Alexa Fleckenstein M.D.

As a physician I sometimes make observations that strike me as plausible – but I don’t have the wherewithal or time to scientifically check on them. Writing a blog might be one method to test an idea, and find out if others made similar observations. So, here is my first one, pertaining to urge incontinence. Wikipedia defines urge incontinence as “involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate.” What really happens is the patient makes it to the stall but then goes before she has a chance to pull down her pants. Or she hears water tinkling, and tinkles herself. The two other forms of urinary incontinence are stress incontinence and overflow incontinence. Stress incontinence comes from weak pelvic floor muscles – when you sneeze or run or laugh, you suddenly can’t hold your urine. Overflow incontinence is a constant dribbling of urine – as if the faucet can’t be shut off. All three forms are common in people of a certain age – therefore the hilarious TV ads for adult diapers. But according to my patients, incontinence is no laughing matter. People thus afflicted (women are in the majority here, probably because of what childbirth can do to one’s organs) are on the constant lookout for the nearest restroom. The interesting part of Wikipedia’s definition of urge incontinence is “for no apparent reason.” Urge incontinence has been linked to stroke, Alzheimer’s, spina bifida, multiple sclerosis (MS), Parkinson’s – they all can lead to urge incontinence. All are neurogenic causes (stemming from the brain and the nerves) – we lump them in one group, but still they are poorly understood. And then there is “idiopathic” urge incontinence. Idiopathic means: Doctors have no clue at all. But they think it has to do with local inflammation around the bladder. Years ago a patient with urge incontinence told me that she could make the urge disappear (at least long enough to make it to the bathroom), if she stretched her neck. For a while I was not sure if any sudden distraction – like clapping your hands or hopping up and down – would do the same. But lately I returned to my first hypothesis, namely that the stretching of the neck works best. Because I have observed that the condition occurs more often in people with less than stellar posture, especially the ones whose head is slightly bent most of the time. Standing tall and erect, at least for a moment, seems to release the urge. As for the mechanism – are certain spinal nerve fibers pinched when the head is bent? We need more research on that. Poor posture is more common in people with gluten intolerance and food allergies – it seems as if they don’t have the muscular strength to keep their heads straight on their shoulders – perhaps on the basis of poorly functioning mitochondria (this is all speculation on my part; I would be happily disproved). If urge incontinence is your problem, try this out – nod a bit, stretch your neck - and write me if it works for you! Perhaps one day a peer-reviewed study will be done.