Acupuncture for Urinary Incontinence
Stress incontinence, also known as stress urinary incontinence (SUI), is a condition where urine involuntarily leaks from the urethra as a reaction from a stressor such as exercise, coughing, laughing, or sneezing. This lack of control can occur without warning and become emotionally distressing.
Incontinence occurs due to weakness or stretching of the muscles involved with urination. The pelvic floor muscles help support the urethra, while the urinary sphincter controls the release of urine.
The elderly population and women who have had two or more children are more likely to experience stress incontinence. Males may experience stress urinary incontinence due to benign prostate hypertrophy or post-prostate surgery, which can weaken the urinary sphincter. Stress urinary incontinence is often a chronic condition.
Some causes of stress urinary incontinence include cystitis, prostatitis, urinary tract infection, pregnancy, diabetes mellitus/insipidus, diuretic medication or beverages (i.e. caffeine, alcohol), hypothyroidism, stress, trauma, multiple sclerosis, irritable bladder, bladder stones/tumors, Parkinson’s disease, post-surgery, and post-menopausal changes in the bladder and urethral wall (Maclean and Lyttleton 2008).
Secondary concerns of stress incontinence are urinary tract infections, breakdown or excoriation of skin due to extended contact of urine on the skin, and lifestyle limitations such as avoiding going into public for long periods of time.
People with stress incontinence may be embarrassed about their condition and isolate themselves. Those with severe stress incontinence can require extra care and supplies such as diapers, extra clothing, and extra bedding.
To assess stress urinary incontinence, a Western medical professional will likely request the patient’s medical history, and perform a physical exam, a urine sample test, and a urinary stress and/or bladder function test. These tests can measure how much urine stays in the bladder after urination and/or bladder pressure.
Western treatment applies several approaches for this condition.
Pelvic floor exercises are often recommended, such as Kegels
Lifestyle changes like limiting drinking of fluids or certain kinds of fluid such as caffeinated or alcoholic beverages
Peri-urethral injections to thicken the outlet of the urethra
Estrogen may be prescribed to thicken the mucosa of the urethra
Surgery: suspension of the bladder neck
Botox, Beta-3 adrenergic catalysts, and anti-cholinergic medication are treatment options but have a high rate of side effects including constipation, dry mouth, and urinary tract infections. This may explain why many people discontinue conventional Western treatments after one year (Peirano 2020).
While some progress can be made, prognosis is generally poor for stress incontinence based on Western medicine. Cleveland Clinic states that stress urinary incontinence tends to last a long time and is typically more chronic than acute.
TCM & Urinary Incontinence
From a Chinese medical standpoint, stress urinary incontinence is treated based on different patterns. Deficiency patterns contributing to stress urinary incontinence include:
Deficiency Patterns
Spleen (and Lung) Qi Deficiency
Kidney Qi/Yang Deficiency
Kidney Yin Deficiency
Excess Patterns
Damp-Heat Pouring Down
Damp-Heat in the Gallbladder
Liver Qi Stagnation
Integrative Medicine: A Study on PTNS and Bladder Dysfunction
Relatively recent studies have investigated stimulation of the tibial nerve as an effective treatment for overactive bladder and related symptoms such as incontinence and nocturia. These studies are finding that tibial nerve stimulation with electro-acupuncture sends impulses up to the nerve roots in the spine to reduce bladder spasms, relax the muscles, and restore bladder function. This form of neuromodulation is known as Percutaneous Tibial Nerve Stimulation (PTNS). The tibial nerve is responsible for innervation of the urinary bladder and sacral plexus at the base of the spine. It controls the bladder and pelvic floor. PTNS stimulates the tibial nerve and sacral plexus, correcting misinformation happening between the brain and the urinary bladder (Peirano 2020).
The tibial nerve travels along the medial side of the leg, along the Spleen and Kidney channels. Acupuncture points that can stimulate the tibial nerve are Ranggu Kid-2, Taixi Kid-3, Shuiquan Kid-5, and Sanyinjiao SP-6. Electrostimulation should be applied with the positive lead on one of the Kidney acupuncture points listed above and the negative lead on Sanyinjiao SP-6 to a depth about 1-2 cun deep. Amplitude of the electrical current should be increased until flexion of the big toe or fanning of the toes occurs; the amplitude can be turned down slightly after this effect is achieved. Discomfort or a buzzing sensation near the needle site can indicate that the needle is not deep enough. Also, if the electrical stimulation is too uncomfortable, the needle may be too close to the PTN (the acupuncture points are close by, but directly not on the PTN) (Peirano 2020).
PTNS treatment is recommended in 30-minute sessions 1-3 times weekly, for at least 6-12 weeks. While this may require time, consistency, and commitment, PTNS is overall shown to increase quality of life and decrease amount of urinary leakage and frequency. (Peirano 2020). This therapy is less invasive than surgery and is associated with minimal side effects as compared to prescription drugs or surgery.
A 13-week double-blind randomized control trial conducted by Peters et Al. involved 220 participants with overactive bladder symptoms such as frequency, nocturia, urgency and incontinence. Frequency Voiding Charts (FVC), Global Response Assessments (GRA) and Quality of Life assessments (QoL) were used to measure the trial outcomes. The Global Response Assessments consisted of a 7-point scale based on the individual's perception of changes. Treatment was considered successful when an individual reported moderate improvement in their GRA.
At the end of the 13-week study, participants in the PTNS group reported 54.5% moderated or marked improvements compared to 21% in the sham electroacupuncture group. Frequency Voiding Charts (FVC) showed significant improvements in urinary frequency, nocturia, voiding with moderate/severe urgency, and/or incontinence in the PTNS group than compared to the sham group (Peters et Al. 2010). This study showed PTNS treatment can significantly improve urinary symptoms as compared to sham therapy.
In conclusion, stress urinary incontinence treatment can be individually tailored to the patient based on their Chinese medical patterns and enhanced by incorporating PTNS therapy. Chinese medicine and PTNS offer less invasive treatment options than conventional treatments for those suffering from stress urinary incontinence and other urinary disorders.
If you suffer from urinary incontinence, please consider working with an acupuncturist. I offer acupuncture on Maui as well as herbal wellness consultations online. Book a free 15-minute consultation to see how I can best help you on your path to optimal health and wellness.
Sincerely,
Meghane Hernandez, Maui Acupuncturist and Herbalist
Bibliography
Cleveland Clinic Medical. (n.d.). Incontinence: Leakage, causes, diagnosis, treatment &
Prevention. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17596-urinary-incontinence#outlook-prognosis
de Wall, L., & Heesakkers, J. (2017, January 1). Effectiveness of percutaneous tibial nerve
stimulation in the treatment of overactive bladder syndrome. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565382/
HealthCMI. (2017, August). Acupuncture beats drugs for urinary incontinence. NCCAOM.
https://www.nccaom.org/wp-content/uploads/pdf/Acupuncture Beats Drugs For Urinary Incontinence.pdf
Maclean, W., & Lyttleton, J. (2000). Clinical Handbook of Internal Medicine (1st ed.). Redwing
Book Co.
Mayo Foundation for Medical Education and Research. (2024, February 14). Stress
incontinence. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/stress-
incontinence/diagnosis-treatment/drc-20355732
Peirano, K. (2020, February 17). Acupuncture effectively treats overactive bladder, incontinence
and urinary leakage without surgery, medications or side effects with dr Kim Peirano lac
san rafael ca. Lion’s Heart Acupuncture & Wellness. https://www.lionsheartwellness.com/lionsheartblog/acupuncture-effectively-treats-overactive-bladder-without-surgery-medication-or-side-effects
