Put Yourself in Control of Urinary Incontinence.

Take a drug. Have an operation. Wear an adult diaper. Those are the three options offered by most doctors when they treat someone for urinary incontinence, the involuntary leaking of urine. But some alternative-minded experts say that those therapies should be last resorts, not standard recommendations. They estimate that between 80 and 90 percent of people with urinary incontinence, most of whom are women, can find relief with safer and less bothersome therapies.

Medication can have side effects. Surgery has its risks. An absorbent pad isn't a solution.
Before resorting to such drastic measures, most people -fi v should try behavioral and dietary methods to solve the problem, says Genevieve M. Messick, M.D., a physician in Columbus, Ohio, who specializes in urinary incontinence and pelvic floor dysfunction. Only when natural treatments fail should people resort to the others.

CAFFEINE: Cut Down to Reduce Irritation
"Caffeine is an irritant that causes the bladder to be more spastic," explains Dr. Messick. It's also a diuretic, which means that it makes your body produce more urine. "These two factors can make incontinence worse," she says.

Caffeine isn't found only in cola, tea, and coffee, adds Dinne Kaschak Newman, a nurse practitioner who works with adults in Philadelphia. It's also present in chocolate and some over-the-counter drugs, such as Excedrin, Anacin, and Midol.
"If you suspect that caffeine intake is causing your bladder problems, gradually decrease the level of caffeine you're getting and see if there's an improvement in symptoms," Newman advises.

ALCOHOL: Abstinence Can Counter Incontinence.
The muscles of the pelvic floor control the opening and closing of the urethra, the tube through which urine leaves the bladder. Weak pelvic floor muscles are one of the main causes of urinary incontinence in women. Alcohol causes these muscles to weaken further, and since alcohol also has a diuretic effect, the weak muscles are forced to hold back extra urine. Thus, the wisest course is to cut back on or cut out alcohol and see if your symptoms improve, Dr. Messick advises. If they do, you know you have to curtail your alcohol consumption.


ASPARTAME: Bitter for Your Bladder
"Artificial sweeteners containing aspartame can irritate the bladder. From my experience, they appear to be a common cause of bladder dysfunction, urinary urgency or frequency, and incontinence," says Newman.
"I had a patient who had been through surgery and had taken medications, all without relief," she says. "But when she abstained from using aspartame, her incontinence cleared up."

WATER: More Is Better
People with urinary incontinence sometimes try to gain control by drinking less water. After all, less water means less urine, which means less chance of an accident, right? Not so, says Newman. Drinking less produces more concentrated urine, which irritates the bladder. This in turn may increase the frequency of urination and the chance of an accident.
She recommends drinking eight 8-ounce glasses of water a day, but sip it throughout the clay rather than drinking a lot at one time. This will help prevent those overwhelming sensations of urgency, says Newman.
The one time that you want to drink less is in the evening, she adds. She suggests that you mil drink any liquids for at least 3 hours before you go to bed. That way, you'll be less likely to wake up during the night with the urge to urinate.

KEGELS: Do Them Right
The muscles of the pelvic floor are like a sling supporting the bladder and urethra. Strengthening those muscles allows women with incontinence (or men who are incontinent following prostate surgery) to keep urine in the bladder until they decide to let it out.

"Some health professionals will tell you that exercises to strengthen the muscles of the pelvic floor (called Kegels, after the gynecologist who invented them in the 1940’s) don't work," says Kathryn Burgio, Ph.D., director of the continence program at the University of Alabama at Birmingham. But, she says, that's because Kegels usually aren't taught properly. Done correctly, the exercises work for most people who do them.
In fact, you may see significant improvement after 8 weeks, says Dr. Burgio. Here's how to do them right.


First, you need to know where the muscles arc. You can locate them by stopping or slowing the stream of urine the next time you go to the bathroom, says Dr. Burgio. The muscles that you use to do that are the pelvic floor muscles. Another way to identify them is to tighten the same muscles that you use to stop yourself from passing gas in public. Women can also find them by tightening the vaginal muscles.

Several times a day, squeeze the muscles and hold the contraction for 10 seconds, says Dr. Burgio. At first, you may not be able to hold for that long, but don't worry. Start by holding for a count of 3 (1, Mississippi; 2, Mississippi; 3, Mississippi), then let go. Over time, build up to a count of 10.
Some people have a tendency to contract their abdominal muscles by mistake. Breathing normally and regularly while doing the Kegels will help keep your abdomen relaxed, says Dr. Burgio. Also, you can put one hand over your abdomen to double-check that you're not tightening the muscles there, she adds.

When you're doing Kegels correctly, you'll feel a lifting sensation in the area of your vagina or a pulling sensation in your rectum, says Newman.
To build up the muscles, you need to do 45 Kegels a day. It's best to do them 15 times in a row three times a day.

"The most common error is that people simply forget to do them," says Dr. Burgio. The best way to remember to do your Kegels is to pick a few activities that you do every day, such as taking a shower, brushing your teeth, or eating a meal, and do the exercises during those activities.
Docs that sound like too much distraction? just stay with it. "At first, you'll have to concentrate quite a bit," says Dr. Burgio. "But after they become a habit, you'll start doing them automatically."

URGE STRATEGY: To Gain Control
Imagine that you have a powerful urge to urinate. It's a sensation that you can't ignore. The moment you feel the urge, you rush to the bathroom because you're afraid that if you don't, you'll have an episode of urge incontinence, which simply means losing urine before you make it to the bathroom.
People with this type of incontinence often find that urges come more and more frequently, and pretty soon, their bladders seem to have taken over their lives. What's worse, all of that rushing just jiggles the bladder and increases abdominal pressure, which can push urine out.
Well, it's time to regain control—with an "urge strategy." Here's what
Dr. Burgio recommends

1. When you get the urge, stop what you're doing and stay put. Sit
2. down when possible, or stand quietly.    ,
3. Remain very still. When you are still, it's easier to control your urge.
4. Squeeze your pelvic floor muscles quickly several times, but don't relax fully between contractions.
5. Relax the rest of your body. Take a few deep breaths and let go of your tension. Concentrate on suppressing that urgency.
6. Wait until the urge subsides.
7. Walk to the bathroom at a normal pace. Do not rush. Continue squeezing your pelvic floor muscles quickly while you walk.

If you do this each time the urge strikes, "you will have a much better chance of staying dry on your way to the toilet," says Dr. Burgio.