Overactive Bladders and Sleep

Overactive bladder (OAB) is a condition in which the bladder cannot hold urine normally. One of the most common symptoms of this health problem is urinary incontinence or leaking urine. Many people suffer in silence, but if you are currently experiencing a bladder-related difficulty you are truly not alone. It’s estimated that at least 33 million Americans have overactive bladder. (1)

Under Construction

Sometimes a person experiencing overactive bladder doesn’t have any underlying health problem. Other times, an overactive bladder can be the result of medications or other more serious health issues, such as diabetes, kidney disease, multiple sclerosis (MS) or Parkinson’s disease. (2) OAB can also occur after surgery or childbirth. How much is too much when it comes to urination? People with OAB typically have to urinate more than 8 times per day or more than once at night. (3)

It’s crucial to address overactive bladder symptoms right away. Early treatment can reduce, or even completely get rid of, the highly unwanted symptoms. (4) With some time and effort, there are several very doable and natural ways you can overcome an overactive bladder.

What Is an Overactive Bladder? Symptoms to Look For

Overactive bladder is a syndrome, or a set of symptoms, that is believed to be due to sudden contractions of the muscles in the wall of the bladder. (5) When you have overactive bladder syndrome, the muscles controlling bladder function start acting involuntarily. This often leads to urinary incontinence or loss of bladder control. The urine leakage experienced by someone with OAB can be as little as several drops to up to several ounces. Sometimes, incontinence can be a sign of something simple like drinking way too many caffeinated beverages on a daily basis. Other times the underlying cause can be something more serious.

An overactive bladder is said to account for 40 to 70 percent of incontinence. (6) What is incontinence? Incontinence is a lack of voluntary control over urination or defecation. When you have overactive bladder, you can experience urinary incontinence or loss of control over urination.

There are actually two different types of overactive bladder. “Dry” is when you have a sudden, urgent need to urinate many times during the day. “Wet” means you have the sudden, urgent need to urinate and you experience bladder leakage, which is also referred to as urge incontinence. Both “dry” and “wet” can occur without any underlying health condition. (7) An estimated 60 percent of OAB patients have dry OAB (no leakage) while 40 percent have wet OAB (urine leakage). (8)

OAB symptoms can differ on an individual case basis. Common symptoms of an overactive bladder include: (9)  an urgent need to urinate  urine leakage frequent trips to the bathroom

These symptoms can be serious life disruptors during the waking and sleeping hours of a person’s life. Having to constantly go to the bathroom, and not knowing when you might have urine leakage, can cause a lot of stress. If you already have overactive bladder, then you know how important it is to be near a bathroom at all times.

You’re probably wondering just how many trips to the bathroom per day is considered normal. An OAB sufferer typically feels the need to urinate eight or more times in a full day or 24 hour period. This urgent need to relieve oneself might even exist when fluid intake is low. (10)

Causes and Risk Factors

Aging

OAB occurs in both men and women. It’s possible to have overactive bladder at any point in your life. But, it’s especially common in older adults. The prevalence of OAB in people younger than 50 years of age is less than 10 percent. After the age of 60, the prevalence increases to 20 to 30 percent.  (11)

The following are some of the other most common underlying causes and risk factors associated with OAB symptoms: (12)

Nerve Damage

A healthy, normal functioning bladder holds urine until it gets full and is prompted to empty by nerve signals. However, when nerve damage occurs in the body, the muscles surrounding the urethra (the tube that takes urine out of your bladder) can be too loose. This undesirable looseness can cause someone to become incontinent. What can cause nerve damage that can then lead to bladder leakage? Some possibilities include:

  • Back or pelvis surgery
  • Diabetes
  • Herniated disc
  • Multiple sclerosis
  • Parkinson’s disease
  • Radiation
  • Stroke

Weak pelvic muscles

When a man or woman’s pelvic floor muscles are weak, bladder control issues can happen. The pelvic floor muscles are like a sling that holds up the uterus and bladder. For women, a pregnancy and childbirth can often lead to a stretching and weakening of the vital pelvic floor muscles.  When pelvic floor muscles are compromised for this reason or another, the bladder can then sag out of place. The opening of the urethra also stretches and urine easily leaks out.

Menopause

For women, the bladder often changes after the body goes throughmenopause and makes OAB more likely. One theory is that there is a loss of estrogen that makes up bladder tissue. Or, it’s just due to aging or a combination of both.

Extra weight or obesity

Need another reason to aim for a healthy waistline? Carrying around extra pounds is linked to OAB and urine leaks. This makes a lot of sense since excess weight puts more pressure on the bladder.

Diuretic medications

Diuretics or water pills are very commonly prescribed for high blood pressure. These medications cause your body to get rid of water and salt faster through the urine. As a result, this can cause the bladder to fill up faster and possibly leak.

Other causes behind some OAB symptoms include bladder stones, urinary tract infection (UTI), urethral strictures, benign prostatic enlargement (BPH) or bladder tumors. Often, no apparent cause of overactive bladder can be determined. This is called idiopathic overactive bladder. (13)

 

Overactive Bladder vs. Urinary Incontinence

Overactive Bladder

  • Condition in which the bladder can no longer hold urine normally.
  • Often feel a sudden urge to urinate or experience an accident.
  • Defining symptom is urgency, or the inability to postpone urination.
  • OAB is typically a chronic problem
  • Often requires strengthening of pelvic floor muscles to get rid of symptoms like urinary incontinence.
  • Symptoms including urinary incontinence are ongoing.
  • Bladder muscle problems at the root of it.
  • Can result from regularly consuming alcohol and caffeine in large quantities.
  • Serious health conditions can lead to OAB including a stroke, diabetes, kidney disease, multiple sclerosis (MS), or Parkinson’s disease.

Urinary Incontinence

  • Is when you lose control of your bladder.
  • Isn’t a condition; it’s a symptom.
  • Is a symptom of OAB.
  • Can be caused by a loss or weakening of control over the urinary sphincter.
  • Can be a sign of something simple like a singular occasion of too much fluid consumption, a temporary problem.
  • Is a common symptom of a UTI along with a burning sensation during urination and/or blood in the urine.

Conventional Treatment

Conventional treatment typically involves prescription medications, specifically antimuscarinic drugs, that aim to calm the bladder.  The seven common drugs for overactive bladder include: darifenacin (Enablex); fesoterodine (Toviaz); mirabegron (Myrbetriq); oxybutynin (Ditropan XL, a skin patch called Oxytrol, a topical gel called Gelnique, and generic); solifenacin (Vesicare); tolterodine (Detrol and generic, Detrol LA) and trospium (Sanctura, Sanctura XR and generic).

An analysis of these drugs demonstrated that none of these medications are obviously better than the others. What difference did they find? In addition to cost variations, there were also different side effects including constipation, dry mouth, drowsiness, blurry vision and dizziness. Even most conventional doctors will hopefully tell you to try lifestyle modifications before turning to medications. (14)

In more serious cases, a doctor may inject botulinum toxin (BOTOX®) to calm the bladder muscles. Again, this treatment is not without possible and often serious side effects including urinary tract infection, urinary retention (not being able to empty the bladder completely), hematuria (blood in the urine), fatigue and insomnia. (15)

8 Natural Remedies for an Overactive Bladder

1. Kegel Exercises

If a weak pelvic floor is at the root of your OAB then kegel exercises can help a lot. These pelvic floor exercises can be done anywhere at anytime and they benefit both men and women.  When done regularly, they can really help an overactive bladder.

Melody Denson, MD, a board-certified urologist with the Urology Team in Austin, TX, recommends these exercises for OAB. She says, “They will trigger a reflex mechanism to relax the bladder. If you feel a tremendous urge to urinate, doing a kegel before you run to the bathroom will help settle down the bladder spasm and help you hold it until you get there.” (16)

2. Avoid Dietary Triggers

Significantly reduce the following foods and drinks that are known to contribute to overactive bladder: (17)

  • Alcohol
  • Caffeinated beverages and foods
  • Citrus juices and fruits
  • Soda and other carbonated beverages
  • Spicy foods
  • Artificial sweeteners
  • Milk and milk products
  • Sugar and high sugar foods (also don’t overdo it on honey and choose a high quality honey to use)

Caffeine, alcohol and certain medications like diuretics are known to be major causes of acute incontinence, especially in the elderly population. (18) Cranberry juice is surprisingly another thing to avoid if you have OAB. Although cranberry juice is often recommend for bladder health, it actually acts as an irritant if you have OAB. (19)

3. Watch Fluid Intake

It’s essential to drink enough water each day to avoid dehydration. However, if you are drinking too many liquids right before bed, you are more likely to need to empty your bladder. Many OAB sufferers have nocturia, which is the need to urinate several times a night. This is obviously very disruptive to a good night’s sleep. Additionally, a really sound sleeper may not get out of bed fast and can end up unintentionally wetting the bed. To reduce this risk and OAB symptoms at night, it’s recommended to limit fluid intake before bedtime. One suggestions is to not drink any liquids after 5 or 6 p.m. (20)

4.  Double-Void

Another natural way to help with OAB symptoms, especially at night, is to double-void. This means that you urinate not once, but twice before going to bed. Melody Denson, MD (board-certified urologist) recommends, “Go to the bathroom, then brush your teeth and go through the rest of your bedtime routine. Then, just before you’re about to lie down — even if you don’t feel like you have to go — try to urinate and see if you can squeeze out another tablespoon or so.” (21)

5.  Schedule bathroom trips

To help retrain your bladder, you can try keeping a daily dairy of urinary urges and trips to the bathroom, as well as any urine leakage. After you figure out how many times you’re going to the bathroom daily, you can start scheduling your trips, adding on about 15 minutes to the normally expected time. Even if you don’t have to go to the bathroom, stick with the scheduled times. As time passes, you can increase the amount of time that passes between urinations. This is meant to improve bladder control. (22)

6.  Delay Urination

Delaying urination is another part of a typical bladder retraining technique. It may not sound pleasant, but if you can hold out another few minutes after feeling the urge to urinate, you can help retrain your bladder. By gradually increasing the holding time, you can eventually and ideally go at least three to four hours without having to go to the bathroom. At some points, if you find that you really just can’t hold it any longer, use the bathroom (I don’t want you to have a visible accident!), but stick to your next scheduled urination time. (23) Using relaxation techniques, such as deep breathing, can help make the delay time more bearable.

7. Try Acupuncture

A study published in the British Journal of Urology offers another natural treatment option for OAB: acupuncture! The study’s 20 subjects received acupuncture treatment once per week for a total of 10 weeks. Each treatment session was 30 minutes long and targeted acupuncture points SP6, CV4 (RN4) and KI3.  The results of this study were excellent: 77 percent of patients with idiopathic detrusor instability were symptomatically cured. (2425) Idiopathic detrusor instability (IDI) plays a role in OAB because it a common cause of lower urinary tract storage symptoms including urgency, frequency and urge incontinence. (26)

8. Stop Smoking

The reasons to stop smoking cigarettes are basically endless. Here is another. Smoking not only irritates the bladder, it also increases the risk of bladder cancer.  Smoking cigarettes can also lead to coughing spasms that increase problems with stress incontinence. (27) Stress urinary incontinence occurs when the bladder leaks urine during physical activity or exertion including coughing or lifting something heavy. (28) Anyone who smokes and is dealing with overactive bladder should quit smoking right away.

 

Precautions and Proper Diagnosis

The main symptoms of OAB can also occur in other health conditions like bladder cancer, urinary tract infection (UTI) and enlarged prostate. Seeing blood in your urine is not a symptom of OAB. (29)

A sudden and frequent need to urinate is common in both OAB and a UTI. How can you tell the difference between these two urinary health issues? Unlike OAB, a UTI also comes with other symptoms such as discomfort while urinating. In addition, OAB symptoms are continuous while UTI symptoms are sudden and may also include a fever. (30)

Overflow incontinence is characterized by the involuntary release of urine from an overfull urinary bladder, often in the absence of any urge to urinate. This condition is not associated with OAB. It typically occurs in people who have a blockage of the bladder outlet, which can occur with benign prostatic hyperplasia, prostate cancer or a narrowing of the urethra. Overflow incontinence can also occur when the muscle responsible for removing urine from the bladder is too weak to empty the bladder in a normal way. (31)

It is very important to see a doctor to ensure a proper diagnosis if you experience any changes in your urine and/or urination habits.

Stop overactive bladder with arctic angelica

If you have an overactive bladder and need to go to the bathroom several times a day or night, it gets tiring in more ways than one. Or, worse yet, if you deal with enuresis (bed-wetting) because of a weak and leaking bladder, you feel frustrated and embarrassed.

But you are not alone. About 17 percent of women and 16 percent of men over the age of 18 have overactive bladder issues. As we age, an overactive bladder becomes common — affecting one in five adults over the age of 40.1

Urinary incontinence, whether due to chronic bladder irritation, bladder weakness, bacteria or prostate enlargement (technically known as benign prostatic hyperplasia, or “BPH”), which causes urgency and urinary frequency, affects at least 25 million Americans. Most of the sufferers are women, but one-third of women andmen 30 to 70 years old have experienced some symptoms of urinary incontinence.1

And while bed-wetting is often associated with children, there are some adults who, because of their overactive or weak bladders, have never experienced a dry night.

Conventional prescription approaches aren’t always effective, cause side effects and can be risky as well. Of course, in many cases, even natural approaches dealing with bladder health and incontinence are divided between men and women. However, clinically tested Angelica archangelica can offer a true ray of hope for both.

Angelica archangelica contains a number of important compounds, including isoquercitrin and other flavonoids, polyphenols and polysaccharides. It is these compounds that are considered to be responsible for the plant’s many amazing effects.2-6

An important thing to note is that Angelica archangelica grows in Iceland — it is not the same as Chinese angelica (Angelica sinensis), also known as dong quai.

This 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 — basically an overactive bladder at night — used Iceland’s Angelica archangelica or a 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.2 Not surprisingly, in Iceland, angelica extract has become the number one herbal treatment to reduce urinary frequency in men, and has replaced saw palmetto berry as the treatment of choice.

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, and the low energy and grogginess the next day.

During this study, three main parameters were measured: the increase in bladder volume, reduction in nocturnal voids and the increase in the duration of the first sleep period. The results were excellent.

In the group with low bladder capacity, those taking the Angelica archangelica extract saw an increase of over 300 percent in bladder capacity.2

In the group reporting more than three nighttime urinations, the arctic angelica extract enhanced sleep and significantly reduced nighttime bathroom visits.2

In the group of men age 70 or older, the angelica extract increased the duration of uninterrupted sleep (measured by time to first awakening) by 280 percent — almost three times that of a placebo!

What’s interesting about this study is that the direct action of Iceland’s arctic Angelica archangelica was not on the prostate, but on improving bladder strength. That’s good news for anyone — men or women. Plus, the angelica extract was very well tolerated and showed no hormonal effects or unwanted side effects like increased blood pressure or heart rate, or reduced libido. That’s a definite difference from many prescription drugs.

Imagine a day without needing to search for a restroom and a night filled with restful sleep. It can happen. That’s why this clinically studied angelica extract is the perfect choice. It provides strong results, no side effects, and peace of body and mind for men and women.

Sources: 1. “Urge Incontinence/Overactive Bladder”, from National Association for Continence. Available at: http://nafc.org/media/statistics/urge-incontinence-and-oab/. Accessed: March 25, 2013.

2. Sigurdsson S, Geirsson G, Gudmundsdottir H, Egilsdottir PB, Gudbjarnason S. A parallel, randomized, double-blind, placebo-controlled study to investigate the effect of a proprietary Angelica archangelica extract on nocturia in men. Scand J Urol. 2013 Feb;47(1):26-32.

3. Sigurdsson S, Gudbjarnason S. Inhibition of acetylcholinesterase by extracts and constituents from Angelica archangelica and Geranium sylvaticum. Z Naturforsch C. 2007 Sep-Oct;62(9-10):689-93.

4. Sigurdsson S, Ogmundsdottir HM, Gudbjarnason S. Antiproliferative effect of Angelica archangelica fruits. Z Naturforsch C. 2004 Jul-Aug;59(7-8):523-7.

5. Sigurdsson S, Ogmundsdottir HM, Gudbjarnason S. The cytotoxic effect of two chemotypes of essential oils from the fruits of Angelica archangelica L. Anticancer Res. 2005 May-Jun;25(3B):1877-80.

6. Sigurdsson S, Ogmundsdottir HM, Hallgrimsson J, Gudbjarnason S. Antitumour activity of Angelica archangelica leaf extract. In Vivo. 2005 Jan-Feb;19(1):191-4.

17% women over 18 who have overactive bladders

16% men who have OB

20% adults over the age of 40 who have OB

Urinary incontinence, whether due to chronic bladder irritation, bladder weakness or bacteria, affects at least 25 million Americans. Most sufferers are women. One-third of women and men 30 to 70 years old experience symptoms of urinary incontinence.

Brain Of The Future
Will Learn In Seconds Any Skill That Normally Takes Years And…

The natural approach to treatment involves the clinically tested Icelandic herb, Angelica archangelica. This Angelica archangelica is not the same as Chinese angelica (Angelica sinensis), also known as dong quai.

Angelica archangelica contains a number of important compounds, including flavonoids such as isoquercitrin, polyphenols and polysaccharides, that are responsible for the plant’s effects.

The angelica extract taken from the leaf of the plant was tested in an eight-week, randomized, doubleblind, placebo-controlled study reported in the Scandinavian Journal of Urology; subjects suffering from nocturia—basically an overactive bladder at night—used Iceland’s Angelica archangelica, or a placebo. The subjects were aged 45 and older, which is when both sexes begin noticing urinary frequency.

Of course, one of the biggest problems with nocturia isn’t just the inconvenience of having to go to the bathroom; it’s the disruption of sleep, and the low energy and grogginess the next day.

There are a few things that are measured when researchers test those dealing with nocturia, including nocturnal urinary output and capacity. Bladder capacity decreases with age, and the bladder tissue gets weaker. This not only makes people feel a “need to go” but also makes them more prone to accidental “leaks” before they can find a bathroom or while they sleep.

During this study, three main parameters were measured: increase in bladder volume; reduction in nocturnal voids; increase in the duration of the first sleep period.

In the group with low bladder capacity, those taking the Angelica archangelica extract saw an increase of more than 300 percent in capacity. In the group reporting more than three nighttime urinations, the Arctic angelica extract enhanced sleep and significantly reduced nighttime bathroom visits.

Interestingly, among those men aged 70, it increased the duration of uninterrupted sleep (measured by time to first awakening) by 280 percent—almost three times that of placebo.

The direct action of Iceland’s Arctic Angelica archangelica improves bladder strength and reduces bladder nerve irritation, and is therefore appropriate for both sexes. The isoquercitrin content in Iceland’s Arctic angelica may be partly responsible for its effectiveness. Isoquercitrin can inhibit the activity of leukotrienes in the bladder and urethra that stimulate cell receptors, triggering overactive bladder contractions. The result is less urinary urgency and greater bladder capacity.

References“Urge Incontinence/Overactive Bladder”, from National Association for Continence. Available at: http://wwwnafc.org/media/statistics/urge-incontinence-and-oab/. Accessed: March 25, 2013. Sigurdsson S, Geirsson G, Gudmundsdottir H, Egilsdottir PB, Gudbjarnason S. A parallel, randomized, double-blind, placebo-controlled study to investigate the effect of SagaPro on nocturia in men. Scand J Urol. 2013 Feb;47(1):26-32. Sigurdsson S, Gudbjarnason S. Inhibition of acetylcholinesterase by extracts and constituents from Angelica archangelica and Geranium sylvaticum. Z Naturforsch C. 2007 Sep-Oct;62(9-10):689-93. Sigurdsson S, Ogmundsdottir HM, Gudbjarnason S. Antiproliferative effect of Angelica archangelica fruits. Z Naturforsch C. 2004 Jul-Aug;59(7-8):523-7. Sigurdsson S, Ogmundsdottir HM, Gudbjarnason S. The cytotoxic effect of two chemotypes of essential oils from the fruits of Angelica archangelica L. Anticancer Res. 2005 May-Jun;25(3B):1877-80. Sigurdsson S, Ogmundsdottir HM, Hallgrimsson J, Gudbjarnason S. Antitumour activity of Angelica archangelica leaf extract. In Vivo. 2005 Jan-Feb;19(1):191-4.Disclosure in accordance with the Federal Trade Commission regulation 16 CFR, Part 255: this post is sponsored by an advertiser.

Scand J Urol. 2013 Feb; 47(1): 26–32. 
Published online 2012 Jul 2. doi:  10.3109/00365599.2012.695390
PMCID: PMC3549610

A parallel, randomized, double-blind, placebo-controlled study to investigate the effect of SagaPro on nocturia in men

Abstract

Objective.

This study aimed to investigate the effect of SagaPro, a product derived from Angelica archangelica leaf, on nocturia.

Material and methods.

Sixty-nine male patients 45 years or older with at least two nocturnal voids were randomized to receive SagaPro or placebo in a double-blind design for 8 weeks. Voiding diaries were assessed before and after the treatment.

Results.

The results indicate that SagaPro is safe. The actual number of nocturnal voids (ANV), nocturnal polyuria index (NPi) and nocturnal bladder capacity index (NBC index) decreased in the test population, but there was no significant difference between the treatment groups. Subsequent subgroup analysis showed that SagaPro significantly reduced the NBC index and nocturnal voids per sleeping hour in comparison to the placebo in participants with baseline NBC index above 1.3. When participants with sleep disorders were excluded from this group, ANV was also significantly reduced for the SagaPro group in comparison to the placebo group.

Conclusion.

SagaPro, made from an extract of the medicinal herb Angelica archangelica, is safe. This study did not show that SagaPro improved nocturia overall compared to placebo. Subgroup analysis suggested a beneficial effect in individuals with decreased nocturnal bladder capacity, which warrants further study.

Keywords: angelica archangelica, nocturia, nocturnal bladder capacity index (NBC index), nocturnal polyuria index (NPi), SagaPro.

Introduction

Nocturia is defined as the need to wake from sleep one or more times to void [1]. Having at least two voids per night is associated with impaired health-related quality of life [2]. The prevalence of nocturia increases with increasing age in both men and women. The bothersomeness of nocturia is largely due to the fact that it interferes with the quality of sleep, which may have a significant negative impact on how the individual feels the next day. Nocturia may affect not only nocturics, but also their partners, whose sleep may also be affected [3]. For patients who are aged 60–70 years, the prevalence of nocturia is between 11% and 50%; for those aged 80 years, the prevalence is between 80% and 90%, with about 30% experiencing two or more episodes nightly [4].

Important factors relating to nocturia include benign prostate enlargement and overactive bladder, diabetes mellitus, heart failure, renal failure, peripheral oedema, nephrotic syndrome, hyperproteinaemia and liver diseases [5]. The main causes of nocturia are global polyuria, nocturnal polyuria, decreased bladder capacity and sleep disorders [5]. Among the parameters used to assess the contribution of factors underlying nocturia are nocturnal polyuria index (NPi) and nocturnal bladder capacity (NBC) index [6]. The NPi is usually calculated by dividing the nocturnal urinary volume output by the total urinary output and thus a high NPi indicates increased nocturnal urine production. An NPi of 0.35 normally reflects nocturnal polyuria [6], although the limit may be lower or 0.2 for young people [7]. The NBC index is calculated from the actual number of nightly voids, nocturnal urine volume (nightly voided volume plus the first morning voided volume) and the functional bladder capacity. A high NBC index, which reflects reduced nocturnal bladder capacity, has been found to be more prevalent among Asian men suffering from nocturia than their Caucasian counterparts [8]. An NBC index of 1.3 has recently been suggested as a cut-off point above which reduced nocturnal bladder capacity should be investigated as a cause of nocturia [9].

SagaPro is a phytochemical product from Angelica archangelica leaf that has been used in Iceland for 6 years in the treatment of nocturia. The herb A. archangelica has been used both in folk medicine and as a vegetable. Extensive research has shown that A. archangelica contains several important bioactive compounds, including flavonoids and other polyphenols, terpenes, coumarins and polysaccharides, with various biological effects [10–12]. The roots, fruits and leaves of the herb have been used in folk medicine, and it is one of the most respected medicinal herbs in Nordic countries, where it was cultivated during the Middle Ages [13,14] and exported to other parts of Europe [15]. A water extract from A. archangelica leaf, as is SagaPro, has been found to have antitumour activity in vivo [16]. Among the many bioactive phytochemicals present in SagaPro is isoquercitrin (unpublished results), which could conceivably play a role in the effect of SagaPro on nocturia experienced by the users. Isoquercitrin is a flavonoid that influences the activity of leukotriene LTD4. Leukotrienes (LT) are compounds which are derived from arachidonic acid (20:4n-6) in smooth-muscle cells in the bladder and cause contractions by stimulating receptors. LTD4 also causes contraction in coronary arteries, pulmonary arteries and subcutaneous arterioles. Isoquercitrin inhibits the activity of leukotrienes (LTD4), either by inhibiting the production of LTD4 or by inhibiting binding to receptors in smooth-muscle cells in the bladder [17–19].

The purpose of this study was to examine the safety of SagaPro and its therapeutic effect on nocturia.

In conclusion, SagaPro, made from an extract of the medicinal herb Angelica archangelica, is safe. This study did not show that SagaPro improved nocturia overall compared to placebo. Subgroup analysis suggested a beneficial effect in individuals with decreased nocturnal bladder capacity, which warrants further study.

Acknowledgements

The study was supported by the Technology Development Fund of the Icelandic Research Council. The study was managed and monitored by Encode Clinic, Iceland.

Declaration of interest: Steinthor Sigurdsson, Perla B. Egilsdottir and Sigmundur Gudbjarnason are employed by SagaMedica, the producer of SagaPro.

References

[1] Staskin D, Kelleher C, Avery K, Bosch R, Cotterill N, Coyne K, et al. Initial assessment of urinary and faecal incontinence in adult male and female patients. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence. 4th ed. Plymouth: Health Publications; 2009. 
[2] Tikkinen KA, Johnson TM, Tammela TL, Sintonen H, Haukka J, Huhtala H, et al. Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland. Eur Urol. 2010;57:488–96.  [PubMed]
[3] Chartier-Kastler E, Tubaro A. The measurement of nocturia and its impact on quality of sleep and quality of life in LUTS/BPH. Eur Urol Suppl. 2006;5:3–11.
[4] Weiss JP, Blaivas JG. Nocturia. J Urol. 2000;163:5–12.  [PubMed]
[5] Udo Y, Nakao M, Honjo H, Ukimura O, Kawauchi A, Kitakoji H, et al. Analysis of nocturia with 24-h urine volume, nocturnal urine volume, nocturnal bladder capacity and length of sleep duration: concept for effective treatment modality. BJU Int. 2011;107:791–8.  [PubMed]
[6] Weiss JP, Blaivas JG, Stember DS, Chaikin DC. Evaluation of the etiology of nocturia in men: the nocturia and nocturnal bladder capacity indices. Neurourol Urodyn. 1999;18:559–65.  [PubMed]
[7] Walmsley K, Staskin DR. Nocturia: when is it not related to overactive bladder? Curr Urol Rep. 2003;4:441–5.  [PubMed]
[8] Mariappan P, Turner KJ, Sothilingam S, Rajan P, Sundram M, Stewart LH. Nocturia, nocturia indices and variables from frequency–volume charts are significantly different in Asian and Caucasian men with lower urinary tract symptoms: a prospective comparison study. BJU Int. 2007;100:332–6.  [PubMed]
[9] Burton C, Weiss JP, Parsons M, Blaivas JG, Coats AC. Reference values for the nocturnal bladder capacity index. Neurourol Urodyn. 2011;30:52–7.  [PubMed]
[10] Sigurdsson S, Ogmundsdottir HM, Gudbjarnason S. Antiproliferative effect of Angelica archangelicafruits. Z Naturforsch C. 2004;59:523–7.  [PubMed]
[11] Sigurdsson S, Ogmundsdottir HM, Gudbjarnason S. The cytotoxic effect of two chemotypes of essential oils from the fruits of Angelica archangelica L. Anticancer Res. 2005;25:1877–80.  [PubMed]
[12] Härmälä P, Vuorela H, Törnquist K, Hiltunen R. Choice of solvent in the extraction of Angelica archangelica roots with reference to calcium blocking activity. Planta Med. 1992;58:176–83.  [PubMed]
[13] Halldórsson B.  Grasnytjar. Copenhagen: August Friedrich Stein; 1783. 
[14] Bjarnason AH.  Íslensk flóra með litmyndum. Reykjavík: Iðunn; 1983. 
[15] Newall CA, Anderson LA, Phillipson JD.  Herbal medicines – a guide for health-care professionals.London: Pharmaceutical Press; 1996. 
[16] Sigurdsson S, Ogmundsdottir HM, Hallgrimsson J, Gudbjarnason S. Antitumour activity of Angelica archangelica leaf extract. In Vivo. 2005;19:191–4.  [PubMed]
[17] Piper PJ. Leukotrienes: possible mediators in bronchial asthma. Eur J Respir Dis Suppl. 1983;129:45–64.  [PubMed]
[18] Bjorling DE, Saban MR, Bruskewitz RC, Saban R. Response of the isolated guinea pig bladder to exogenous and endogenous leukotrienes. J Urol. 1994;152:1281–6.  [PubMed]
[19] Yoshimura N, Chancellor MB. Interstitial cystitis and bladder research: progress and future directions: highlights of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the Interstitial Cystitis Association (ICA) International Research Symposium October 19–20, 2000, Minneapolis, MN. Rev Urol. 2001;3:146–51. [PMC free article]  [PubMed]
[20] Scheuermaier K, Meyers M, Surprise M, Loughlin KR, Duffy JF. Reciprocal relationship between age-related sleep disruption and urological symptoms. BJU Int. 2011;107:871–3. [PMC free article][PubMed]

SagaPro is a proprietary, aqueous extract of Angelica archangelica leaves, sustainably harvested from wild plants grown in the pure air and soil of Iceland. SagaPro is ideal for men and women looking to support bladder strength and urinary tract function.*

Saga Pro - For Urinary Frequency - Angelica Leaf

Item: 858002002092
Shipping Info (Below)

 

Are you being woken up continuously throughout the night to urinate? Have you experienced an enuresis accident? Stay in bed longer and sleep more peacefully with the help of Angelica, a natural herb which grows wild in the pure air and soil of Iceland. The Angelica leaf extract (Angelica archangelica) used in Saga Pro’s tablets help relieve symptoms of frequent nighttime urination so you can enjoy a deeper sleep getting the rest you deserve.
Info:  30 Tablets
Price/ea:

Reg Price: $29.99 

  Qty:

 

Category: FOR YOUR BODY > Men’s Health
Product Notes:Cultivated from the Angelica plant native to Iceland, this natural plant extract reduces the symptoms of an overactive bladder or an enlarged prostate.NPN: 80046093.
Ingredients:

 

Each tablet contains:
100 mg Angelica (Angelica archangelica) leaf extract (5:1).

Non-medicinal ingredients: Dicalcium phosphate, potato starch, corn starch, silicon dioxide, talc, povidone, hypromellose, magnesium stearate, glycerol.

Suggested usage:

Adult men: take two tablets daily before bedtime. Store in a cool, dry area.

Warnings: Keep out of reach of children. Consult a healthcare practitioner prior to use if have a peptic ulcer, and to exclude a diagnosis of prostate cancer, or after use if symptoms persist or worsen. Avoid prolonged exposure to sunlight, ultraviolet light, or UV therapy.

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