Acupuncture may help reduce urinary incontinence episodes and symptoms in women

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Acupuncture reduced episodes and symptoms of urinary incontinence in women, according to a meta-analysis of 10 clinical studies.

Various forms of acupuncture have significantly reduced episodes of stress urinary incontinence (SUI, PP=0.01 to PP=0.0007). The benefits came from comparisons between acupuncture and sham procedures, pelvic floor muscle training (PFMT), and incontinence medications.

Electroacupuncture for SUI had the strongest supporting evidence, while the benefits of UUI came from single studies of different types of acupuncture and need confirmation in additional studies, reported Priya Kannan, PhD. , from the Polytechnic University of Hong Kong, and Umar M. Bello, PhD, from Glasgow Caledonian University in Scotland, Explore.

“We recommend that future trials evaluating the effectiveness of acupuncture be of high quality, be sufficiently powered, follow the experimental protocol for acupuncture and simulation groups, and adhere to the CONSORT statement in the reports,” the authors concluded.

Acupuncture has found success in treating a variety of chronic conditions, especially conditions that have proven difficult to treat with conventional therapies. In particular, the popularity and acceptance of acupuncture has increased in high-income countries, Kannan and Bello noted.

Acupuncture includes a wide range of therapeutic techniques, some of which have been evaluated in randomized trials for SUI, UUI and mixed incontinence in women, including hand, laser, body and electroacupuncture, continued the authors. There is limited evidence in urinary incontinence for other types of acupuncture, including Saam, auricular, fire needle, scalp, and elongated needle.

Basic research has produced a plausible mechanistic basis acupuncture to treat urinary incontinence. In animal models of overactive bladder, sacral acupuncture reduced symptoms, possibly by inhibiting nociceptive afferent C-fibers. Electroacupuncture reduced the effects on the micturition center of bladder irritation in rats.

According to traditional Chinese medicine theory, urinary incontinence results from a deficiency ‘Qi’ kidneys, Kannan and Bello continued. Acupuncture applied to acupuncture points on the bladder and kidneys regulates Qi to promote recovery of bladder function and improve urinary incontinence.

Previous reviews of acupuncture for urinary incontinence have yielded inconclusive results and required updating to incorporate new studies. Kannan and Bello performed a systematic review and meta-analysis to provide a more contemporary perspective on the use of acupuncture to treat urinary incontinence in women.

Literature searches identified 158 potential publications, which the authors narrowed down to 10 after multiple screenings and reviews.

The meta-analysis included five studies of women with SUI: two moderate quality studies comparing electroacupuncture with sham procedures, two low quality studies comparing electroacupuncture plus PFMT with medication, and one low quality study. quality comparing hand acupuncture to no treatment. Three low-quality individual studies compared body acupuncture, electroacupuncture, and laser acupuncture versus simulation for UUI. One study (both low quality) evaluated body acupuncture versus sham and electroacupuncture versus PFMT for mixed incontinence.

The two moderate-quality SUI studies showed that almost twice as many women had at least a 50% reduction in incontinence episodes with electroacupuncture (RR 1.73, 95% CI 1 ,46-2.04). The two low quality studies showed that more than twice as many women reported complete healing with electroacupuncture plus PFMT ( RR 2.67, 95% CI 1.51-4.71). Outcome assessment of hand acupuncture was similar to no treatment (P=0.77).

For urge incontinence, the body acupuncture study showed a mean reduction of 2.70 incontinence episodes at 4 weeks compared to sham (95% CI -4.86 to – 0.54). Comparing electroacupuncture and sham showed a mean reduction of 2.40 episodes in favor of acupuncture at 6 weeks (95% CI -3.88 to -0.92). Comparing laser acupuncture and sham showed a mean reduction of 3.60 episodes in favor of acupuncture at 3 weeks (95% CI -5.34 to -1.86).

None of the mixed incontinence studies showed a benefit of acupuncture over control.

Guidelines published by the American Urological Association and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction already include an evidence-based treatment for urge incontinence similar to acupuncture: percutaneous tibial nerve stimulation.

“During this therapy, a provider places an acupuncture-like needle behind the ankle,” said Christina Escobar, MD, of NYU Langone Health in New York. MedPage today by email. “A light electrical type simulation is applied to this needle for 30 minutes using a special device. This therapy takes place once a week for 12 weeks. We then usually do a booster session every month if the patient wishes to continue the treatment. There are very few side effects to this therapy and studies show a success of this therapy around 60%.”

Individual patients occasionally seek traditional acupuncture treatment for urinary incontinence and report anecdotal success, she added.

“These therapies are so low risk that if they work for patients, I often encourage them to pursue them as part of our treatment plan,” Escobar said.

  • Charles Bankhead is editor for oncology and also covers urology, dermatology and ophthalmology. He joined MedPage Today in 2007. Follow

Disclosures

The study was supported by Hong Kong Polytechnic University.

The authors reported no relevant relationships with industry.

Escobar disclosed relationships with Medtronic, Axonics and Pfizer.

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