Having trouble "down under"? Most women will develop a urinary tract infection at some point in their lives; and if you count difficulties with urinary frequency, urgency, and incontinence, "one out of three women has bladder problems, and an even greater number of women can potentially develop problems," says Raymond Bologna, MD, co-author of The Accidental Sisterhood (Pelvic Floor Health, 2007), a self-healing therapy guide for women with bladder issues. The good news is that conditions that affect this delicate system are highly treatable—and preventable—sans drugs or surgery.

Nutrition

  • Exalt cranberries. Bladder infections result when bacteria—most often E. coli—migrate up the urethra and start growing in the bladder. Because women have a shorter urethra than men, they get more urinary tract infections (UTIs); some of the most susceptible candidates suffer through multiple infections each year. If you're among those ranks, make cranberries a habit. Native to North America, cranberries have been used to help prevent UTIs for more than a hundred years. This tart fruit contains compounds called proanthocyanidins that block bacteria from sticking to the bladder walls, derailing a budding infection. Regular consumption reduces UTI frequency, according to new research. For bladder health, drink 16 ounces of pure, unsweetened cranberry juice daily, or chomp on 11/2 ounces of dried cranberries.
  • Munch crucifers. Iothiocyanates—found in broccoli, cauliflower, and related plants—protect against bladder cancer by detoxifying potential carcinogens, keeping cells developing normally, and eradicating abnormal (potentially cancerous) cells. People who eat large quantities of vegetables rich in these nutrients lower their risk of bladder cancer by 29 percent.

Herbs and supplements

  • Cranberries, again. For some, eating or drinking a lot of cranberries can trigger stomach upset or diarrhea. If that's true for you, consider taking cranberry concentrate; 400 mg twice a day is a healthful dose. In a 2007 study of women plagued with recurrent bladder infections (a disheartening six or more in the prior year), supplementing with cranberry extract brought that number to zero, and women who continued supplementing remained infection free during the next two years.
  • Probiotics for prevention. Several strains of the bacteria Lactobacillus reduce the chances of developing a bladder infection in the first place. Large colonies of these helpful bugs form a physical barrier that blocks E. coli and other harmful agents from migrating into the bladder, where they would otherwise cause an infection. To reduce UTI risk, supplement with Lactobacillus (1 to 10 billion live organisms daily), or regularly include fermented dairy products in your diet, such as yogurt, kefir, and cottage cheese. Check labels for "active cultures."
  • Give antibiotics a leg up. Active infections usually require antibiotics, but complementary natural therapies enhance their effect and make it easier on your body. Take cranberry juice or extract concurrently with antibiotics to fight off nasty and persistent bacteria. In addition, check out proteolytic enzymes, such as trypsin or bromelain; research shows that they improve the effectiveness of antibiotic treatment for UTIs. Take 400 mg of a bromelain-trypsin supplement on an empty stomach for best results. And as always when taking antibiotics, use probiotics to replenish your gut and vaginal flora and lessen the chances of antibiotic-induced diarrhea or yeast infection.
  • Magnesium to help you hold it. Urge incontinence, also known as overactive bladder, causes a sudden overwhelming need to urinate and, sometimes, embarrassing leakage. It's much more common in women than men. Several years ago, researchers studying the benefits of magnesium supplements for women with calf-muscle spasms accidentally discovered that magnesium also seems to help with urge incontinence. Double-blind research followed and confirmed these findings, based on a twice-daily dose of 350 mg magnesium hydroxide (which contains 150 mg of elemental magnesium).

Something to talk about
"There was a time when women would not openly discuss health issues, such as breast cancer. They were deeply embarrassed by the problem, and terrified of the consequences following diagnosis. Once they started talking, more women were surviving. Now it's time for women to break down the barriers and do something about incontinence and other issues related to bladder health."

Raymond Bologna, MD, co-author of The Accidental Sisterhood (Pelvic Floor Health, 2007).

Lifestyle
Strengthen your pelvic floor. Your ob-gyn is right about those Kegels. "Pelvic floor exercises, sometimes called Kegels, work for both prevention and treatment of bladder problems like urinary frequency, urgency, urge incontinence, and stress urinary incontinence," says Bologna. "And you only need to set aside five to ten minutes every day or so." If you have active bladder problems, performing the exercises frequently for the longer time will serve you best; if your goal is prevention, do the exercises for the shorter time, less often. But do them no matter what; for all women, this simple habit can make all the difference in long-term bladder health. It can take up to two months of regular pelvic exercising before you see a meaningful difference in your bladder habits, and even then you'll need to keep doing the exercises on a regular basis to reap the benefits, Bologna says.

To find the right muscles, simply stop urinating midstream. The muscles you tighten at that point are your pelvic floor muscles. To strengthen them, start by contracting and holding for as long as you can and count; this is your baseline strength. When exercising, contract and hold for half of your maximum count and rest for that same length of time; for example, if your maximum hold is eight seconds, start with four-second holds, alternating with a four-second rest. Repeat ten times; when it feels easy, increase your hold times.

Speed Kegels are another alternative: Contract and release the pelvic floor muscles quickly in a series of ten or more. As with any new exercise, these could leave you tired or even sore at first, so start out slowly and work your way up.