Written by Renata Filiaci, MSHW

Introduction

Urinary incontinence (UI) is the involuntary loss of urine, which is prevalent among older adults as well as in younger children between the ages of four and nine. Although it is common among older adults, it is not a normal part of aging; UI is the disruption of an effectively and cohesively operating nervous system, bladder, and urethral function. However, age can cause changes in the bladder because of a depletion of estrogen, altered sensitivity in urothelial cells, a decrease in contractility of muscle fibers, and overactive detrusor muscle, which affects the storing of urine. There are three classifications of UI, including urgency, stress, and mixed incontinence. Urgency UI is apparent after the sudden sensation to urinate. Sudden urine leakage is due to an overactive detrusor muscle associated with the use of diuretics, aging, and neurodegenerative diseases, such as stroke, Parkinson’s, and multiple sclerosis. Constant urinary tract and bladder infections could increase the development of urgency UI, as well. Stress UI is the unintentional leakage apparent with intraabdominal pressure, such as sneezing, coughing, lifting heavy objects, or bending. Stress UI is familiar in postmenopausal women as well as in obese or diabetic persons, birth-related trauma, pelvic surgery, pharmaceutical medications, and neurodegenerative diseases. Mixed UI is the combination of both types, particularly common in older women (Banasik & Copstead, 2019; DeMaagd & Davenport, 2012). Many allopathic and pharmaceutical medicinal approaches exist yet could cause a variety of physiological and adverse effects; however, lifestyle change and complementary and alternative protocols are available and safe for managing urinary incontinence.

Discussion

    Anticholinergics are the most common medication prescribed for urinary incontinence (UI). This allopathic medicinal approached is used to control the overactivity of the detrusor muscle by inhibiting the M2 and M3muscarinic acetylcholine receptors in the bladder. Although anticholinergics reduce UI symptoms, they present many adverse effects located in different organ systems, such as cardiac tissue, central nervous system and brain, eyes, gastrointestinal tract, and salivary glands (DeMaagd & Davenport, 2012; Chughtai, Kavaler, Lee, Te, Kaplan, & Lowe, 2013). Nonpharmacological interventions and management have been assessed as useful, such as proper nutrition and elimination of bladder provoking substances, weight loss, reduction of stress, cessation of smoking, exercise, herbal supplements, and electroacupuncture. It is essential to eliminate any food or beverage that aggravates UI. Excessive consumption of caffeine, alcohol, and carbonated drinks have a diuretic effect as well as and exacerbate UI symptoms. Also, eliminating spicy, citrus, artificially sweetened, and tomato-based foods could prevent the development of UI and limit symptoms. Fluid restriction could be a discussed lifestyle change with only drinking between 1.5 to 2.0 liters daily of specifically water (DeMaagd & Davenport, 2012; Pang, Chang, Zhou, & Jin, 2016; Lukacz, Sampselle, Gray, Macdiarmid, Rosenberg, Ellsworth, & Palmer, 2011).

    There have been proven studies that the use of herbal supplementation can relieve and reduce UI symptoms. Gosha-jinki-gan is a blend of ten different traditional Chinese herbs composed of composed of Rehmanniae radix, Achyranthis radix, Corni fructus, Moutan cortex, Alismatis rhizome, Dioscorea rhizoma, Plantaginis semen, Hoelen, processed Aconiti tuber, and Cinnamomi cortex. Gosha-jinki-gan has been studied in clinical trials involving rat, dog, and human subjects, in which it inhibited acetylcholine administration and bladder sensation leading to decreased urinary frequency and bladder contraction. Hachi-mi-jio-gan, a similar blend to Gosha-jinki-gan, is composed of eight different herbs, such as Rehamanniae radix, Cori frunctus, Dioscorea rhizome, Alismalis rhizome, Hoelen, Moutan cortex, Aconitii tuber, and Cinnamomi corte. Hachi-mi-jio-gan has been effective in relaxing acetylcholine-induced contraction of smooth muscle in rat bladders (Chughtai, Kavaler, Lee, Te, Kaplan, & Lowe, 2013).

    Low to moderately intense exercises can lower UI incidences as well as reduce stress, depression, and anxiety as those are all contributing factors of UI. Exercise interventions also improve day-time symptoms of UI (DeMaagd & Davenport, 2012). Pelvic floor muscle training (PFMT) exercises can be done by women as they strengthen the detrusor muscle to retrain and regain control of urinary function (Lukacz, Sampselle, Gray, Macdiarmid, Rosenberg, Ellsworth, & Palmer, 2011; DeMaagd & Davenport, 2012). In a clinical trial, 130 female patients were allocated into either a PFMT group or a control group for twelve weeks. After designated protocol, the PFMT group urinary leakage went from 5.1 to 1.5 g (Pang, Chang, Zhou, & Jin, 2016). Yoga can benefit UI symptoms as well as reduce the possible risks of developing UI. Yoga has been used to modulate pelvic floor muscle tone, improve symptoms, and enhance the quality of life in women after a six week therapy trial; the poses that have been significantly beneficial for UI are frog pose, fish pose, locust pose, plank pose, sitting forward bend and seated twist (Pang, Chang, Zhou, & Jin, 2016). Electroacupuncture involving the lumbosacral region has also been assessed as a valuable treatment for women with stress UI. Electroacupuncture is a form of acupuncture where electric currents are used with the needles in specific parts of the body. In a clinical trial, participants were randomly selected for electroacupuncture or sham electroacupuncture which involved no skin penetration. After a six week trial, women who received electroacupuncture had resulted in less urine leakage (Liu et al., 2017). 

Conclusion

Urinary incontinence (UI) is the involuntary loss of urine, associated with the disruption of an effectively and cohesively operating nervous system, bladder, and urethral function. There are many possible reasons for the development of UI, such as the use of pharmaceutical medications or diuretics, aging, neurodegenerative diseases, obesity, constant urinary tract and bladder infections, the loss of estrogen, birth-related trauma, and pelvic surgery. Anticholinergic allopathic medication is likely to reduce symptoms but presents many adverse effects. Researchers have gathered complementary and alternative protocols that can safely reduce and relieve symptoms, such as proper nutrition and elimination of bladder provoking substances, weight loss, reduction of stress, cessation of smoking, exercise, herbal supplements, and electroacupuncture.

References

Banasik, J. L. & Copstead, L-E. C. (2019). Pathophysiology (6th ed.). St. Louis, MO: Elsevier Inc. Chughtai, B., Kavaler, E., Lee, R., Te, A., Kaplan, S. A., & Lowe, F. (2013). Use of herbal supplements for overactive bladder. Reviews in urology, 15(3), 93-6. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821987/

Demaagd, G. A., & Davenport, T. C. (2012). Management of urinary incontinence. P & T : a peer-reviewed journal for formulary management, 37(6), 345-361. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411204/

Liu et al. (2017). Effect of Electroacupuncture on Urinary Leakage Among Women With Stress Urinary Incontinence A Randomized Clinical Trial. JAMA, 317(24), 2493-2501. doi:10.1001/jama.2017.7220

Lukacz, E. S., Sampselle, C., Gray, M., Macdiarmid, S., Rosenberg, M., Ellsworth, P., & Palmer, M. H. (2011). A healthy bladder: a consensus statement. International journal of clinical practice, 65(10), 1026-36. doi: 10.1111/j.1742-1241.2011.02763.x

Pang, R., Chang, R., Zhou, X-Y., & Jin, C-L. (2016). Complementary and Alternative Medicine Treatment for Urinary Incontinence. Synopsis in the Management of Urinary Incontinence. DOI: 10.5772/66705