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Wednesday, 22 October 2014 10:17

Acupuncture and bladder incontinence?

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Q: Can acupuncture cure bladder Incontinence where the muscle has been damaged due to radio therapy and the bladder continually leaks?

A: We're not sure how much background information we are missing. The fact that you have had radiotherapy points to surgery of some kind, possibly the bladder or the prostate, and if so the radiotherapy may be the precipitating factor rather than the cause itself.

There isn't a great deal of research which we can point to. Studies like

seem to point in a favourable direction, and when we were asked a similar question last year we replied:

Q: In 2010 I had a T.U.R.P on my prostate and after the operation I had stress incontinence for several weeks. I still have slight leakage now and again e.g. when lifting something heavy. I wondered if acupuncture is used to treat this problem.

A: There is no evidence which we can find of the treatment of post-TURP incontinence with acupuncture. Most research into male incontinence is done on subjects who have had spinal injuries, but the evidence from these is not very conclusive. There are some very useful articles on the problem, such as

but none which make a positive recommendation for treatment. If you google the condition you may find a number of individual practitioners who make claims about treatment in this area, mainly from the USA, but you would be well advised to treat such websites with caution.

Having said that, the use of acupuncture treatment to improve the overall function of the system is one of its purposes. In ancient times patients paid the doctor to keep them well, not to get them better after they had become ill, and the underlying theories of Chinese medicine are about maintaining good health as much as trying to resolve symptoms. It is possible that there have been aspects of the condition itself and of the treatment which you have received which have lowered your system as a whole, and a skilled practitioner might find that there are aspects of your balance which, if corrected, may have consequences for your ability to recover successfully foir what can be quite unpleasant surgery.

We are aware, though, that without a proven evidence base for treating this condition any form of treatment aside from the ones outlined in the article above will involve a certain leap of faith, and as such we would recommend that whatever you might try you draw a very sharp line in the sand about the number of sessions you have before determining whether to carry on, and to set measurable outcomes for your progress. 'Feeing a bit better' is difficult to quantify, and can change very quickly, but recording episodes on a chart is hard evidence.

We recommend that you visit a BAcC member local to you for advice on whether they think acupuncture treatment may be of benefit to you based on a brief face to face assessment

We think this remains the best advice we can give without knowing more about the specifics of your case. We have treated people who have had muscle damage after radiotherapy and it can be a long haul, but each case is unique and different. What we can say with certainty is that it won't do any harm, and may help to alleviate some of the stress that is no doubt accompanying what can be a very distressing symptom. We have found that it has been an aid to recovery, but that is very much what we hope to achieve with traditional acupuncture, a speeding up of natural healing after damage. The limiting factor, though, is the extent of the damage; radiotherapy can be a 'blunt object' kind of treatment, and can sometimes cause irreversible damage in pursuit of a more wide-ranging benefit from the problems it is aimed at eradicating.

A:  There are no hard and fast rules about the frequency of treatment. It is fair to say, however, that clinical practice in China is radically different from that of Western Europe. It would not be at all unusual to have a course of ten treatments daily for a problem like yours, although this would perhaps be more likely immediately after the first tendinopathy developed.

In China, though, acupuncture is an accepted part of the state healthcare system so cost is not an issue, and in any event this is what practitioners have always done. In the UK, where cost is a factor, it is much more usual to have treatment weekly, occasionally bi-weekly if someone has an acute problem which needs more intensive treatment. This does not lessen the efficacy of the treatment; the intention is to trigger and reinstate the body's own healing systems, and this can be achieved just as well over time.

The key thing when a chronic condition is being treated is to set clear outcomes (range of movement, analogue scales of pain experienced, and so on) to determine whether there has been any improvement, and to set regular review periods to assess progress. Most BAcC members tend to use the four or five treatment mark as a point at which to make a judgement about how things are going, and to agree with the patient about continuing rather than just making repeat bookings week after week.

The important thing, if you have already started treatment and have any concerns about treatment, is to discuss them with the practitioner. This avoids any build up of frustration or annoyance if things aren't progressing as well as you would like.

A:We were asked this question a little while ago, and our answer was:

A great deal depends on what is causing the dark circles to appear. Normally we all associate dark circles under the eyes with tiredness, but assuming that this is not the case with your question, there are a number of diagnostic patterns within Chinese medicine for which dark circles might indicate an underlying weakness of energy, or 'qi' as the Chinese call it. Some people's inherited energy, for example, can have been compromised by the health of either parent at conception or by a difficult pregnancy. In these sorts of cases, their management of their life has to be a little more careful, i.e. they may not be able to manage 60 hour working weeks and party all weekend. In some cases the dark circles are a permanent feature.

The key thing to bear in mind is that this will be one symptom or sign amongst a number of others, and treatment would generally be focused on the underlying imbalance. You will see, however, a growing number of websites which promise to do away with dark circles and other signs with facial or cosmetic acupuncture. The BAcC's view is that these procedures are useful when used in the context of a traditional diagnosis and treatment of the whole system. If they are simply applied as one-off symptomatic treatments in many cases whatever gains are made will be lost very rapidly. That is not to say that there may not be cases where this is a sign of local stagnation which acupuncture might help to clear, but in the majority of cases treating the whole system would probably be necessary as well.

We cannot give out referrals to specific members who focus on this kind of work, but it is a relatively straightforward search using google to find a BAcC member in your area who also does facial or cosmetic acupuncture. There are indeed a number of organisations set up by BAcC members as support networks for people doing this kind of work, and they have searchable databases of members who have taken postgraduate training in this area. We recommend that you find someone who is both a BAcC member and trained in cosmetic acupuncture to assess whether treatment may be of benefit to your specific needs.

We think that with the benefit of hindsight we placed too much emphasis on the use of 'facial' or 'cosmetic' acupuncture.' That is not to say that this is not an interesting case of an ancient technique being used to meet modern needs, but there are more cases of darkness under the eye which are the result of a long-standing systemic weakness or simple genetic inheritance than there are case which are going to be fixed by a couple of good nights sleep and a few needles.

We would advise you to visit a BAcC member local to you, not necessarily one who uses cosmetic acupuncture, and see what they can tell you based on a brief face to face assessment.

Q:  I had my first acupuncture session for neck and shoulder pain at an NHS Hospital 4 days ago. I felt  dizzy as hadn't eaten so he stopped after 10 minutes . However,  that afternoon I had a shooting pain a few times in my hand then a few twinges behind my eye.  This has past but I now have a recurring pain in the joints just before my fingernails.  Shall i continue my treatment next week ?

A:  We are sorry to hear of your experience. We are not sure whether the practitioner is a BAcC member - in an NHS hospital this is highly unlikely - but we assume not because it is always one of our basic pieces of advice to a first-time patient to make sure that they have eaten something before treatment. In our experience, not eating can lead to light-headedeness and a possible faint. Although we wouldn't want someone to have treatment immediately after a three course dinner, a normal pattern of eating should be enough to ward off any short term adverse effects.

As far as what you have experienced after the treatment is concerned, you need to look at it from two different perspectives. If the acupuncture was undertaken by a physiotherapist or other conventional healthcare professional, the chances are that they would have been looking for trigger points, knots in the muscle, which when needled tend to relax and relieve some of the tension which causes the pain. Western medical acupuncture can be a little more vigorous than traditional Chinese acupuncture, with larger gauge needles and sometimes repeated insertions. Had the practitioner needled into a nerve you would have been very immediately aware; the feeling is unmistakable. What may have happened, though, is that there has been a small bruise formed at the needle site which has impinged on the nerves travelling through the area. This might account for the reactions you have experienced and are continuing to experience. The fact that the initial symptoms were more severe and have abated suggests that if there was internal bruising it is starting to heal.

From a traditional chinese acupuncture perspective it is possible that the treatment has caused some of the blocked energy in that area of the body to move. If the treatment was administered by a traditional practitioner this will have diagnostic significance and they will pay particular attention to what you have to report. This may also be the unintentional consequence of someone using one system of medicine having an effect only recognised by another. There is a point, for example, used in the treatment of tennis elbow which if over-vigourously needled can reduce someone's blood pressure quite dramatically, although the practitioner working with Western Medical Acupuncture would be unaware of this consequence.

On balance, though, this does sound like a minor physical injury caused by the needling itself, and whether or not you decide to have treatment, it is important that you keep your appointment and describe what has happened in great deal to the practitioner. If as is likely the symptoms have continued to abate you would probably benefit from continued treatment. However, the choice remains yours and if you are not reassured by the explanation or worried by the continuing symptoms you can simply decline the treatment which cannot be undertaken without your consent.

Can acupuncture work for meralgia paresthesia?  I have seen Mike Cummings in the past. Would it be possible to see him again?

A: First things first, Mike, although a long-standing and respected colleague of ours, is not actually a BAcC member. He is the medical director of the British Medical Acupuncture Society, and his contact details can be found by logging on the BMAS homepage and using the find a practitioner function.

The problem you have, meralgia paraesthetica, is not one for which a great deal of research has been conducted. There has been rather helpful systematic review

and a study published last year

which seems to offer considerable encouragement. In all honesty, if your health is otherwise good, Mike is probably the person you need to see, based on the fact that he is known to you and we are sure that he uses the electroacupuncture which this trial seems to find so effective in dealing with the problem.

That is not to say that traditional acupuncture in the hands of a BAcC member is not going to be equally effective! The great strength of traditional Chinese acupuncture is that it looks at the symptoms which the patient brings to us in the round, and while in many cases the symptom is what it is and no more, there are equally many cases where the symptom is a sign that other parts of the system are struggling. Our belief is that if someone simply treats the symptom in these cases it is like turning off an alarm bell because it is uncomfortable. Sooner or later it will ring again or ring louder.

If Mike is unavailable in the short term we would recommend that you contact a BAcC member local to you to have a brief face to face assessment of what acupuncture may be able to offer you. The symptoms you have, although usually the consequence of nerve entrapment, are explained in Chinese medicine as a weakness or blockage in the flow of energy, or 'qi' as it is called, and the use of needles to reinstate the flow has a two thousand year history. There is often a considerable overlap between the two systems, the traditional acupuncture which we use and the medical acupuncture which Mike uses, but it's all the same body so that is not a surprise. The points are often the same one; it is simply the rationale which is different, although we are aware that medical acupuncture would not claim to look at the symptom in its wider context within acupuncture.