Urinary incontinence is when loss of bladder control or urinary leakage occurs and it can happen to anyone although it’s more prevalent in older adults. Incontinence is a common problem and the Urology Care Foundation states, “A quarter to a third of men and women in the U.S. suffer from urinary incontinence. That means millions of Americans. About 33 million have overactive bladder (also known as OAB) representing symptoms of urgency, frequency and with or without urge incontinence.” While incontinence can affect daily life, there are treatments that help manage symptoms and Eat This, Not That! Health spoke with Dr. S. Adam Ramin, MD, urologist and medical director of Urology Cancer Specialists in Los Angeles, CA who explained everything to know about incontinence. Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.

Dr. Ramin says, “Urinary incontinence is the medical term used to explain a sudden loss of bladder control, leading to unexpected urine leakage. Some people can experience urinary incontinence on occasion when they cough or sneeze, or they feel an intense urge to urinate that comes on so quickly they don’t reach the toilet in time. In other cases, however, when urinary incontinence happens with more regularity, it’s the sign of an underlying condition that requires evaluation. It may surprise you to learn that urinary incontinence on its own is not a disease. It’s a symptom. When I explain this fact to people, it often surprises them. Some people suffer for years with the symptoms of urinary incontinence, having never gotten to the bottom of what’s causing it, simply because they assumed it was something they’d need to ‘just deal with.’ Nothing can be further from the truth.” 

Dr. Ramin explains, “Another important but not well-known consideration about urinary incontinence is that it includes five subtypes associated with unique symptoms. They are as follows: 

Stress Incontinence: Occurs when stress, or pressure, is placed on the bladder through activity (exercise, laughing, coughing, or sneezing).

Urge Incontinence: Is characterized by an intense need to urinate, followed by an uncontrollable loss of urine.

Overflow Incontinence: Involves the frequent dribbling of urine due to the bladder’s inability to empty itself fully.

Functional Incontinence: Occurs when a physical or mental impairment prevents an individual from getting to the toilet in time to urinate.

Mixed Incontinence: The experience of one or more types of incontinence.”

According to Dr. Ramin, “Your risk for either type of incontinence can be raised if you have a family history of someone with bladder leakage, you are a tobacco smoker, or simply from getting older as the bladder muscles lose some of their strength as we age and are no longer able to hold as much urine. The symptoms of urinary incontinence are as varied as its underlying causes. In women, causes can range from an untreated urinary tract infection to a prolapse of the pelvic organs. In men, prostate enlargement can be an underlying urinary incontinence cause. For both men and women, obesity can also play a significant role in the development of urinary incontinence. Especially when weight is concentrated in the abdominal area, it can place increased stress and pressure on the bladder and other organs in the area. Some neurological disorders such as a stroke or spinal cord injury can cause problems with the nerve signals that govern bladder control.”

The newly revealed research, which was published in the Annals of Internal Medicine, sought to compare how effective nonpharmacologic (non-medicated) treatments were over pharmacologic (medicated) treatments in curing or at least improving the symptoms associated with urinary incontinence in women. In a nutshell, what the researchers found was that most nonpharmacologic and pharmacologic treatments were better than no treatment at all in improving urinary incontinence outcomes for the women studied. What’s more, the research also revealed that behavioral modification was even more effective than certain medications in successfully treating urinary incontinence.”

Dr. Ramin says, “Behavior modification as a treatment option for urinary incontinence includes doing things like reducing fluid intake, regularly performing Kegel exercises, avoiding coffee, tea and other foods that are known bladder irritants. While the study findings support that these efforts do indeed work, unfortunately, behavioral modifications tend to have the lowest rate of conformity in terms of patient compliance. Many people who suffer from urinary incontinence are hesitant to do these things for a variety of reasons, including the simple truth that habits are hard to break.  Even so, I routinely recommend behavioral modification to my patients. I encourage them to reduce their fluid intake, especially if they are drinking excessive fluids. Some common bladder irritants beyond coffee and tea include spicy foods and energy drinks containing a high concentration of caffeine. These all can cause increased urgency of urination and urge incontinence. Regularly performing Kegel exercises can help both with stress and urge incontinence, and you can do them anywhere at any time.”

“In general, foods that lead to bladder mucosal irritation are alcohol, coffee, black tea, spicy foods, acidic fruits, foods with a high-fat content such as fried foods, and highly processed foods such as those found in boxes and cans,” says Dr. Ramin. “Furthermore, the chemicals found in cigarette smoke can also reach the bladder mucosal cells, causing genetic mutations and increasing the risk of or eventually leading to the development of bladder cancer.  

Most Recommended Foods for Bladder Health

Fruits, Vegetables, Vitamins & Nutrients:

• Green vegetables, 
• Red, yellow, and green bell peppers 
• Cauliflower
• Carrots
• Red cabbage
• Berries

Each of the above-listed foods is known to have antioxidant and anti-inflammatory properties. These ingredients are best consumed raw with a dash of squeezed lemon + olive oil in salads with greens like lettuce or arugula. Simple salads with four or fewer ingredients, including avocados and olive oil, are great for preventing and reducing bladder inflammation.

Protein Sources: 

• Grilled or baked small chickens or hens, as they are hormone-free
• Oven-prepared Salmon or seared Ahi tuna
• Organic poultry cooked on a grill or baked in the oven.

Carbohydrate Sources: 

• Multi-grain bread
• Quinoa
• Couscous

I am a massive proponent of freshly prepared meals whenever possible and trying not to consume processed foods. So, of course, if we have a “best foods” list, it’s essential to include a list of those foods that should be avoided or consumed infrequently. 

Least Recommended Foods for Bladder Health

• Alcohol
• Spicy foods 
• Sodas
• Fried meats,
• Red meat, 
• Yogurt, milk, and cheeses
• Processed foods (those found at a drive-thru, in a can, or from a box)
• Coffee has chemical irritants that can cause bladder mucosa injury, so be sure to drink it only in moderation

In addition, complex carbohydrates found in bleached bread, pasta, and baked pastries can cause inflammation and irritate the bladder mucosa.

While what we eat significantly impacts our bladder and overall urologic health, our behaviors do too.”

Dr. Ramin suggests the following: 

• “Don’t hold urine too long. Once you have the urge to go, try to get to the bathroom within 1/2 hour.
• Drink water regularly to keep the color of your urine light yellow to clear. The darker the urine color, the more dehydrated your body.
• Perform Kegel exercises – Tighten the muscles around the urethra and hold for 5 seconds. Perform this exercise at least 20 times per day. Doing so will help with symptoms of overactive bladder or bladder irritation and help prevent incontinence in the future.”

Dr. Ramin doesn’t recommend doing the following: 6254a4d1642c605c54bf1cab17d50f1e

• “Holding urine too long will damage the bladder muscle and mucosa, eventually leading to incontinence, infection, or poor bladder emptying.
• Smoking, excess alcohol intake, and eating high salt concentrations can all cause bladder mucosal injury.
• Avoid exposure to gasoline and benzene chemicals as they increase the risk of developing bladder cancer.”

Dr. Ramin advises, “For most patients, the treatment of urinary incontinence generally involves some options, and many patients do benefit from behavioral modifications and medications. However, first, proper and appropriate evaluation is in order and requires a thorough history and physical, as well as some necessary tests. These tests can aid the physician in determining what kind of treatment therapy will work best. Three important exams are cystoscopy, urodynamics, and MRI imaging of the spine. While less invasive treatments like medications and behavioral changes may be offered without doing these diagnostic tests, the more invasive procedures like Botox therapy of bladder, pelvic prolapse surgery, vaginal sling surgeries, should follow testing. These more invasive treatments are typically only considered when less complicated therapies have failed to provide relief from the symptoms associated with urinary incontinence, or the condition is seriously interfering with healthy, active daily living. Finding a physician who will provide you with all of the options available to you and his/her recommendations for your specific circumstances is crucial. Subsequently, as a team, you should then discuss the pros and cons of each option and together develop a plan that feels like a good one. Since urinary incontinence is generally not considered a medical emergency, it is possible to gradually elevate the complexity of care and treatment options, especially when there is a strong desire to avoid more invasive treatment procedures. More than anything, however, it is vital for anyone living with urinary incontinence to know there are many effective treatment options available today and they are not alone.”