Although you might feel embarrassed if you have urinary incontinence, you should nevertheless let your doctor know about it. It could be a symptom of a disorder that could lead to more trouble if not treated.

Causes


In most cases, the problem is curable and treatable.

Two categories of urinary incontinence are acute incontinence and persistent incontinence.

The acute form is generally a symptom of a new illness or condition (e.g., bladder infection, inflammation of the prostate, urethra or vagina, and constipation).

Side effects of some medications, such as water pills, tranquilizers, and antihistamines can also result in acute urinary incontinence.

Acute urinary incontinence comes on suddenly. It is often easily reversed when the condition that caused it is treated.

Persistent incontinence comes on gradually over time. It lingers or remains, even after other conditions or illnesses have been treated. There are many types of persistent incontinence. The 3 types that account for 80 percent of cases are:

• Stress Incontinence – Urine leaks out when there is a sudden rise in pressure in the abdomen (belly). The amount ranges from small leaks to large spills. This usually happens with coughing, sneezing, laughing, lifting, jumping, running, or with straining to have a bowel movement. Stress incontinence is more common in women than in men.
• Urge Incontinence – This inability to control the bladder when the urge to urinate occurs comes on suddenly, so there is often not enough time to make it to the toilet. This type typically results in large accidents. It can be caused by a number of things, including an enlarged prostate gland, a spinal cord injury, multiple sclerosis, or Parkinson’s disease.
• Mixed Incontinence – This type has elements of both stress and urge incontinence.

Other types of persistent incontinence are:

• Overflow Incontinence – Constant dribbling of urine occurs because the bladder overfills. This may be due to an enlarged prostate, diabetes, or multiple sclerosis.
• Functional Incontinence – With this, a person has trouble getting to the bathroom fast enough, even though he or she has bladder control. This can happen in a person who is physically challenged.
• Total Incontinence – In this rare type, with complete loss of bladder control, urine leakage can be continual.

Treatment


Care and treatment for urinary incontinence will depend on the type and cause(s). The first step is to find out if there is an underlying problem and to correct it. Treatment can also include pelvic floor exercises, called Kegel exercises, and other self-care measures (see Self-Care Tips in this section on pages 172-173). Medication, collagen injections (for a certain type of stress incontinence), or surgery to correct the specific problem may be needed.

Your primary doctor may evaluate and treat your incontinence or send you to a urologist, a doctor who specializes in treating problems of the bladder and urinary tract.

Questions to Ask

Have you lost control of your bladder after an injury to your spine or back?
Do you have these problems? Fever and shaking chills Back pain (sometimes severe) in one or both sides of the lower back or just at your midline Nausea and vomiting
Does your loss of bladder control come with any of these symptoms? Loss of consciousness Inability to speak or slurred speech Loss of sight, double or blurred vision Sudden, severe headaches Paralysis, weakness, or loss of sensation in an arm or leg and/or the face on the same side of the body Change in personality, behavior, and/or emotions Confusion and dizziness
Is the loss of bladder control more than temporary after surgery or an abdominal injury?
Do you have any of these problems? Burning Frequent urination Blood in the urine or cloudy urine Abdominal or low back pain
With the loss of bladder control, do you have diabetes or any of these symptoms of diabetes? Extreme thirst Unusual hunger Excessive loss or gain in weight Blurred vision Easy fatigue, drowsiness Slow healing of cuts and/or infections
If you are a man, do you have any of these problems? Dribbling urine and/or feeling the need to urinate again after you have finished urinating Voiding small amounts of urine often during the day The need to urinate while sleeping An intense and sudden need to urinate often A slow, weak, or interrupted stream of urine
Do you leak urine when you cough, sneeze, laugh, jump, run, or lift heavy objects?
Did you lose some bladder control only after taking a new medicine or after taking a higher dose of a medicine you were already taking?

Self-Care Tips

• Avoid or limit drinks, foods, and medicines that have caffeine (e.g., coffee, tea, colas, chocolate, and No-Doz).
• Limit carbonated drinks, alcohol, citrus juices, greasy and spicy foods, and items that have artificial sweeteners. These can irritate the bladder.
• Drink 1–2 quarts of water throughout the day.
• Go to the bathroom often, even if you don’t feel the urge. When you urinate, empty your bladder as much as you can. Relax for a minute or two and then try to go again. Keep a diary of when you have episodes of incontinence. If you find that you have accidents every 3 hours, for example, empty your bladder every 21/2 hours. Use an alarm clock or wristwatch with an alarm to remind you.
• Wear clothes you can remove quickly and easily when you use the bathroom. Examples are elastic-waist bottoms and items with velcro closures or snaps instead of buttons and zippers. Also, look for belts that are easy to undo, or don’t wear belts at all.
• Wear absorbent pads or briefs.
• Ask your doctor if you would benefit from using self-catheters. A self-catheter is a clear, straw-like device, usually made of flexible plastic, that you insert into the opening of the urethra; it helps you empty your bladder completely. Your doctor will need to show you how to use one. You need a prescription for self-catheters.
• Empty your bladder before you leave the house, take a nap, and go to bed.
• Keep the pathway to your bathroom free of clutter and well lit. Make sure the bathroom door is left open until you use it.
• Use an elevated toilet seat and grab bars if these will make it easier for you to get on and off the toilet.
• Keep a bedpan, plastic urinal (for men), or portable commode chair near your bed. You can get these at medical supply stores and drugstores.

Kegel Exercises


To strengthen your pelvic floor muscles, do Kegel exercises . They can help treat or cure stress incontinence. Even elderly women who have leaked urine for years can benefit greatly from these exercises. Here’s how to do them:

• First, identify where your pelvic floor muscles are. One way to do this is to start to urinate, then hold back and try to stop. If you can slow the stream of urine, even a little, you are using the right muscles. You should feel muscles squeezing around your urethra and anus.
• Next, relax your body, close your eyes and just imagine that you are going to urinate and then hold back from doing so. You should feel the muscles squeeze like you did in the step before this one.
• Squeeze the muscles for 3 seconds and then relax them for 3 seconds. When you squeeze and relax, count slowly. Start out doing this 3 times a day. Gradually work up to 3 sets of 10 contractions, holding each one for 10 seconds at a time. You can do them in lying, sitting, and/or standing positions.
• Women can also use pelvic weights prescribed by their doctor. A woman inserts a weighted cone into the vagina and squeezes the correct muscles to keep the weight from falling out.
• When you do these exercises:
  • Do not tense the muscles in your belly or buttocks.
  • Do not hold your breath, clench your fists or teeth, or make a face.
  • If you are not sure you’re doing the exercise right, consult your doctor.
• Squeeze your pelvic floor muscles right before and during whatever it is (coughing, sneezing, jumping, etc.) that causes you to lose urine. Relax the muscles once the activity is over.
• It may take several months to benefit from pelvic floor exercises and you have to keep doing them daily to maintain their benefit.

The History of Acupressure

Because acupressure evolved from acupuncture, an ancient Chinese healing practice, the history of this form of treatment begins with traditional Chinese philosophy as it applies to the healing arts. The fundamental principle of Chinese philosophy is the concept of yin and yang. The yin and yang are two opposite, yet complementary, forever-entwined forces that underlie all aspects of life. Yin-yang is depicted as the subtly curved light and dark halves of a circle. Both proceed from the t’ai chi (the Supreme Ultimate). According to this philosophical system, the human body, like all matter, is made up of five elements: wood, fire, earth, metal, and water. Each element corresponds to an aspect of the body, such as the organs, senses, tissues, and emotions, as well as to aspects of nature, such as direction, season, color, and climate. The five-element theory, combined with the principle of yin and yang, forms the basis of the Chinese concept of balance. The intention is to balance yin and yang and to balance the energies of the five elements.

Yin is earthy, female, dark, passive, receptive, and absorbing. It is represented by the moon, the tiger, the color orange, a broken line, and the shady side of a hill. Yin is cool, inward, still, and soft.

Yang is represented by the sun, the dragon, the color blue, an unbroken line, and the sunny side of a hill. Yang is hot, outward, moving, aggressive, and bright.

Because yin and yang are intertwined halves of the same whole, all things, and all people, contain elements of both, although at any one time, one or the other will be predominant. Thus, a baby or young child is more yin; an older child more yang. When your child asserts herself, it is her yang that is coming to the fore.

The sun is yang, the moon is yin. We awaken in the morning and greet the sun. It is natural to be active and moving throughout the daylight. As twilight descends into night, we become more passive and quiet. Nighttime expresses the qualities of yin.

Chinese medical theory teaches that the two branches of the body’s nervous system, the sympathetic and parasympa-thetic, correspond to the two halves of the yin-yang circle. The sympathetic branch is the part of the nervous system that mobilizes our bodies to respond to stress. It initiates the fight-or-flight re-sponse, a more yang part of the cycle. The parasympathetic branch replen-ishes and supports the body during rest, the yin part of the cycle. These two branches oppose and balance each other to create stability and health. When the yin and yang are balanced within the body, all the body’s functions are healthy. Illness is caused by an imbalance between yin and yang.

Conventional Western medicine typically pinpoints and directly treats only the affected part of the body. Chinese medical philosophy encompasses the entire universe. Everything that affects the patient is considered, including emotion, environment, and diet.

Chinese philosophy proposes a way of life based on living in accordance with the laws of nature. This profound connection with nature is reflected in the language used to describe illness. For example, a patient may be diagnosed with a “wind invasion” or “excess
heat.” Acupuncture (or acupressure) points may be chosen to “disperse wind,” “remove summer damp,” or “disperse rising fire.”

In traditional Chinese medicine, every aspect of health is described in terms of a balance between yin and yang. For example, yin illnesses are caused by excessive expansion (overweight as a result of eating too much sugar, for example), while yang illnesses are caused by excessive contraction (sunstroke or fever). An imbalance of yin and yang factors can be demonstrated by showing how red blood cells respond to different substances. When red blood cells are placed in water (yin), they absorb the water, expand, and finally burst. When red blood cells are placed in a concentrated saline (salt) solution (yang), they contract, shrink, and shrivel. In a solution of normal saline (0.9 percent salt), the yin and yang are perfectly balanced and the cells remain virtually unchanged. An example of how the ancient yin-yang theory can be used to describe concepts in conventional medicine can be found in the treatment of breast and prostate cancer: Female hormones (yin) help control prostate cancer (yang); male hormones (yang) help control breast cancer (yin). The interplay of the yin and yang-as one increases, the other decreases-describes the process of the universe and everything in it. In more familiar Western terms, as modern physical science teaches, “For every action, there is an equal and opposite reaction.”

The Five Elements and Their Correspondences
in Nature and the Human Body

In traditional Chinese Philosophy, all matter is considered to be composed of five elements (wood, fire, earth, metal, and water). The elements in turn have correspondences in various aspects of the natural world, including the human body. According to this philosophy, health is achieved when yin and yang, and the energies of the five elements, are all in proper balance. The elements and some of their corresponding characteristics and parts of the body are illustrated in the chart below.
THINGS IN NATURE	ELEMENT
	Wood	Fire	Earth	Metal	Water
Direction	East	South	Middle	West	North
Taste	Sour	Bitter	Sweet	Pungent	Salty
Color	Green	Red	Yellow	White	Black
Growth Cycle	Germination	Growth	Ripening	Harvest	Storing
Environmental Factor	Wind	Heat	Dampness	Dryness	Cold
Season	Spring	Summer	Late Summer	Autumn	Winter
HUMAN BODY
Organs	Liver, gallbladder	Heart, small intestine	Spleen, stomach	Lung, large intestine	Kidney, bladder
Sense/Organ	Eye	Tongue	Mouth	Nose	Ear
Tissue	Tendon	Vessel	Muscle	Skin and hair	Bone
Emotion	Anger	Joy	Meditation	Grief and Melancholy	Fright and fear

In Chinese philosophy, the energy that pulses through all things, animate and inanimate, is called chit Health exists when there is a harmonious balance under heaven of both internal and external forces. Each bodily organ must have the right amount of chi to function. Too much or too little chi causes an imbalance, resulting in illness or disease. Chi flows through all things, enters and passes through the body, creating harmony or disharmony.

Chinese medicine works directly with the natural, vital energy-or chi-of the body. The goal of acupuncture and acupressure is to normalize the body’s energies. Chi can tee tapped at specific points along channels known as meridians. Activating one key point sets up a predictable reaction in another area. By tonifying (increasing energy in) a specific area, the yin-yang balance is treated. Moving an excess of chi from one area and directing it to another, weaker area, corrects the yin-yang balance.

Acupuncture is an ancient protocol. As a component of Oriental medicine, it has been practiced for centuries. The Huangdi Neijing (Canon of Medicine), written about 500-300 B.C., is the oldest surviving medical text. Among other medical practices, it describes the use of acupuncture.

Acupressure Today

Acupressure is a form of body work in which pressure is applied to specific acupuncture points to balance internal function. Acupressure is practiced around the world.

The Chinese have a very descriptive term for taking advantage of a combination of two or more healing systems-a practice this book advocates. They say the’ patient is “walking on two legs.” A two-year study conducted jointly by the Northwestern University Medical School and Evanston Hospital in Evanston, Illinois employed a combination of acupuncture and acupressure. In this study, patients suffering from chronic head aches of all types, including migraine, cluster, whiplash, and tension, were first treated with acupuncture. The patients were then individually instructed in specific acupressure techniques to use when a headache seemed imminent. The researchers reported that the need for prescription painkillers and other drugs was eliminated entirely in most patients-thus verifying the effectiveness of “walking on two legs.”

Working with an Acupressurist

There are professionally trained and college-educated acupressurists, just as there are acupuncturists. If you wish to consult a trained acupressurist, check the yellow pages of your telephone book. You’ll find this category listed in most large cities.

For the most part, though, the gentle form of acupressure recommended in the Treatment and Care entries in Part Two of this book is something you can do yourself, at home, to ease a hurting or ailing child.

Treating Your Child with Acupressure

In The Chinese Art of Healing (Bantam, 1972), author Stephan Palos identifies the hand as “man’s original medical tool.” We instinctively use our hands to alleviate pain. When we suffer a bump or bruise, have a cramp, or hurt anywhere inside, we rub, knead, or massage the painful spot.

When your child is ill, gently working the acupressure points recommended in the appropriate entry in Part Two will probably be beneficial (the illustrations in Part Three provide guidelines for locating all of the acupressure points recommended). Your child will very likely love receiving an acupressure treatment.

Massaging a particular point will help relieve symptoms as well as strengthen and balance the yin-yang in your child’s body. For example, applying acupressure to the point identified as “Large Intestine 11” helps relax the intestine, thus relieving constipation. Another related

point is Stomach 36; massaging Stomach 36 helps tone an upset digestive tract. When your child is ill, the appropriate acupressure points, as well as other areas of your child’s body, will be tender. Use your intuitive sense. Ask what feels good.

Common Acupressure Points

In acupressure, there are twelve lines c ailed meridians that run along each side of the body. Each pair of meridians corresponds to a specific organ. For example, there is a pair of Lung meridians, Spleen meridians, Stomach meridians, and Liver meridians. Acupressure points are named for the meridian they lie on, and each is given a number according to where along the meridian it falls. Thus, Spleen 6 is the sixth point on the Spleen meridian. The table on page 38 lists some of the acupressure points most often recommended in the entries in Part Two of this book.

Administering Acupressure

When you give your child an acupressure treatment, your tools are your hands, notably your thumbs and fingers, and occasionally your palms. For the most part, you will be using the balls of your thumbs and fingers, never the nails. Before administering acupressure, make sure your fingernails are clipped short, so that you do not inadvertently scratch your child.

Choose a time of day when your child is most relaxed, perhaps after a warm bath and just before bedtime. Have her take a few deep breaths. This aids relaxation and will automatically focus your child’s attention inward on her body.

You might want to start an acupressure session with a loving and comforting back rub, a treat most children welcome, especially when ill. Remain calm and unhurried. Make sure to keep your child warm throughout the treatment. You can apply pressure to the points directly onto the skin, or through a shirt or light sheet.

Work right-side and left-side acupressure points at the same time. Use your fingers or thumbs to apply threshold pressure to the point. Threshold pressure is firm pressure, just on the verge of becoming painful The idea is to stimulate the point without causing the body to tighten up or retract a the pain. The pressure you exert should not hurt your child. Firm but gentle is the rule.

Apply from one to five minutes of continuous pressure. Or apply pressure for ten seconds, release for ten seconds, reapply pressure for ten seconds, release for ten seconds. Repeat this cycle five times.

To learn how to locate specific acupressure points, specific points
which are helpful for different childhood conditions are
included in
Administering an Acupressure Treatment.

When your child is ill, acupressure is a wonderful way to use your hands with a loving, nurturing touch, while also stimulating your child’s body to heal. By using the acupressure points described in this book, you will be working to relieve the underlying cause of illness. At the same time, your gentle healing touch will convey your love and concern to your child.

Common Acupressure Points

Point	Effect	Indications
Bladder 23	Increases circulation to the urinary tract and reproductive organs.	Vaginitis, urinary tract infection; lower back pain.
Bladder 28	Master point for the bladder.	Urinary tract infection.
Bladder 60	Increases circulation to the urinary tract and reproductive organs.	Urinary tract infection.
Four Gates	Motion sickness; chickenpox; croup; hay fever; herpes; hyperactivity; pain; fever; poison ivy; sleeplessness; weight problems.	Urinary tract infection.
Kidney 3	Strengthens the bladder and kidneys; increases circulation to the reproductive organs.	Bedwetting; urinary tract infection; vaginitis.
Kidney 7	Strengthens the bladder and kidneys.	Bedwetting.
Large Intestine 4	Beneficial to the head and face; relieves congestion and headaches; removes energy blocks in the large intestine; clears heat.	Acne; common cold; headache; menstrual cramps; teething; sore throat; fever; toothache.
Large Intestine 11	Relieves itching; reduces allergic reactions.	Chickenpox; hay fever; constipation.
Large Intestine 20	Decreases sinus congestion.	Hay fever; sinusitis.
Liver 3	Quiets the nervous system; relaxes muscle cramps and spasms.	Asthma; menstrual cramps; teething; headache; eye pain.
Liver 7	Clears the lungs; moistens the throat.	Asthma; common cold; sore throat.
Neck and Shoulder Release	Relaxes the muscles of the neck and shoulders; relaxes the body.	Headache; weight problems.
Pericardium 6	Relaxes the chest; relieves nausea; relaxes the ming.	Asthma; motion sickness; croup; sleeplessness; stomachache; vomiting.
Points Along Either Side of the Spine	Improves circulation; relaxes the nervous system; balances the respiratory system; relaxes the spine.	Anxiety; colic; common cold; menstrual cramps; nervousness; insomnia.
Spleen 6	Reduces uterine cramping.	Menstrual cramps.
Spleen 10	Detoxifies the blood.	Acne; herpes; impetigo; poison ivy, boils, vaginitis.
Stomach 36	Tones the digestive system; strengthens overall wellbeing.	Colic; diarrhea; chronic runny nose; vomiting, constipation, indigestion; stomachache.

From Smart Medicine for a Healthier Child by Janet Zand, N.D., L.Ac., Robert Rountree, MD, Rachel Walton, RN, ©1994. Published by Avery Publishing, New York. For personal use only; neither the digital nor printed copy may be copied or sold. Reproduced by permission.

She had two episodes of cystitis over the past year. Both times she
experienced burning in the bladder on urination. She had tried to treat
herself with herbs without success. She complained of burning and stinging in the bladder on urination, especially at the end of the stream.
The pain was worse right before and at the end of urination. She
experienced a lot of urgency at first.

Abby also complained of recurrent vaginitis. She had a profuse, thick, creamy vaginal discharge. When it got bad, her labia were red,
swollen, and burned.

She had terrible cramps just before her menses. She felt a drawing,
squeezing sensation in her ovaries. It was somewhat better when she doubled
over. The pain always occurred in the middle of the night. Her
menstrual flow was heavy at the beginning of each period. The first night she
had to get up in the middle of the night to change her menstrual pad. Her
cramps tapered off with the flow. Her sexual energy was good.

Abby had a past history of eczema which had gone away when she eliminated
dairy from her diet. She had a tendency to constipation. Her nails were
very soft.

She liked olives and chocolate. Lately she was less thirsty. She was
not particularly warm or chilly. She slept well, mostly on her back.

We gave Abby Apis mellifica 200C in one dose.
Apis, made from an angry honeybee, is often thought of as an acute
remedy for beestings, but less frequently considered as a constitutional
remedy.

Think about the symptoms of a beesting, and you will have a good idea of when
to prescribe Apis. The area around the sting becomes hot, red, and
swollen. There is usually burning, stinging pain. The discomfort is often
relieved by cold applications. Apis is an important remedy for other
conditions in which the person has similar symptoms to a beesting. These
include cystitis, vaginitis, ovarian cysts, and most edematous diseases. You
have undoubtedly heard about beesting treatments for arthritis. In cases of
rheumatic arthritis with symptoms corresponding to Apis, the homeopathic
mode of administration is considerably more comfortable than subjecting oneself
to multiple beestings. Apis is a classic remedy for anaphylaxis, though
Carbolic acid is often considered first in extreme cases. Apis
is also useful in cases of meningeal irritation. One keynote of this remedy is
the “brain cry” or “cri encephalique”- the piercing shriek of children with
encephalitis.

Roger Morrison, MD, elaborated on the mental and emotional picture of
Apis at the 1991 International Foundation for Homeopathy Case
Conference. People needing Apis are busy bees. They are hard-working,
industrious, practical type folks. They are very protective of their hives,
often devoting a great deal of their time and energy to home and family. As Dr.
Morrison said, “You don’t want to cross a bee…or someone needing Apis
.”

It is also interesting to mention that people needing Apis are
generally not very thirsty. Abby’s thirst had diminished of late…

One month after taking the Apis, Abby wrote us a letter because she
was unable to keep her follow-up appointment. “The rash on my eyes has
virtually disappeared… I have lost my thirst though I am forcing myself to
drink water… ” Her vaginal discharge was gone. She experienced periodic
“twinges” of itching. She mentioned that she was feeling a lot of pressure at
work and was very concerned because her husband had multiple sclerosis.

Abby called nine days later to report that the swelling was completely gone
until she was exposed to a strongly aromatic shampoo. At that time her symptoms
returned. Apis 200C was repeated. She had one more episode of the
swelling six weeks later, which was quickly relieved by another dose of
Apis 200C.

Abby returned to see us five and a half months after the third dose of
Apis. She reported that she had been feeling great. She had no more
recurrences of cystitis, vaginitis, or swelling of the eyelids.

The ovarian pain had not returned. Now, eleven months after the first dose of
Apis, she has not needed further treatment.

Dr. Judyth Reichenberg-Ullman and Dr. Robert Ullman are licensed
naturopathic physicians and are board certified in homeopathy and teach homeopathy to licensed health care professionals. They
practice in Edmonds, WA at 131 3rd Ave., N., Edmonds, WA 98020 and can be
reached at (206) 774-5599. Their book, The Patient’s Guide to Homeopathic
Medicine, is now available.

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