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Urinary
Incontinence
Sue:
Urinary incontinence is embarrassing and many women do not want to talk about it,
yet suffer in silence. What can they do?
  Larrian:
Because the pharmaceutical industry recognized that the biggest users of oversize
Kotex were incontinent women, a new market has evolved, which always means newer or better
products in direct proportion to sales. Incontinence has many causes, the most common
being a stretched or damaged pudendal nerve from delivery of babies. First degree
incontinence ( the cough and you leak enough to cross your legs) can be treated by simply
take one decongestant a night ( such as pseudophed) and doing pelvic floor exercises. In
my book, I illustrated how to perform "Killer Kegels". Once the uterus starts to
drop down into the vagina, women are usually told they need a hysterectomy. When I
practiced, I performed uterine suspensions for this type of incontinence and simply
restored the uterus back to a proper alignment, which brought with it the correct
alignment of the pelvic floor and bladder neck. However, once the uterus has already been
removed and incontinence develops, bladder neck suspension surgery is an option. I would
not consider the injection procedures ( teflon, collagen, fat ) as they simply don't last
very long, and the type of incontinence they are treating could better be handled by the
above two techniques. If women don't want to consider surgery, a new device has been
approved that is inserted into the urethra and essentially blocks the bladder neck from
the inside. This is a reasonable approach for people with multiple sclerosis or true
neurogenic bladders, but as far as I am concerned, it's not the panacea for women's
incontinence.
FREE Book Excerpt
"You Don't Have to Live with Cystitis"
Menopause and
incontinence
(and your bladder) p.
178
Larrian:
Betty
Betty came to see me with a common complaint of early menopause. She felt the need
to urinate frequently.
Where before she could drink lots of fluid and wait hours
before voiding- " I've always been a real camel," she said- she now found
herself wanting to run to the toilet every half hour. She could repress this urge if
she just told herself it was a false signal. But if she gave in, only a little urine came
out. It began she said, "to drive me crazy".
On standard tests, Betty's bladder looked great.
Her bladder pressure and flow rates were normal. She could indeed move dirt
across the sidewalk. Her back was not troubling her and there were no
caruncles. She looked normal.
But her problem could be traced back to that loss
of estrogen that accompanies menopause.
There are estrogen receptors in the trigone, the triangular
area in the base of the bladder. The trigone ( fully described in Chapter Five)
arises from different embryologic tissue than the rest of the bladder and strongly
responds to estrogen. The tissue has what are called receptor sites., which are
like keyholes to molecules of hormone. The estrogen then helps maintain a protective GAG
layer on the trigone.
As your bladder fills, the trigone is shielded from urine by this protective layer.
But when the bladder is half full, tiny molecules in urine stimulate sensory nerves in the
trigone that it is time to void.
But when you lose estrogen, the GAG layer thins and it takes only a small amount of urine
to defeat the barrier. The result is urinary frequency, as Betty was experiencing.
"You know," she said " I wet my bed when I
was a kid and I had to go to the bathroom all the time. I felt like this back
then." Betty had reverted to what I call the teeny-weeny bladder club.
Many women with urinary frequency have insufficient protective lining in their trigones.
This can be caused by different factors but the result is always frequency.
The solution to Betty's problem was straightforward.
When she went on oral estrogen replacement therapy, her symptoms
disappeared. The estrogen induced her protective GAG layer to thicken and restore
normal bladder function. As Meryls did she decided to avoid progestins because they
upset what estrogen builds back up in the bladder.
Many women past menopause also have a problem with their thyroid hormone.
I believe this is an issue that is not carefully evaluated by many gynecologists.
Thyroid hormone is important for cellular maturation and may be linked, in a complicated
interaction, with estrogen and other sex hormones. It exerts real effects on bladder
tissue. I find many patients symptoms of urinary frequency disappear when they take
medication to put their thyroids back into normal range.
Go
back to introduction 
Urinary Incontinence
There are a number of causes of stress and
urge incontinence - stress incontinence & urge incontinence. The loss of estrogen
during perimenopause/menopause weakens the lining of the bladder, urethra, and vagina
leaving them more susceptible to injury and inflammation. How many trips to the bathroom
do you make during the night? What can be done about incontinence? How to do Kegel
Exercises? and how to use natural remedies like cranberry juice to help you with your
symptoms.
Classic French Omelette
 This week's Recipe of the Week is brought to us by Dr. Larrian
Gillespie the author of The Goddess Diet. Dr. Gillespie, in addition to learning how to
cook from the very best chefs, has developed a successful weight loss and maintenance
program for all women. Her Classic French Omelette is a terrific dish for breakfast,
lunch, or dinner. She says, "The first thing I was taught at cooking school in France
was how to make an omelette. I've adapted this recipe to include soy and my
favorite herb de Provence." |
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