To Your Health

Q. I can't believe that at age 26 I have the same problem as my 63-year-old mother. We both leak urine if we sneeze or laugh. I have two children, and I have heard that this can make a difference. Since I can't turn back the clock (and these two children are worth the misery), is there anything else that I can do?

A. It seems that one of the costs of motherhood is the "stress incontinence" that you describe. There are a couple of things that might still help.

For instance, women who consume caffeine in the range of 450-500mg per day (four cups of regular coffee) have about twice the risk of stress incontinence as those who drink the equivalent of two cups of coffee per day. I don't know how much the risk diminishes when no caffeine is consumed, but since you may be more vulnerable than most, it would certainly do no harm to eliminate all caffeine. Remember that caffeine is found in cola drinks, regular and green tea, chocolate, and Maté herbal tea. A serving or two of each of these during the day in addition to a serving or two of coffee would bring you close to the 450 mg/day level.

The connection of stress incontinence with sneezing may have another component besides just the push that a sneeze incites. Histamine, which mediates the common allergic response of a drippy nose, also weakens the involuntary muscles that hold urine in the bladder. During allergy season when pollen or mold count goes up, the elevated histamine may work with the increased abdominal pressure of a sneeze to allow urine to leak out. An allergist can test and discover which allergens are serious enough to warrant treatment.

Nutritional help for allergies most often comes from supplements of vitamin C and pantothenic acid. Unless you get diarrhea from your vitamin C supplement, you can take 2,000mg/day and maybe even more if more provides extra benefits. Pantothenic acid is apparently safe in enormous amounts, 2,000 to 10,000 mg/day, though you may find that as little as 500 mg/day is sufficient. It is safe to experiment with a wide range of pantothenic acid supplements at different times of the year, and you should be able to find the amount you need for each season.

A surprising clinical observation is that vitamin B-12 deficiency is often associated with stress incontinence. Vitamin B-12 deficiency is more likely to develop as one ages, because a certain protein called "intrinsic factor" diminishes with age. If intrinsic factor is absent, vitamin B-12 supplements are needed, and are absorbed better from a sublingual (under-the-tongue) tablet.

The same stomach cells that make intrinsic factor make stomach acid, so inefficient digestion often results from lack of stomach acid. Incomplete digestion increases the risk of food allergy or intolerance, which in turn may increase the risk of stress incontinence. Stomach acid can also be replaced using capsules of betaine hydrochloride.

The muscles that hold urine in the bladder can be strengthened just as any other muscle. The exercise that builds up these muscles (and indeed all the pelvic muscles) is called Kegel exercise and consists simply of deliberately stopping the urine stream several times during each voiding. You can do the exercise several times a day, and a few months of such exercises may work wonders.

Some medications, especially antidepressants, can aggravate this problem, and you should consult your physician if you suspect this. Your physician would also be able to prescribe one of the new drugs that allow your bladder to hold more urine without leakage, though there may be some side effects.

Your children will cost you even more than the embarrassment of a leaky bladder, but they are indeed worth it all. I hope their other cost is no more than doing without caffeine, checking for allergies and incorporating some exercises into your life.