then shrug their shoulders and accept “the wetness” as inevitable.
The effects of this “leakage” damage “the social, psychological, occupational, domestic, physical, and sexual aspects” of the lives of many women.4 Fortunately, there is quite a bit we can do to treat incontinence.
Types of Incontinence
The Journal of the American Medical Association defines urinary incontinence as “any unintentional leakage of urine.” But before examining the different types of urinary incontinence, it is useful to understand the anatomy of the urinary system.
The kidneys filter metabolic waste products and other substances out of the blood, combine them with fluid, and send the watery mixture into the bladder via tubes called the ureters. The bladder is essentially an expandable sack with a sphincter, or “drain,” on the bottom. The bladder sits atop the muscles of the pelvic floor, which support it and prevent it from “drooping” down on other internal structures. Nerves signal the brain when the bladder is full, announcing that it is time to void. When that happens, the sphincter opens and the urine flows out through a thin tube called the urethra. Muscles in the bladder walls and other muscles surrounding the top of the urethra make this possible. They work in opposition, with one set contracting while the other relaxes. Most of the time, with the bladder empty or only partially filled, the muscles in the bladder wall are relaxed; there is no pressure to squeeze the urine out. Meanwhile, the muscles in the urethra contract tightly to make sure not a drop leaks out. But when the brain gets the “full” signal from bladder nerves, the muscles switch actions, with those in the bladder wall contracting to force the urine out, and those in the urethra relaxing to allow it to pass through.
If the muscles in the bladder squeeze inappropriately, or those of the urethra relax at the wrong time, one will suffer one or more of the several types of incontinence:
Stress incontinence. Sixty percent of those with incontinence suffer from this type, which strikes when one laughs, sneezes, coughs, or moves in such a way as to put pressure on the bladder. The problem lies in the inability of the sphincter to completely close off the flow of urine. The weakness might develop because the muscles of the pelvic floor weaken, possibly due to childbirth, allowing the bladder to push down against the urethra. The urethra muscles that normally keep the sphincter closed may be damaged, or the abdominal muscles may be pushing on the bladder. Stress incontinence is the most common form of incontinence in women, and it may be related to stresses put on the urinary system by pregnancy and childbirth, or by the
Urge incontinence. This is the reverse of stress incontinence, with the problem linked to overactive bladder muscles instead of a weakened sphincter. Urge incontinence produces a sudden and powerful urge to urinate, and one quickly finds oneself wet. This may happen when you have had a little bit to drink, when you hear or see running water, or even in your sleep. Damage to the bladder nerves may be to blame, or the problem may be due to injections, a stroke, an injury, multiple sclerosis, Alzheimer’s disease, or Parkinson’s disease. Whatever the reason, the bladder muscles contract and force the urine out at the wrong time. Urge incontinence also is called reflex incontinence or unstable bladder.
Overflow incontinence. Rare in women, this is a case of overfilling and overflowing. A blockage in the urethra can cause overflow incontinence, as can nerves that fail to fire off a signal to the brain when the bladder is full. Diabetes or other diseases may weaken the muscles in the bladder wall. Whatever the cause, the bladder fills with more urine that it can handle, and the excess forces its way out.
Functional incontinence. Also known as environmental incontinence, this is an inability to get to the bathroom, as opposed to a problem with the urinary system. For example, people with Alzheimer’s may not be able to recognize the urge to urinate or to explain that they need to go to the bathroom.