Urinary incontinence affects around 3.5 million people of all ages in the UK (DoH 2000; the Continence Foundation 2000). For many, urinary incontinence severely restricts their routine activities and damages their quality of life and self-esteem. It can be due to several problems, the most common being urge urinary incontinence and stress urinary incontinence.
Around 1.5% of adults in Europe and the USA have urge urinary incontinence (involuntary leakage immediately preceded or accompanied by urgency) (Abrams 2003; Irwin 2006). This is usually due to overactive bladder syndrome (defined as urgency, with or without urge incontinence, and usually with frequency and nocturia) (Abrams 2003). The symptoms of an overactive bladder are thought to be due to involuntary contractions of the detrusor muscle in the bladder wall during the filling phase of the micturition cycle (Andersson 1997). Treatment of urge urinary incontinence usually comprises general and lifestyle measures, bladder retraining and physiotherapy and drug therapy with antimuscarinics. Unwanted effects of antimuscarinic drugs include dry mouth, gastrointestinal disturbances such as constipation, blurred vision, dry eyes, drowsiness, difficulty in micturition, palpitations, skin reactions such as dry skin and rash, headache, angioedema, and arrhythmias (Joint Formulary Committee 2009).
About 10-40% of women who have given birth have postpartum stress urinary incontinence (i.e. involuntary leakage of urine with increases in intra-abdominal pressure) (Mørkved 1999; Rortveit 2003). Incontinence continues long term in about 12% of women who have delivered vaginally and about 7% who have delivered by Caesarean section (it affects just under 5% of nulliparous women) (Rortveit 2003). Postpartum stress urinary incontinence is usually treated using physical therapies, including pelvic floor muscle training, with or without biofeedback, weighted vaginal cones and electrical stimulation (DTB 2003).
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How acupuncture can help
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being.
Animal studies have shown that acupuncture treatment may specifically be of benefit in people with urinary incontinence by:
- decreasing the expression of c-Fos in the brain. Induction of stress urinary incontinence in rats has been shown to increase expression of c-Fos (Chung 2008).
- controlling nitrergic neurotransmitters in order to increase nitric oxide levels in bladder tissue, thus relaxing smooth muscle and allowing increased bladder capacity (Chen 2006).
There are systematic reviews for acupuncture in two particular instances of urinary incontinences: post-stroke (Thomas 2008) and bed-wetting in children (Bower 2005). Both reported consistently positive results but the poor quality of the component trials allowed only tentative conclusions. A general review found acupuncture to be the only CAM therapy with evidence of benefit, albeit at a preliminary level (Hartmann 2009). Individual trials for a variety of types of urinary incontinence (urge, stress, diabetic, post-hysterectomy, post-stroke) have largely positive outcomes across a range of acupuncture interventions and control groups (Engberg 2009; Tang 2009; Kim 2008; Tian 2007; Yi 2008; Liu 2008; Yun 2007: see Table overleaf). Acupuncture may be most useful when given in addition to appropriate exercise regimes, but larger and better designed trials are needed to fully elucidate its effects for people with urinary incontinence.