|Vinpocetine Adds a New Capability
Vinpocetine Helps with Urinary Incontinence|
Compound from periwinkle shows promise for
being able to banish embarrassing leaks
By Will Block
ou’re an attractive, unattached lady of a certain age, and you’re at a party, where you meet a handsome gentleman who seems … interested. Your heart skips a beat as you imagine what could happen if things go well. After some friendly chit-chat, you and Prince Charming find a quiet corner where you can sit and talk. He finally gets around to saying, “So, tell me about yourself.”
About the last thing you would say, unless you wanted PC to beat the world speed record in heading for the door, is, “Oh, there’s not much to tell, really, other than my problem with urinary incontinence—you know, involuntary leakage—but I heard about this new remedy recently, and …” (Whoosh!)
Why Are Women Most Affected?
It may seem unchivalrous to choose a woman as the subject of that story, but it reflects a simple truth: urinary incontinence afflicts far more women than men. That’s because a woman’s … uh … well, if we have to explain it to you, you really need to get out more often. Actually, though, justice eventually prevails when, by age 85, the incidence of incontinence is the same in men and women, the men having caught up owing mainly to their inevitable prostate problems.
With age, there is a gradual decline in bladder capacity and contractility, and uninhibited bladder contractions become more prevalent. There is an increase in the volume of residual urine left in the bladder after urination, which contributes to the frequency with which one has to go. Although these factors do not cause incontinence, they facilitate its occurrence from factors that can cause it, such as urinary tract inflammations or infections, alcohol or drug abuse, psychiatric disorders, and pharmaceutical side effects.
There Are Different Kinds of Incontinence
Leakage can also be caused by sneezing, coughing, laughing, lifting, etc. The sudden surge in pressure on the bladder overpowers the urinary sphincter’s ability to hold the fluid back, and the result can be anything from a dribble to a gusher. This is called stress incontinence. The problem is basically a mechanical one; it can be treated with exercises, certain drugs, or, as a last resort, surgery. The main objective is to stimulate and strengthen the urinary sphincter and the pelvic muscles so the pressure surge can be resisted.
The most common kind of incontinence, however, is urge incontinence, in which an abrupt, intense urge to urinate cannot be suppressed long enough to get to the bathroom. The leading cause of these “accidents” is overactivity (involuntary contractions) of the muscular coat of the bladder, called the detrusor. If the urinary sphincter is too weak to resist the pressure caused by these contractions, the urine will leak, sometimes copiously. The main therapeutic objective here is to relax the detrusor so the pressure surges don’t occur in the first place.
Careful Evaluation Is Necessary
Because the causes and characteristics of stress incontinence and urge incontinence are different, medical experts emphasize the need for careful patient evaluation to be able to find the best treatment. This often entails the patient’s keeping a detailed event log for several days so the doctor can match the symptoms to the probable cause. Doing so is all the more important because there are other, less common types of incontinence that can further muddy the diagnostic and therapeutic waters.
The patient’s disease states may be important too. For example, diabetes is known to double the risk for severe urinary incontinence in postmenopausal women. This should provide an added incentive to lose weight, which can potentially improve both diabetes and incontinence.
Don’t Let Embarrassment Stall Treatment
Urinary incontinence is understandably embarrassing—no one wants to talk about it, and certainly no one wants to hear about it. (The most tactful response would be a probably disingenuous “Really? What a coincidence! Me too!” Then you’d have to compare notes.) Many victims feel so humiliated that they avoid telling even their doctors. That’s foolish, because doctors are there to help patients, not judge them, and any doctor could tell you that incontinence is common in older folks (about one in three) and can often be treated successfully.
Treatment options include: Kegel exercises for strengthening the perineal muscles (“down there”—these exercises are good for improving sexual function too); exercise in general to maintain physical fitness; good diet, including avoidance of caffeine; behavioral adjustments, such as a disciplined bathroom schedule; drugs or supplements that have proven to be beneficial; and surgery.
Nutritional supplements are appealing, for all the usual reasons: low cost, high safety, few or no side effects, and good efficacy, often as evidenced by a very long history of use in folk medicine. One such supplement, recently discovered to be beneficial for urge incontinence, is vinpocetine (vin-PAW-seh-teen). This remarkable compound is known principally as a potent cognitive enhancer with both neuroprotective and cardioprotective effects, but it also helps to prevent and relieve certain disorders of vision and hearing.* It’s extracted from the seeds of the periwinkle (Vinca minor), a perennial shrub indigenous to central and southern Europe, with light blue to violet flowers. Periwinkle has been valued as a medicinal plant for at least two millennia.
In modern times, vinpocetine came to prominence as the principal active ingredient in a cognitive-function-enhancing drug called Cavinton, which was introduced in clinical practice in Hungary in 1978. Since then, vinpocetine has become one of the most successful compounds of the Hungarian pharmaceutical industry, both as a medicine and as a valuable research tool. It has become a widely accepted reference standard in pharmacological research pertaining to cognitive deficits in various dementias and in biochemical studies of the actions of cyclic nucleotides, which are key compounds in the regulation of many important metabolic processes.
Vinpocetine’s Five Modes of Action
There has been much research on vinpocetine’s physiological actions, which fall into five categories:
- Selective enhancement of cerebral circulation and oxygen utilization (without significantly affecting these functions throughout the rest of the body).
- Significant increase in the brain’s tolerance of hypoxia (impaired oxygen supply), a condition that can contribute to dementia.
- An anticonvulsant effect, which might prove useful in the treatment of epilepsy (see the sidebar).
- Inhibition of phosphodiesterase-1 (PDE-1), which is one of a large family of enzymes, the phosphodiesterases, that play vital roles in various biological processes, especially the regulation of smooth-muscle tone.
- Improvement of the flow properties of blood by making red blood cells more deformable, and inhibition of platelet aggregation, which can lead to blood clots.
Vinpocetine for Epilepsy
Of the many things that can trigger an episode of urinary incontinence, one is particularly dramatic: an epileptic seizure, which is a sudden, temporary disruption in the usually well organized flow of electrical signals within the brain. The chaotic signals manifest themselves in various ways, including disturbed sensations, uncontrollable jerking motions, and loss of consciousness. Such seizures look frightening but are usually harmless, as long as the victim is protected from accidental self-injury until the episode ends, usually in less than 2 minutes.
In a recent study, Mexican researchers used a chemical compound, 4-aminopyridine (4-AP), to induce epileptic attacks artificially in guinea pigs. They found that vinpocetine could prevent some of the neurological disruptions associated with the convulsive seizures, as indicated by EEG (electroencephalogram) readings. In addition, they were able to show that vinpocetine prevented the substantial hearing loss induced by 4-AP. The authors concluded, “Vinpocetine could be a promising alternative for the treatment of epilepsy.”
- Sitges M, Nekrassov V. Vinpocetine prevents 4-aminopyridine-induced changes in the EEG, the auditory brainstem responses, and hearing. Clin Neurophysiol 2004;115:2711-7.
Vinpocetine—Viagra for the Brain
Because vinpocetine is a cerebral vasodilator (a compound that causes cerebral arteries to expand, thereby lowering blood pressure and increasing blood flow), it can be thought of as “Viagra for the brain.” There’s actually a sound scientific basis for that analogy, because vinpocetine and Viagra (sildenafil) have similar biochemical mechanisms of action—but in different parts of the body, for the most part. Sildenafil works its magic by inhibiting PDE-5, and in so doing it has achieved pharmacological superstardom—a hard act to follow. Vinpocetine inhibits PDE-1, an action that does nothing for the genitals but is nothing to sneeze at.
Because the roles played by the various PDEs assume different relative importances in different bodily organs, drugs or supplements that selectively inhibit the actions of one PDE but not the rest (as sildenafil and vinpocetine do) allow some degree of organ specificity in treating various disorders. As it turns out, such specificity occurs in the bladder, where the effects of PDE-1 prevail over those of its chemical cousins. This gives vinpocetine a good shot at helping to alleviate urinary urge incontinence—which it does.
Vinpocetine Helps with Incontinence in Worst-Case Scenario
Standard drug therapies for urinary incontinence are plagued by high failure rates and a spectrum of unpleasant side effects. A study by German scientists indicates that vinpocetine may be effective even when standard prescription drugs have failed. Although the study was admittedly small and preliminary, its positive results are encouraging, because they fit the expectations for vinpocetine based on what we know about the neuromuscular problem underlying urge incontinence.
The results were all the more encouraging because they were obtained on a “worst-case scenario” group of 19 test subjects (10 women and 9 men, average age 56) whose condition was so poor that they failed to respond to standard drug treatments and had all been recommended for surgery to correct their problem.
This study was their last chance before surgery—and for 11 of them (58%), it paid off. Treatment with vinpocetine (5 mg/day for 2 weeks, then 10 mg/day for another 2 weeks) produced a marked improvement in eight subjects, and a slight improvement in three; the other eight subjects did not respond to the treatment.
Don’t Despair—Take Action!
If you are afflicted with urinary incontinence, or someone near and dear to you is, don’t despair! You have a lot of company (even though you may never know who they are), and your healthcare provider can help you find a suitable treatment that may solve your problem. Talk to him or her about vinpocetine and how it might help you.
You probably worked hard to get where you are today, and you deserve to be able to go about your life unencumbered by the fear of embarrassing accidents. With the right kind of help, you may be able to stop the leaks and be confident enough to go to parties again. Who knows whom you might meet …
- Beers MH, Jones TV, Berkwits M, Kaplan JL, Porter R, eds. The Merck Manual of Health and Aging. Merck Research Laboratories, Whitehouse Station, NJ, 2004.
- Hampel C, Gillitzer R, Pahernik S, Melchior SW, Thüroff JW. Drug therapy of female urinary incontinence. Urologe [A] 2005;44:244-55.[In German]
- Rizzo M. Diabetes ups incontinence risk for older women. Reuters Health report, July 8, 2005.
- Kiss B, Karpati E. Mechanism of action of vinpocetine. Acta Pharm Hung 1996 Sep;66(5):213-24.[In Hungarian]
- Truss MC, Stief CG, Ückert S, Becker AJ, Schultheiss D, Machtens S, Jonas U. Initial clinical experience with the selective phosphodiesterase-1 isoenzyme inhibitor vinpocetine in the treatment of urge incontinence and low compliance bladder. World J Urol 2000;18:439-43.
Will Block is the publisher and editorial director of Life Enhancement magazine.