Katharine Roulon, a 49-year-old elementary-school teacher, knows where most of the local public bathrooms can be found in her home city of Madison, Wisconsin. Roulon has developed a coping mechanism urologists refer to as “bathroom mapping,” and her knowledge of nearby restrooms prevents her from wetting herself at work, dampening her pants at the store, or embarrassing herself at the school picnic. Roulon first started to bathroom-map when she began to feel a constant need to urinate, coupled by an occasional “accident” from loss of bladder control. Roulon believes that she can manage this private problem, both by regular trips to the restroom and by using her invaluable mental map in the event of an emergency.

Urinary leakage and an overactive bladder aren’t just inconveniences: Both are health issues that affect an overwhelming number of Americans. For a variety of reasons, women, who are almost twice as likely as men to develop urinary incontinence, often don’t understand or recognize that their symptoms constitute a more serious—and treatable—health condition. Because of confusion, embarrassment, or resignation, some women choose not to seek professional help.

“Many women think urinary incontinence is a natural part of becoming old, or they are too embarrassed to seek treatment,” observes Nancy A. Huff, MD, a board-certified urologist at Boulder Medical Center in Boulder, Colorado. “But these problems are very common, and there’s no need to be embarrassed.” The good news is that no one has to simply struggle through urinary incontinence. How to plot a better course to a cure? With knowledge, of course: Begin your education by taking Delicious Living’s test to learn more about what you can do to help yourself.

True or False? Urinary incontinence is a medical problem that primarily affects the elderly.
False. Hardly confined to nursing homes and senior centers, urinary incontinence (UI), or the unintentional loss of urine, is widespread among Americans of all ages. Although figures for urinary incontinence vary (partially due to the large number of unreported cases), the National Bladder Foundation estimates that some 20 to 25 million Americans suffer from UI, with the occurrence much more prevalent among women. In fact, one study found that UI affected more than 50 percent of women ages 20 to 80 (British Journal of General Practice, 1994, vol. 44, no. 381).

Although the incidence of urinary incontinence does increase with age, the same landmark study also found that the condition was prevalent in 47 percent of the younger women studied, between the ages of 20 and 49.

“It’s not just an elderly problem,” says Karen Benton, ND, a partner in a naturopathic clinic in Battle Ground, Washington. “Urinary incontinence can happen to anyone, regardless of age and for a variety of reasons.”

True or False? Frequent urination can be normal and does not necessarily indicate the presence of a bladder-control problem.
True. According to Benton, the number of times a woman urinates per day depends primarily on her daily fluid intake and bladder size, and it does not necessarily signal a bladder-control problem. “If you’re drinking more than eight glasses of water a day, it would be expected for you to have to urinate every hour to two hours,” says Benton.

However, if you’re finding that you need to urinate more than eight times during waking hours and more than twice during sleeping hours—the clinical standard most doctors delineate for frequent urination—and you’re not drinking more than a half-gallon of fluid a day, you may have a type of urinary incontinence known as overactive bladder (OAB). OAB results from a spontaneous contraction of the detrusor muscle that lines the bladder wall, causing patients to experience a pressing and repeated need to urinate. To diagnose OAB, Huff tries to discern if the patient demonstrates one of two primary symptoms: frequency and urgency of urination. Some OAB patients can also experience incontinence before being able to find a bathroom.

Because OAB is considered a form of urinary incontinence, specific figures for its occurrence differ; a recent estimate indicates that 1 in 11 American adults suffers from the condition.

True or False?A woman’s risk for urinary incontinence increases as she grows older.
True. Menopause lowers a woman’s estrogen levels, causing urethral tissue to atrophy. This can contribute to bladder prolapse, when the organ drops from its normal position, as well as subsequent UI problems, says Benton. A study conducted among postmenopausal women found that 56 percent reported UI at least weekly (Obstetrics and Gynecology, 1999, vol. 94, no. 1).

One way to counteract low estrogen levels and ensuing tissue atrophy is by increasing your amount of dietary phytoestrogens, plant hormones found in soy-based foods that contain estrogenic properties. If you suspect you may be allergic or sensitive to soy, do not introduce it or increase your intake before you consult a doctor knowledgeable about current research on soy, says Michael Traub, ND, at the Lokahi Health Center in Kailua-Kona, Hawaii.

“Oftentimes, a hormone deficiency can underlie a larger medical problem that you wouldn’t want to treat with soy,” notes Traub.

True or False? Medications and possibly surgery are the most effective treatments for incontinence or overactive bladder.
False. According to Huff, holistic measures, such as changes in diet and exercise, are the first steps for patients with urinary incontinence. “Conservative measures are the cornerstone of treatment for UI and OAB,” says Huff. “There are lots of simple things that can make you better.”

After ruling out other, more serious medical conditions, Huff recommends that patients who suffer from UI begin by making dietary changes to eliminate foods known to aggravate the bladder. These include alcohol, caffeine (found in tea, coffee, and chocolate), carbonated beverages, spicy foods, and acidic foods (such as tomatoes, citrus fruits, and citrus juices).

When a patient’s problem persists, Margot Longenecker, ND, at the Connecticut Center for Natural Medicine, advocates a more strict elimination diet to rule out bladder inflammation from food sensitivity. Longenecker encourages her patients to stop eating wheat, corn, dairy, citrus, and soy foods for six weeks before slowly reintroducing one group at a time to determine which, if any, is the symptom-causing culprit.

Food aside, no doctor can talk bladder-control treatment without bringing up the therapeutic exercises known as Kegels. These exercises work to strengthen the deep pelvic-floor muscles and can be done up to 20 times a day for five repetitions, advises Traub. To do your daily Kegels, you’ll need to contract your pelvic floor, the same muscle you would use to stop urination midstream.

However, Huff cautions that like any muscle, the pelvic floor can become strained. Seeing a physical therapist trained in Kegels can prevent overexertion or improper technique. Ask your doctor or urologist for a referral.

Herbal tinctures and teas, as well as common anti-inflammatory supplements, can also help calm an irritated bladder.

In addition, herbal tinctures and teas (see “Herbal Remedies for Urinary Incontinence,” below), as well as common anti-inflammatory supplements, such as bromelain, flaxseed oil, and vitamins C and E, can also help calm an irritated bladder, says Longenecker.

True or False? Overactive bladder is a common condition of women who suffer urinary tract infections and should be treated similarly.
False. OAB and urinary tract infection (UTI) are distinct medical conditions that stem from different circumstances, according to Benton. Because UTIs, caused by bacteria in the urinary tract, share similar symptoms with OAB, such as frequent and urgent urination, the two problems can easily be confused. With UTIs, however, symptoms tend to come on more quickly and severely than with OAB, and the infection usually is accompanied by a burning sensation upon urination. Although your body may be more susceptible to OAB if you’ve had recurring UTIs, Benton notes that there is no solid correlation between the infection and the onset of incontinence.

Incontinence help

Bladder Advisory Council
800.828.7866; www.incontinence.org

National Association for Continence
800.252.3337; www.nafc.org

National Bladder Foundation
877.252.3337; www.bladder.org

Despite these facts, many OAB sufferers still self-treat their condition with the same home remedies commonly prescribed for UTIs. However, you can easily exacerbate your OAB by using suppositories or drinking acidic cranberry juice, warns Benton. “Over-the-counter suppositories can be very irritating to the urethra,” says Benton. “I don’t recommend cranberry juice for most bladder problems. Both suppositories and cranberry juice can worsen an overactive bladder.”

If you’re experiencing symptoms, it’s always best to visit your physician for an accurate diagnosis.