Dr. Rubman on Natural Solutions for Female Incontinence

It’s an embarrassing and distressing complaint among women, and also a common one. One minute you’re laughing or coughing or sneezing or running, and the next you’re mortified because you just leaked a little urine. Millions of women — in fact, twice as many women as men — suffer from urinary incontinence. A third of new mothers leak urine in the months after childbirth and a recent survey found that 16% of women — and up to 32% of older women — say they have some problems with incontinence.

For some women, urinary incontinence is merely a minor annoyance, but for others, it is so debilitating that they avoid social occasions or physical activities for fear of leakage. I recently spoke with Daily Health News contributing editor Andrew L. Rubman, ND, to learn more about this condition and what women can do about it. He told me that there are many natural solutions for incontinence and most women who seek naturopathic treatment are able to avoid drastic measures like diapers, drugs (which may have multiple side effects) or surgery (which is never risk-free).

You may recall that I recently spoke with Dr. Rubman about incontinence and pelvic-abdominal issues in men (see Daily Health News, January 5, 2009), so we began by reviewing what’s similar and what’s different. As in men, the sacral plexus exerts neurological control over urination, defecation and sexual function in women, but the female version of the story gets more complicated from there. A woman’s urinary tract is structurally different from a man’s, plus we undergo hormonal and physical changes related to pregnancy, childbirth and menopause.


Causes of female incontinence are very broad, ranging from structural issues, to hormonal issues, to bacterial and neurological challenges. However, most of these problems can be helped with natural treatment…

  • Pregnancy and childbirth can weaken the pelvic floor muscles and ligaments that support the bladder, sometimes causing leakage. Forceps deliveries may raise risk, and the more times a woman has given birth, the greater her risk of pelvic weakness in the months and years to come.
  • Hysterectomy may cause shifts in how and where organs sit in the pelvis.
  • Obesity stresses the bladder by putting additional pressure on it, as well as on the pelvic floor.
  • Age and gravity. Physiological changes in digestion that decrease the uptake of ingested calcium and magnesium can result in weakened muscle tone, says Dr. Rubman.
  • Misalignment in the sacroiliac joint. The sacroiliac joint, which is located in the lower back between the spine and hip joint, sometimes gets moved out of alignment, often from childbirth. If it doesn’t self-correct over time, this can lead to weakened pelvic muscles and ligaments.
  • Hormonal changes.  Lower estrogen levels following menopause may affect the muscles around the urethra, increasing the risk of leakage.  
  • Urinary tract infections (UTIs). Women are more apt to have urinary tract infections than men. Their shorter urethras make it easier for microbes to ascend into the urinary tract and embed in the lining of the bladder. Dr. Rubman notes that mold and yeast, which often underlie vulnerability to bacterial colonization, thrive in a moist environment, and the resulting inflammation and infection encourage leakage.
  • Antibiotic treatment or poor diet. Antibiotics, which are often prescribed to women for UTIs, suppress the good bacteria right along with the bad. This can lead to fungal overgrowth and Candida infection at the urethral opening in the vulva. Eating too many processed foods and simple carbohydrates likewise can facilitate inflammation and microbial overgrowth.
  • Irritable bowel syndrome. Inflammation in one area — for example, the bowel — can cause inflammation in another, Dr. Rubman explains. The physical proximity of these outlets also means that chronic microbial overgrowth in the bowel can potentially infiltrate the bladder.
  • Fibroids. These benign uterine growths may press on the bladder and cause leakage.
  • Abnormal nerve signals. Involuntary spasms of the bladder can be caused by damage to the nerves of the bladder, spinal cord or brain, typically the result of trauma or Parkinson’s, stroke, MS or brain tumor.


Just as there is no single reason for urinary incontinence, there is no single solution. In his practice, Dr. Rubman prescribes a variety of strategies for his patients…

  • Get tested for yeast and fungal infection. Often doctors make the mistake of only testing for bacteria, then routinely prescribe antibiotics for UTIs, Dr. Rubman told me, and might then miss an underlying problem with yeast, mold and fungi. Dr. Rubman typically orders a specific culture to check for the presence of yeast and fungus. Pending the results, he generally prescribes probiotics such as Lactobacillus and Bifidobacterium to bring microbial colonies back into balance.
  • Strengthen pelvic floor muscles. A Cochrane Database of Systematic Reviews article suggests that pelvic floor muscle training, both in late pregnancy and post-partum, may help prevent and/or treat incontinence related to childbirth.

To perform Kegel exercises: Locate your pelvic muscles by pretending to tighten your vagina around a tampon. Now alternately contract and relax your pelvic muscles, holding the relaxation phase for the same amount of time (about three seconds) as the contraction. Do three or four sets of 10 daily.

  • See a physical therapist. There are physical therapists specially trained in women’s health, who can teach women correct pelvic floor strengthening techniques. Ask your doctor for referral to someone in your area or go to the American Physical Therapy Association Web site at www.apta.org.
  • Maintain a proper weight. A study in the Journal of Urology in 2005 found that losing 5% to 10% of body weight can effectively treat urinary incontinence in women who are overweight or obese. Besides losing weight, other behavioral modifications that can help include quitting smoking, limiting alcohol and caffeine intake, and following an anti-inflammatory diet (high in lean protein such as fish and low in refined carbs and processed foods).
  • Get an adjustment. If a misalignment in your sacroiliac joint is contributing to incontinence, see a chiropractic, osteopathic or naturopathic physician to properly align it.
  • Have a glass of cranberry juice… the unsweetened kind, that is. Cranberry juice helps acidify urine, and contains a compound which makes the urinary tract more slippery. The resulting decrease in friction and reduced pH makes it harder for bacteria and other microorganisms to take hold. Supplements can help too — Dr. Rubman prescribes the freeze-dried extract produced by Eclectic Institute. Note: Some women find cranberry juice irritating to the bladder.
  • Take vitamin C. Like cranberry juice, vitamin C (ascorbic acid) helps acidify the urine. Dr. Rubman often prescribes vitamin C from Bronson Vitamins in doses varying with individual needs (http://www.bronsonvitamins.com).

The important thing to know is that incontinence is a largely treatable condition. See a naturopathic physician who will custom-design a treatment plan, and if necessary coordinate care with your OB/GYN and urologist to bring the problem under control so you no longer have to be embarrassed by it.