Dealing with an overactive bladder that makes you go to the bathroom several times a day or night, or worse yet, dealing with enuresis (bed-wetting) because of a weak and leaking bladder is possibly one of the most frustrating and embarrassing problems anyone can endure. These are not isolated problems. About 17% of women and 16% of men over the age of 18 have overactive bladder issues. As we age, the overactive bladder becomes more common, affecting one in five adults over the age of 40. For men, the causes of overactive bladder often overlap with symptoms of benign prostate hyperplasia (BPH). Aside from urinary urgency during the day, many men deal with nocturia – a need to go to the bathroom several times a night, which is extremely disruptive to sleep. Of course, nocturia isn’t just limited to men dealing with BPH. The chances increase with age for women, too.

Others deal with daily incontinence. Those who worry that every sneeze or laugh will make them wet their pants are not alone. Urinary incontinence, whether due to chronic bladder irritation, bladder weakness, bacteria, or BPH, affects at least 25 million Americans. Most of the sufferers are women, but one-third of women and men 30 to 70 years old have experienced some symptoms of urinary incontinence.

Conventional prescription approaches bring side effects and risks and aren’t always effective. Of course, in many cases, even natural approaches to dealing with bladder health and incontinence are divided between men and women. However, there is a clinically tested extract of angelica (Angelica archangelica) – the angels’ herb – that is the perfect choice for both.

The angelica I recommend (Angelica arch-angelica) grows in Iceland. It is not the same as Chinese angelica (Angelica sinensis), also known as dong quai. The fruits, leaves, and roots of the plant have been used in folk medicine for centuries, and it was cultivated in the Nordic countries during the Middle Ages. Vikings even used this herb as a form of currency. In fact, banning the theft of angelica was written into some of the earliest law books in Iceland about 1,000 years ago! These days, angelica tea from the leaves and cereal from the seeds are popular foods in Iceland.

More recently, the Islandic angelica has been found to contain several important compounds, including isoquercitrin and other flavonoids, polyphenols, and polysaccharides. It is these compounds that are responsible for the plant’s many beneficial effects. Some scientists believe it is the intense arctic summer with 24 hours of daylight that spur the growth and concentration of nutrients in this herb.

Clinical Results – Stronger Bladder, Better Sleep

Islandic angelica extract is taken from the leaf of the plant and has clinical research to back it up. In an 8-week, randomized, double-blind, placebo-controlled study, men suffering from nocturia – an overactive bladder at night – received angelica leaf extract or placebo. The men in this study were

age 45 and older, which is often when men begin noticing urinary frequency and the first symptoms of BPH. Many times, any urinary frequency issues for men are immediately considered a prostate problem. But that’s not always the case. In fact, overactive bladder is prevalent too and requires a very different approach than we’d use for prostate health. Of course, one of the biggest problems with nocturia isn’t just the fact of having to go to the bathroom; it’s the disruption of sleep, low energy, and grogginess the next day. After a while, the lack of sleep wears down immune resistance, reduces your ability to concentrate, leads to weight gain, and truly hurts your quality of life.

During this study, three main parameters were measured: increase in bladder volume, reduction in nocturnal voids (bathroom trips), and increase in the duration of the first sleep period. The results were excellent. In the subgroup with a bladder capacity of fewer than 260 ml, those taking angelica saw an increase of over 170% in bladder capacity versus the placebo group. In the subgroup with more than 3-bathroom trips during the standardized 8.7-hour night, angelica reduced the trips by up to 48%. And, in the subgroup of men aged 70 or older, angelica increased the first uninterrupted sleep period by 180% vs. the placebo group. This is impressive because the prevalence of nocturia for men aged 70 and older can range from 50% to 80% or more. No wonder so many older individuals only get a few hours of sleep each night. This is hopeful news for several reasons. First, men often don’t seek medical advice for urinary frequency as they may simply figure that it is an unavoidable consequence of getting older. Additionally, there are complications of the prescription drugs to consider. Many of them – whether they are hormone medications themselves or receptor agents that try to balance hormone levels – carry risks and side effects with them. There are also surgical interventions that have many risks and can be unsuccessful. What is especially interesting about this study is that its direct action was not on the prostate, but rather on the bladder. That means it can be beneficial for both men and women. Plus, the angelica extract was very well tolerated and showed no hormonal effects. It also showed no unwanted side effects like increased blood pressure or heart rate, or reduced libido – a definite difference from many prescription drugs. So why does it work? The authors of the study note that the isoquercitrin content in the angelica leaf extract may be at least partly responsible. Isoquercitrin influences the activity of leukotrienes (LTD4) that are derived from arachidonic acid in the smooth muscle cells of the bladder. They cause contractions in the bladder and urethra by stimulating receptors. When this happens, the result is an overactive and potentially leaky bladder and a feeling of “needing to go” throughout the day and night. Isoquercitrin may inhibit the activity of these leukotrienes by either slowing their production or stopping them from binding on the receptor cells that trigger the bladder contractions. The result is less urinary urgency, an ability of the bladder to fill to greater capacity before needing to be emptied, and much more restful, undisturbed sleep.

If you deal with an overactive bladder, BPH, urgency, or frequent trips to the bathroom at night, this angelica extract is a perfect choice. I’d recommend that you start with two capsules per day – one in the morning and once at night – for the first few days, and then drop down to one capsule per day when you start to notice less urgency and better sleep. You’ll be able to tell that it’s working – just count the trips you make to the bathroom.

Michael K Chase, MS, NTP

Nutrition Science and Dietetics