Butterbur

Recently I had a phone call from a friend who was experiencing bladder control problems. Her sudden and frequent urinary urges and occasional leaking was causing concern and embarrassment at the office and at social gatherings.

I explained that women suffer from incontinence twice as often as men. For most it is just a sporadic problem that occurs when coughing, sneezing, or laughing. For others, it is a significant issue that interferes with lifestyle.

Bladder Fundamentals

Ordinarily neurons in the brain and in the smooth muscle of the bladder involuntarily influence the detrusor muscle that surrounds the bladder. This muscle contracts and relaxes depending on the volume of urine in the bladder. The need to urinate usually starts when the bladder is about half full and the time of urination can then be voluntarily controlled unless the bladder becomes too full. Incontinence happens when the smooth muscle of the bladder contracts without warning. Also, as we age, bladder size is reduced producing decreased bladder volume and a need for more frequent urination.

To help relieve my friend’s frequent urge to urinate, I suggested using butterbur (Petasites hybridus), a herb commonly recommended for migraine headaches that is now being used to support healthy bladder control. Butterbur works by relaxing the detrusor muscle, reducing pressure on the bladder. Women, whose urination intervals were every 30 to 90 minutes, given butterbur for eight weeks, reported a significant reduction in urinary frequency to intervals of between 90 and 150 minutes.

Modern Uses for an Ancient Herb

For hundreds of years the leaves and rhizomes of butterbur were traditionally used to treat upper respiratory disorders such as whooping cough, bronchitis, and asthma and to relieve pain, cramps, and spasms of the digestive tract. It was also used for colic, fever, and as a poultice for wounds and skin ulcerations.

Today we know that the main constituents, petasin and isopetasin, are responsible for its anti-spasmodic and anti-inflammatory actions. These actions suggest that butterbur may be beneficial, not only for bladder control, but also for liver or gastrointestinal disorders associated with muscle spasm, obstruction of bile flow, menstrual cramps, ulcers, and kidney stones. In addition, a 1993 German study found that butterbur extract blocked the damaging effects of alcohol on the stomach and helped reduce intestinal ulcerations caused by an anti-inflammatory prescription medication used to treat arthritis.

Antihistamines, used for seasonal allergic rhinitis, or hay fever, are not always effective for nasal congestion and can cause drowsiness. In 2002 the results of a randomized, controlled trial involving butterbur and a popular antihistamine were published in the British Medical Journal showing that butterbur was well tolerated and did not have the sedative effects generally associated with antihistamines, and that butterbur extract was just as effective in treating the symptoms of seasonal allergies.

A Polish clinical study in 1998 found that butterbur may be useful in improving lung ventilation in patients suffering from bronchial asthma or chronic obstructive bronchitis, with no reports of adverse reactions. The results showed a decrease in the number, duration, and severity of asthma attacks, and more than 40 percent of the participants taking prescription asthma medication with butterbur extract reduced the amount of medication by the end of the study.

Dosage and Safety

Butterbur naturally contains unsaturated pyrrolizidine alkaloids (PA) that may cause liver damage and are suspected of being carcinogenic. The good news is that most commercial butterbur extracts have been processed to remove these potentially unsafe compounds. Check the label to make sure the extract is PA-free. Butterbur appears to be safe with no known side effects or interactions with prescription or over-the-counter anti-inflammatory medications. However, it is not recommended for use during pregnancy and lactation.

The extract is typically standardized to contain a minimum of 7.5 mg of petasin and isopetasin. The suggested adult dosage is 50 to 100 mg twice daily with meals.

As for my friend with the bladder control problem, after taking butterbur extract for four weeks, doing regular Kegel exercises to strengthen the pelvic floor, and cutting down on caffeine, she could sit through hour-long meetings at the office without the sudden and uncontrollable need to excuse herself.