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Beyond Kegals: How to Work with Herbs if You Have Incontinence and IC




When Kegals Help and When They Don’t

When someone is having problems with bladder control, the first intervention recommended is usually Kegal exercises to strengthen the pelvic floor muscles. A pelvic floor physical therapist can make a big difference to make sure exercises are being done correctly and that progress is being made. While strengthening the pelvic floor muscles is always supportive, it doesn’t always solve the problem, especially if the underlying cause of the incontinence is Interstitial Cystitis (IC).


IC is not always, or even usually, associated with incontinence. But for some people it can be part of the symptom picture. Inflammation and irritation in the urinary tract, especially during a flare, can be the cause of urinary leakage. When this is the case, the most helpful interventions to reduce urinary leakage will be those that reduce bladder inflammation and irritation.


Food Triggers in Incontinence and IC

While food is not always the culprit, I have found that it is essential to rule out whether food is an underlying cause of someone’s bladder inflammation. If someone is consuming foods that inflame the gut, this will cause not only hyperpermeability and immune dysregulation in the gut, but also may cause an inflammatory reaction in the bladder. Identification and removal of foods that cause bladder inflammation and irritation can be a crucial part of solving bladder control issues for some people. Identifying food triggers can be a lengthy and detailed process. To get the best results, I recommend working with a nutritionist who is familiar with Interstitial Cystitis to help guide you.


Herbal Suggestions to Support Gut and Bladder Healing

When food intolerances are suspected, herbs can also play an important role to reduce inflammation and irritation in both the gut and bladder, as well as to support the healing process in both. The mucosal membrane lining of both the gut and bladder is made up of a layer of glycosaminoglycans, a thin layer that serves to protect the tissues that lie beneath it.  


One of my favorite herbs to soothe and heal the mucosal lining of both the gut and the bladder is marshmallow root (Althaea officinalis). The long chain polysaccharides found in marshmallow root are soothing and healing to mucosal membranes. Other herbs which I often incorporate to address both gut and bladder healing are licorice root (Glycyrrhiza glabra), chamomile (Matricaria recutita), gotu kola (Centella asiatica), and meadowsweet (Filipendula ulmaria). L-glutamine is an amino acid that is also extremely useful for building up the glycosaminoglycan layer in both the gut and bladder.


Many of my clients have almost immediate relief with marshmallow root. As we support the underlying causes with other herbs, they experience long term reduction in flares, and the ability to manage their condition with the removal of dietary triggers and use of maintenance herbs.


If you are not already knowledgeable about herbal preparations, dosages, and safety considerations, I highly recommend that you work with an herbal practitioner who can guide you. Some of these herbs have safety considerations, may not be suitable for certain health conditions, or may not be safe in combination with certain medications.


Herbal Suggestions When Pelvic Floor Tension is a Factor

Another reason why Kegal exercises may not be the solution for some people who deal with incontinence, is that the cause of incontinence can actually be tension in the pelvic floor muscles. There can even be a combination of weak muscles and tension. A pelvic floor physical therapist can be helpful to identify if pelvic floor muscles are tense, weak, or a combination of both. For people who have IC, tension in the pelvic floor is a common underlying factor and can contribute not only to the urinary symptoms of pain, urgency, and frequency, but also to incontinence.


For many of my clients with IC, where the condition is tension-based, we use maintenance doses of herbs to keep the muscles relaxed, with acute antispasmodic formulas as needed. This approach tends to reduce flares significantly and greatly improve quality of life.


One of my favorite herbs to help relax muscles and reduce pain in the urinary tract is kava (Piper methysticum). Kava has muscle relaxant activity and is specific for nerve-related pain. It can help to soothe the nerves in the pelvic region, as well as to relax pelvic floor muscles, thereby alleviating bladder pain and irritability. This can be particularly helpful when stress is a known trigger for bladder irritability and pain.


Some other herbs I like to incorporate when tension is an underlying factor for symptoms of IC are black haw (Viburnum prunifolium) and wild yam (Dioscoria villosa) which both have antispasmodic activity that can support muscle relaxation of involuntary smooth muscles. I also find that anti-inflammatory herbs combine well with kava and antispasmodic herbs, so I will incorporate meadowsweet and/or white willow (Salix alba) as well.


Again, if you are not already knowledgeable about how to use these herbs and their safety considerations, I recommend that you work with an herbal practitioner who can guide you.


In Summary

To summarize, people with IC who also deal with incontinence, may benefit from interventions that reduce bladder inflammation and irritation. This often includes identification and removal of food intolerances, as well as incorporation of herbs that soothe and heal the mucosal membrane of both the gut and bladder. Other people who have IC and incontinence may have pelvic floor tension as an underlying cause. In this case, physical therapy and herbs that relax pelvic floor muscles are interventions that can support bladder control.


There are so many herbs that can help people with these conditions. The ones I have mentioned are not always the ones you hear about most commonly, but these are some of the ones I have found most helpful in my clinical practice. Because Incontinence and IC can have multiple underlying causes, and each case is so individual, it can be really helpful to work with a practitioner to guide you in customizing a plan that addresses your unique needs.


If you are interested in learning about my clinical practice, or scheduling an appointment, please see my information below.


About me


My name is Jillian Bar-av and I am a Registered Herbalist and Licensed Nutritionist. I specialize in supporting people who have complex urinary tract conditions, such as Interstitial Cystitis, with a comprehensive holistic approach that helps people to increase their quality of life. I’ve seen how healing herbs can be for the urinary system and how much they can help people to feel well again. Working with herbs is not only deeply healing, but part of my philosophy that it takes healthy people to create a healthy planet, and I want to make a difference for both.


If you are interested in learning about my clinical practice, or scheduling an appointment, you can do that here: https://www.greenspringherbs.com/treatments


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