A Root Cause Medicine Approach to Bladder Leaks: Lab Testing, Nutrition, and Complementary Therapies

It is estimated that 423 million people aged 20 and older experience some form of urinary incontinence worldwide. However, due to underreporting, this number may be underestimated. Urinary incontinence is most common in elderly women but can also occur in younger men and women. Studies have shown that urinary incontinence is associated with depression, stress, and low self-esteem. Successful management of the condition depends on accurately diagnosing the type of incontinence. (12) 

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What Is Urinary Incontinence?

Urinary incontinence is a medical condition characterized by the involuntary leakage of urine from the bladder. It can range in severity from occasional minor leaks to a complete loss of bladder control. Urinary incontinence can be a temporary or chronic condition, and it affects people of all ages, although it is more common in older adults, particularly women. (15)

Types of Urinary Incontinence

Stress incontinence is the most common type of bladder control problem in younger and middle-aged women (15). It is characterized by involuntary urine leakage during activities that increase abdominal pressure, such as coughing, sneezing, laughing, or physical exertion. It often occurs due to weakened pelvic floor muscles or a compromised urethral sphincter, which cannot adequately support the bladder during these actions. (12) 

Urge incontinence, also known as overactive bladder, is a type of urinary incontinence characterized by a sudden and intense urge to urinate, often leading to involuntary urine leakage before reaching a restroom. This condition typically results from the overactivity of the bladder muscles, causing a frequent and urgent need to void. (12) 

Overflow incontinence is a type of urinary incontinence where the bladder does not empty properly, leading to a continual dribbling of urine or frequent leakage. This condition is often associated with an obstructed urinary tract, nerve damage, or conditions that weaken bladder contractions, causing the bladder to overfill and lose the ability to hold urine. (12) 

Functional incontinence occurs when a person is unable to reach the restroom in time to urinate due to physical or cognitive impairments despite having normal bladder control. In other words, the inability to access or use the bathroom is the primary issue, rather than a problem with the bladder or urinary system. (12) 

Some individuals may experience a combination of more than one type of incontinence, such as stress and urge incontinence. This is referred to as mixed incontinence. (12) 

What Are the Possible Causes of Urinary Incontinence (Bladder Leaks)?

Urinary incontinence can have various underlying causes, and understanding these factors is crucial for proper diagnosis and treatment. The causes of urinary incontinence can broadly be categorized into two main groups: transient and chronic.

Transient causes of urinary incontinence are usually temporary; bladder leaks will resolve once the underlying cause is resolved. Reversible incontinence usually has a sudden onset and has been present for less than six weeks at the time of evaluation (9). Use the mnemonic DIAPPERS to remember most of the reversible causes of incontinence: 

• Delirium
• Infection (acute urinary tract infection)
• Atrophic vaginitis
• Pharmaceuticals
• Psychological disorders
• Excess urine output (due to excess fluid intake, diuretic medications, metabolic disorders, etc.)
• Restricted mobility
• Stool impaction

Chronic causes of urinary incontinence are typically long-term and may require ongoing management. One of the primary causes is weakened pelvic floor muscles, often due to pregnancy, childbirth, or aging. This weakening can lead to stress incontinence. Overactive bladder muscles, often associated with neurological disorders or bladder irritants, can lead to urge incontinence. (9, 14, 15)

Nerve damage can also contribute to urinary incontinence. Conditions such as diabetes, multiple sclerosis, or spinal cord injuries can disrupt the signals between the bladder and the brain, leading to poor bladder control. Additionally, anatomical issues like bladder prolapse or an enlarged prostate can obstruct the urinary tract, causing overflow incontinence. Hormonal changes, such as menopause in women, can lead to changes in the bladder and urethra that may contribute to incontinence. (9, 14, 15)

Functional Medicine Labs to Test for Root Cause of Urinary Incontinence (Bladder Leaks)

The patient history is often the most important factor in identifying the type, severity, and burden of incontinence for the patient (9). The first step in a diagnostic evaluation for urinary incontinence is ruling out causes of transient incontinence; a thorough review of the patient's current list of medications is an important first step. A comprehensive multi-system physical exam can also reveal signs and symptoms of underlying causes for urinary incontinence. For example, the provider should evaluate for signs of volume overload on the cardiovascular exam, abdominal masses and tenderness, bladder distension, reduced joint mobility, and musculoskeletal pain. 

3 Incontience Questions (3IQ)

The 3IQ is an accurate and reliable questionnaire that asks three multiple-choice questions about if, when, and how patients experience bladder leaks. It can be used during an initial diagnostic evaluation to categorize urinary incontinence, especially stress and urge types. (9)

Urinalysis

A urine sample should be collected from the patient to run a urinalysis, a chemical evaluation of a urine sample. Blood, protein, and sugar in the urine can indicate signs of underlying pathologies related to bladder leakage that require additional workup. An abnormal urinalysis should be reflexed to a urine culture to rule out urinary tract infection. 

Comprehensive Metabolic Panel (CMP)

A CMP is a metabolic screening that includes 14 different markers related to blood chemistry and vital organ function. Abnormal results can indicate the presence of underlying health conditions, including diabetes, kidney disease, and heart failure, which can contribute to changes in urination and urinary output, leading to incontinence. 

Comprehensive Hormone Panel

In addition to obtaining a gynecologic history for female patients, including number of births, type of delivery, and pregnancy status, estrogen status should be determined with a hormone panel. Atrophic vaginitis and other anatomical changes to the pelvis may occur due to a lack of estrogen during perimenopause and menopause.

Gut Testing

For patients with constipation suspected to contribute to bladder problems, a comprehensive stool test, SIBO breath test, and food sensitivity panel may be important in ruling out intestinal dysbiosis and adverse food reactions known to cause infrequent and hard bowel movements. 

Additional Labs to Test 

The cough stress test is a clinically accurate maneuver to detect stress incontinence. The patient should be asked to Valsalva and/or cough vigorously when standing with a full bladder while the clinician observes whether there is urinary leakage. Studies have demonstrated that a positive cough stress test accurately diagnoses stress urinary incontinence in women.

Measuring postvoid residual (PVR) urine is recommended to diagnose overflow incontinence, which is important to exclude to prevent irreversible kidney damage in the long term. PVR urine is measured via ultrasound or catheterization after the patient empties their bladder. A PVR urine greater than 200 mL is suggestive of overflow incontinence. (9)

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Conventional Treatment for Urinary Incontinence (Bladder Leaks)

The treatment of urinary incontinence depends on the specific type and underlying causes. Conventional treatments aim to improve bladder control and reduce or eliminate involuntary urine leakage. Lifestyle modifications are often recommended for stress incontinence, including weight management and avoiding bladder irritants like caffeine and alcohol. Pelvic floor exercises, known as Kegel exercises, are a key component of treatment, helping to strengthen the muscles that support the bladder and urethra. (13) 

In cases of urge incontinence, medications may be prescribed to calm overactive bladder muscles and reduce the frequency of these urges. Behavioral therapies, such as bladder training, can also be effective in regaining control over bladder function. Bladder diaries can be helpful tools in assisting patients with timed voiding. (13)

Addressing the underlying cause, such as an enlarged prostate in men or nerve damage, is crucial for individuals with overflow incontinence. In some instances, catheterization may be necessary to empty the bladder regularly. (13)

Surgical interventions, such as sling procedures or bladder neck suspension, may be considered for more severe cases of stress incontinence or when conservative treatments are ineffective. These surgeries aim to provide additional support to the bladder and urethra. (13)

Functional Medicine Treatment for Urinary Incontinence (Bladder Leaks)

Functional medicine takes a holistic approach to health, focusing on identifying and addressing the underlying causes of medical conditions rather than just managing symptoms. Functional medicine can complement conventional approaches by addressing contributing factors that may be missed in standard medical care. 

Nutrition 

Diet plays a crucial role in overall health, including bladder function. Functional medicine may involve dietary modifications to reduce inflammation and support bladder health. Patients should be advised to keep a bladder diary to monitor food/fluid intake and bladder habits to help discern relationships between dietary habits and urination patterns.

Common bladder irritants that can help improve incontinence when avoided include caffeine, alcohol, artificial sweeteners, carbonated beverages, dairy, tomato-based products, citrus fruits, and spicy foods. (4) 

Certain dietary changes can also have profound effects in alleviating constipation, which is a known contributor to transient incontinence. Elimination diets that target identified food sensitivities and eating a diet that contains at least 25 grams of dietary fiber daily can optimize bowel patterns and relieve constipation.

In general, it is recommended to drink six to eight glasses of water daily. Some studies have found that patients with overactive bladder who reduce daily fluid intake by 25% improve urinary urgency, frequency, and nighttime urination. Fluid restriction should be performed under the guidance of a physician, as restricting too much fluid can cause dehydration, bladder irritation, and urinary tract infections. (4) 

Supplements & Herbs

Studies have found an association between vitamin D deficiency and an increased risk of pelvic floor disorders. The risk of developing urinary incontinence was 45% lower among patients with normal vitamin D levels than those with deficiency. (11) 

Diuretic, antibacterial, and antiadhesive herbs are routinely prescribed as natural alternatives to antibiotics for treating urinary tract infections. Botanical agents that are effective in treating urinary infections include cranberry, uva ursi, juniper, berberine-containing herbs, and goldenrod. (3) 

Saw palmetto is promoted as a natural supplement to treat urinary symptoms related to enlarged prostate glands in men. A 2020 randomized, double-blind controlled trial investigated the effects of saw palmetto fruit extract on improving urination issues in Japanese men. The results showed that saw palmetto fruit extract intake for 12 weeks positively impacted urinary urgency, frequency, and incontinence in the study participants compared to those who received a placebo. (7) 

Complementary and Integrative Medicine

A 2020 cross-sectional study using data from 352 women with urinary incontinence explored the benefits of lifestyle modifications and complementary and integrative medicine (CIM) for treating urinary incontinence symptoms. In this study, researchers found the most common types of complementary modalities implemented by the women included prayer, hot applications, and herbal teas. Lifestyle changes practiced by women with urinary incontinence included the reduction of fluid intake, therapeutic diets, and weight loss. Researchers concluded that while there is a generalized low rate of CIM use among women with urinary incontinence, over half of those implementing it into their treatment strategy benefit from it. (6) 

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Summary

Complementary and integrative medicine approaches to treating urinary incontinence offer a promising avenue for enhancing the management and quality of life for individuals dealing with this common condition. These approaches recognize the importance of addressing the underlying causes, emphasizing holistic well-being, and providing a personalized, patient-centered approach to care. Integrating techniques such as pelvic floor exercises, dietary modifications, and herbal remedies into traditional treatment regimens may offer a comprehensive and empowering strategy for individuals seeking relief from urinary incontinence.