This is a nice approach to treatment because it trains you to make better use of what you have got. A thorough review of 13 trials involving 714 women found it to be very effective. In another review of 8 clinical trials on this kind of training, it appeared to be more effective than drugs.

We are not so impressed with the drug options available. The two most commonly used are oxybutynin and tolteridone. They work best in people with overactive bladder, but are not as useful in women whose problem is weak musculature. They also they have side effects. The most common is dry mouth, affecting 70% of patients. Other less common problems include constipation, headache, leg swelling and upset stomach.

Another popular therapy is an antidepressant named duloxetine. In a review of 10 studies involving 3944 patients, this drug did not completely cure incontinence, but it decreased the number of incontinent episodes by about 50%. As expected, it also has side effects, including nausea, dizziness, dry mouth and headache.

Another option is surgery to ‘lift’ the bladder. This actually makes sense because sometimes there is a physical reason for the muscles to be weak – particularly from a strain or tear during pregnancy or deliver. Many different surgical approaches have been tried, including vaginal repair and needle repair, but the most effective of these appears to be the old-fashioned one, and it is an open abdominal surgery.

Another widely used and well-researched approach is the use of estrogen. There have actually been 28 trials involving 2926 women supporting its benefit in treating incontinence. We use bio-identical hormone replacement therapy to treat the symptoms of menopause and andropause, and many of our patients report improvements in the bladder department. The safest estrogen is estriol, and it is best to use it topically.

Here is another interesting option – pumpkin seeds. Based on centuries of traditional use, extracts of the seed of Cucurbita pepo are approved for use in irritable bladder syndrome in Germany. In vitro studies have shown that it affects testosterone levels by affecting the aromatase enzyme and by binding to the androgen receptor. Both of these lead to thicker, stronger muscles in that area.

In an open clinical trial, 50 postmenopausal women and symptoms of stress incontinence received a supplement that combined 262mg of pumpkin seed extract and 50mg of soy isoflavones for six weeks. Their incontinence improved dramatically, from 2.08 times per day to 0.67 times per day. This is better than the results seen with any other treatment. Almost ninety percent of the patients reported improvement, and none reported side effects. This is obviously preliminary proof, and a placebo-controlled trial will be needed – if they show similar benefits, pumpkin seeds will beat out any other therapy. Meanwhile, we already have patients using pumpkin seed extract for prostate enlargement and suggest that women try it for themselves.

Finally, keep in mind that sometimes bladder symptoms have nothing to do with the bladder itself, but rather are clues to irritability of the nerves that control bladder function. This can sometimes be an important clue pointing to mercury toxicity or generalized hypersensitivity, or a lesion that can be treated using neural therapy.

Chronic bladder symptoms are common and have a major impact on quality of life. There are many treatments that may be helpful, but it is important to work with a health care professional who is familiar with functional medicine. This is the best way to ensure success.

Cochrane Database Syst Rev 2006;CD005654.

[ii] Cochrane Database Syst Rev 2004;CD001308.

[iii] Cochrane Database Syst Rev 2008;CD004742.

[iv] Cochrane Database Syst Rev 2004;CD003636.

[v] Cochrane Database Syst Rev 2005;CD001405.

[vi] Jpn J Med Pharm Sci 2003;14:313-22.