Ask an expert - body - genitals / urology - urinary incontinence

Ask an expert - body - genitals / urology - urinary incontinence (6)

Thursday, 16 April 2015 00:00

Can acupuncture help with an irritable bladder?

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Q: I have seen a urologist who says i have an  irritable bladder.   Can acupuncture help with symptoms of frequency?

A: We have been asked this question a few times over the past two years, and one of the answers we gave to a similar question was:

Can acupuncture alleviate symptoms of an irritable bladder?

Q:  I have been diagnosed with an irritable bladder. Can acupuncture alleviate my symptoms, which is an urgent need to urinate.

 A: As our factsheet shows 

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/urinary-incontinence.html

there is some evidence to suggest that urgency of urination can be helped by acupuncture, although there is not yet anywhere near enough evidence to make substantive claims here. If you search the internet there are a number of studies such as this one

http://www.ncbi.nlm.nih.gov/pubmed/15994629

which offer some hope.

However, we have to remind ourselves sometimes that Chinese medicine has been dealing with problems like this for over 2000 years, and has a very sophisticated process for understanding patients' symptoms against a backdrop of an entirely different conceptual framework. The understanding of the body as a system of energy, 'qi', in flow and the concepts of yin and yang to describe its flow and inter-relationships is very alien to the western ear. However, the rather wider understanding of organs as functional units with effects on body mind and spirit, and the underlying premise that symptoms are alarm bells, not the problem itself, can sometimes offer possibilities for understanding a problem in a far wider context. This will often be corroborated by other problems which a patient suffers and by diagnostic signs which the practitioner sees, and can often lead to a situation where a practitioner can tell the patient about symptoms that they haven't yet mentioned. If the problem is a part of a recognised syndrome or pattern of symptoms a practitioner will be able to give a clear idea of prognosis. Even if it doesn't the attempt to re-establish balance in the system can also have an effect on individual symptoms.

We recommend that you talk to a BAcC member local to you an ask for their advice in a brief face to face consultation whether they think that they can help you. We trust that they will give you an honest assessment, and refer you on to other modalities of treatment if they felt that these offered a better prospect of success.

We have had another look at the research evidence which has emerged since we wrote this response, and there are two more papers which make encouraging noises

 http://www.ncbi.nlm.nih.gov/pubmed/25399241

http://www.ncbi.nlm.nih.gov/pubmed/25033919

and evidence of a systematic review about to take place. This is a survey of all papers on the subject which is regarded very highly within conventional medicine since it irons out anomalies in smaller samples.

One of our members has studied this problem for several years and given presentations at our research gatherings and conferences, so we are confident that there is something of importance emerging in the use of traditional acupuncture in this field. However, each individual person is different, however similar their symptoms may be, and the strength of Chinese medicine is that treatment is tailored to the unique needs of the patient, not simply offered as a one size fits all option. Visiting a BAcC member local to you would seem to us to be your best option. Here you will get advice for your own unique presentation.  

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

http://www.ncbi.nlm.nih.gov/pubmed/21092614

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938549/

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: We were asked a question about nocturnal bedwetting some time ago, and answered:

There is some evidence that acupuncture may be of benefit in treating bedwetting in children

http://www.ncbi.nlm.nih.gov/pubmed/15791606

but as is the case with a great deal of the research which is conducted in China, it often falls below the standards required for acceptance in the west. Invariably authors of systematic reviews such as this will make generally encouraging noise about meriting further research, but until and unless major funding is provided for such studies the evidence will remain thin.

However, Chinese medicine has been dealing with problems such as this for over two thousand years, and operates from an entirely different theoretical base in understanding how the body functions. This is expressed in the concept of energy, 'qi', and its balance in and flow around the body, and uses concepts such as 'yin' and 'yang' which we're sure you've come across. There will be a number of ways of understanding the balance of the functional relationships in the body which might explain the symptoms, and the practitioner's skill is used to ensure that the treatment not only resolves the symptom but tries to deal with underlying patterns of imbalance to stop their recurrence.

One note of caution is that although we do not recognise 'experts' in treating particular diseases or patient groups, there is no doubt that children are not simply 'little adults', and the consensus is emerging that some of the diagnostic conclusions and ways of treating are slightly different from the adult versions of the same problems. A growing number of members now seek postgraduate training in paediatric acupuncture, and while we would not say that someone without this training may not be able to help you, we believe that we are fast approaching the point where we say to a prospective patient that we would expect someone who focuses their work on children to have made the effort to undertake further study, be it in the form of a course or a programme of self-study.

Our best advice is to ask a BAcC member local to you whether they or someone they know focuses their work on treating children, and failing that to use 'google' and search under 'acupunture treatment of children' alongside where you live. Many of our members now have their own websites, and usually mention their areas of primary focus (children, pregnancy and fertility, if they have them.

However, most of the research and discussion is about nocturnal wetting, not daytime wetting. In theory, from a Chinese medicine perspective the factors in play would be understood in a similar kind of way. The inability to hold back the flow of water, or to be unconscious of its passing, is evidence of a functional disturbance, and a practitioner will look carefully at the whole system to see what is driving this. The daytime nature does also open up the possibility that there is an emotional component. Here again, acupuncture treatment may be of value, and the standard textbook on the treatment of children with acupuncture lists a number of emotional problems which the authors believe are susceptible to treatment. However, as Clint Eastwood was wont to say in his movies, 'a man has got to know his limitations', and the counselling of children is an expert skill which would not form a normal part of a practitioner's training. The wise practitioner will refer on if they feel this is out of their depth.

Subject to these caveats, though, children, when they respond to treatment, do seem to respond very well, so if one of our members believes that acupuncture may be of benefit, there is some hope that they may well be able to help.

Q:  Please could you recommend an acupuncturist who has experience of percutaneous tibial nerve stimulation to treat stress and urge incontinence in women in the Dorset area. I am enquiring for my mother who lives in Weymouth, Dorset.

A: As our factsheet shows  there is some evidence to suggest that urgency of urination can be helped by acupuncture, although there is not yet anywhere near enough evidence to make substantive claims here. If you search the internet there are a number of studies such as this one

http://ncbi.nlm.nih.gov/pubmed/15994629 which offer some hope

 However, we have to remind ourselves sometimes that Chinese medicine has been dealing with problems like this for over 2000 years, and has a very sophisticated process for understanding patients' symptoms against a backdrop of an entirely different conceptual framework. The understanding of the body as a system of energy, 'qi', in flow and the concepts of yin and yang to describe its flow and inter-relationships is very alien to the western ear. However, the rather wider understanding of organs as functional units with effects on body mind and spirit, and the underlying premise that symptoms are alarm bells, not the problem itself, can sometimes offer possibilities for understanding a problem in a far wider context. This will often be corroborated by other problems which a patient suffers and by diagnostic signs which the practitioner sees, and can often lead to a situation where a practitioner can tell the patient about symptoms that they haven't yet mentioned. If the problem is a part of a recognised syndrome or pattern of symptoms a practitioner will be able to give a clear idea of prognosis. Even if it doesn't the attempt to re-establish balance in the system can also have an effect on individual symptoms.

We recommend that you talk to a BAcC member local to you an ask for their advice in a brief face to face consultation whether they think that they can help you. We trust that they will give you an honest assessment, and refer you on to other modalities of treatment if they felt that these offered a better prospect of success.

We think this still reflects our view. There has been no further research of which we are aware, although there is a study which we did not mention on the last occasion from 1995 which shows encouraging results but is small in number and mainly dealing with men.

The factsheet can be found at:

 

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/urinary-incontinence.html

Q:  I have been diagnosed with an over active bladder. i am taking medication but find i am still having problems. is this something acupuncture is known to help with.

 

A:  As you can imagine, we receive the same questions quite frequently, but with the section now over a year old, some of the answers are more difficult to locate in the archive. The question and answer from last year were:

 

Can acupuncture alleviate symptoms of an irritable bladder?

Q:  I have been diagnosed with an irritable bladder. Can acupuncture alleviate my symptoms, which is an urgent need to urinate.

 

A: As our factsheet shows  there is some evidence to suggest that urgency of urination can be helped by acupuncture, although there is not yet anywhere near enough evidence to make substantive claims here. If you search the internet there are a number of studies such as this one
 
http://www.ncbi.nlm.nih.gov/pubmed/15994629  which offer some hope.
 
However, we have to remind ourselves sometimes that Chinese medicine has been dealing with problems like this for over 2000 years, and has a very sophisticated process for understanding patients' symptoms against a backdrop of an entirely different conceptual framework. The understanding of the body as a system of energy, 'qi', in flow and the concepts of yin and yang to describe its flow and inter-relationships is very alien to the western ear. However, the rather wider understanding of organs as functional units with effects on body mind and spitit, and the underlying premise that symptoms are alarm bells, not the problem itself, can sometimes offer possibilities for understanding a problem in a far wider context. This will often be corroborated by other problems which a patient suffers and by diagnostic signs which the practitioner sees, and can often lead to a situation where a practitioner can tell the patient about symptoms that they haven't yet mentioned. If the problem is a part of a recognised syndrome or pattern of symptoms a practitioner will be able to give a clear idea of prognosis. Even if it doesn't the attempt to re-establish balance in the system can also have an effect on individual symptoms.
 
We recommend that you talk to a BAcC member local to you an ask for their advice in a brief face to face consultation whether they think that they can help you. We trust that they will give you an honest assessment, and refer you on to other modalities of treatment if they felt that these offered a better prospect of success.
 

We think this still reflects our view. There has been no further research of which we are aware, although there is a study which we did not mention on the last occasion from 1995 which shows encouraging results but is small in number and mainly dealing with men.
 

Tuesday, 20 November 2012 12:10

Can acupuncture help stress incontinence?

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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
 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938549/
 
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.  

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