Counseling Sheet

Agatha M. Thrash, M.D.

Preventive Medicine

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Incontinence of urine may be of several different kinds, including stress and urgency, which are discussed here.

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A. Stress Incontinence

• Occurring on laughing
• Occurring on running
• Occurring on crying or any kind of emotional stress
• Occurring on sneezing, coughing, or straining

B. Urge Incontinence

• Loss of urine only when the urge to urinate occurs
• Loss of urine when the intention to empty the bladder has been received by the conscious brain
• Full bladder incontinence—the bladder empties itself when it gets full, sometimes without the knowledge of the person until the warm urine is felt on the skin‍

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‍Treatment

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1. Exercises

• Kegel exercises—Six times daily for one minute each time, practice contracting to the full extent of the power of the musculature of the perineum, buttocks, thighs, and lower abdomen for cutting off an imaginary urinary stream. These contractions should follow each other as rapidly as is possible to get a full and intense tightening. Then relax fully before repeating the contraction. At least 20 contractions should be done during the one minute.
• While passing the urine, after urination has been fully established, practice stopping the urine flow. Then start it up again, and a second time practice stopping the urine flow totally. Then empty the bladder and press the remaining urine from the bladder with a straining action.
• Bridging—While lying on the back on the floor, support the entire weight of the body on the heels and the shoulders by lifting the hips and thighs, head and arms, off the floor. This exercise should be maintained for 3 seconds only on the first day. If no discomfort arises from having done the exercise, the second day the time may be advanced from one to three seconds. Continue advancing the number of seconds daily up to one minute.
• Winging—While lying face down on the floor, lift both the lower and the upper extremities, shoulders and head, off the floor behind your back, supporting the weight entirely with the abdomen. This exercise should be maintained for 3 seconds only on the first day. If no discomfort arises from having done the exercise, the second day the time may be advanced from one to three seconds. Continue advancing the number of seconds daily up to one minute.

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2. Positions

• Knee-chest position—Kneel on the bed or floor, bend over to rest head and arms on the bed. Try to actually get your chest on the bed. This position allows the organs inside the abdomen to move toward the head which promotes good circulation and stretches the muscles of the perineum, encouraging good tone. Hold the knee-chest position for 1-5 minutes.
• Stand, sit, and lie with good posture. When performing any physical function, whether it be exercising out-of-doors, chopping vegetables in the kitchen, doing shop work, or sitting at the computer, good posture should always be maintained. If the head and shoulders are carried forward during walking, it can lead to neck or shoulder pain. The skeleton should be entirely balanced, one vertebra held directly perpendicular to the one below it as much as possible so that the back and neck are in the "neutral position," the cheek bones directly over the collar bones, and the knees relaxed, not hyperextended. Mental and emotional benefits, grace and dignity, self-possession, courage, and self-reliance, are all promoted by an erect bearing. Keep the shoulders back and down, and the head erect.
• Practice deep breathing. Practice breathing deeply before sleeping, while sitting at one's desk, working in the house, or exercising out-of-doors. Every time you go through a door, take a deep breath.

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3. Foods

‍Many people are sensitive to certain foods or beverages, causing the bladder to become unusually sensitive. Then upon stress or filling, the bladder gets such a stimulus to contract that the voluntary muscles are unable to prevent loss of urine. In order to prevent this sensitivity, one may discover those foods to which one is sensitive and remove them from the diet. Eliminate the following list of foods for 28 days, or until the incontinence stops.

Dairy products (causing over 60 percent of all food allergies), chocolate, colas, coffee, tea, eggs, pork, beef, fish, all flesh foods, legumes, peanuts, soybean products, citrus fruits and juices, tomatoes, potatoes, eggplant, peppers, corn, cornstarch, corn products, rice, wheat, oatmeal, yeast, cane sugar, cinnamon, irritating substances, spices, beer, alcohol, artificial food colors (both artificial and material), strawberries, apples, bananas, nuts (all kinds), seeds, lettuce, garlic, onion.

As soon as the 28 days are up, or the incontinence ceases, start adding the foods back one at a time every 5 days, until the incontinence returns. Make a list of all those foods causing the incontinence.

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‍4. Herbal Remedies

• Horsetail or Shavegrass—1/4 cup steeped for half an hour in 1 quart of boiling water. Use one quart a day.
• Corn silk—1/3 cup to 1 quart boiling water. Remove from heat and steep for 30 minutes.
• Buchu tea—One teaspoon of tea in a cup. Pour one cup of boiling water onto the leaves. Steep for 30 minutes. Drink 1-8 cups daily as needed for soothing of the bladder.
• Uva-ursi tea made and used as above.‍

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5. Cervical Diaphragm

A recent report in a medical journal indicates that a cervical diaphragm, such as is used for contraception, may control stress incontinence in women almost completely. It will require fitting by your doctor. Cut away the part that fits over the opening of the cervix, leaving just the ring around the cervix. The ring will press against the bladder neck and control most leakage. It can be easily inserted by the person herself.