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Ask an expert - body - genitals / urology

21 questions

Wednesday, 21 November 2018 14:29

Can acupuncture help an overactive bladder

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Q: I have suffered from an overactive bladder for about 12years. I need to go to the toilet about every hour and every two hours at night. I need to get this problem under control, as I have limited abilities to do as I want. I have had to cancel a holiday as waiting at the airport would have been too stressful not to mention being on the plane and needing the toilet so much. I would value your help as I cannot carry on like this. I am 67 and want to claim my life back if possible. 

A: We have been asked about this on a number of occasions, and a typical answer has been:

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 traditional acupuncture 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.  

This is, as you can see, a 'stacked' answer, two together, and when we receive enquiries which we have answered before we often quote them and look at any more recent developments. There is nothing more to add, with the systematic review still being undertaken.

However, there is a treatment which is not really acupuncture as such caller percutaneous posterior tibial nerve stimulation of which we said in reply to someone else

The technique  is called percutaneous posterior tibial nerve stimulation, about which you can read here:

https://www.nice.org.uk/guidance/ipg362/chapter/1-Guidance


It is not really an acupuncture technique as such, at least it certainly is not a part of the ancient traditional Chinese medicine which we all practise. It is a modern technique using needles as electrodes which, as is often the case in modern developments of acupuncture, is described as working 'by a mechanism which is not yet properly understood.' It may well be that a traditional acupuncturist has decided to add this to their repertoire, but it is not a part of our core training.

This is not something which we would normally offer, but there may be practitioners in your area who do. If all else fails this would be worth a go. Another left field suggestion might be NLP hypnotherapy, a specific form of hypnotherapy of which we have often heard good reports. Where a problem starts to generate itself, i.e. the fear of needing to go can often generate the urge to go, there are a number of ways to try to break the cycle. Western medicine offers one or two drug treatments which suppress the urge to go for a number of hours, but we are not convinced of the safety of using this as a long term strategy. Something like hypnotherapy, which can break the cycle of urge and frequency and give a person some control back, may be an option worth exploring.

Obviously, though, we believe that traditional acupuncture may be well worth a go, and hope that you find some relief from this life-changing situation

Q. Is there any evidence that acupuncture can help with urology problems ie enlarged prostrate.. P s a 7.5 blood reading,am on wait and see for next 6 months advised.

A. There isn't a great deal of research evidence for the treatment of prostate problems, which we find rather surprising given that it is one of the more frequently occurring problems and more recently the most prevalent cancer in men.

There was a systematic review published exactly a year ago

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380320/

which made encouraging noises but as usual said that more and better research was needed. Systematic reviews are the top of the pile in research terms. Because they accumulate the results of several trials they tend to iron our anomalies, and so random excessively good and bad results get evened out. If there is a general report of good results that is good news.

Of course, prostate problems are not a modern invention! That said, there is much about the modern lifestyle which predisposes men to issues in this area. The issues which men have in terms of discomfort, problems with passing water and occasional blood in the water have affected men since time began, and the diagnostic systems of Chinese medicine have ways of looking at the symptoms which are the same whatever the system of medicine in use and placing them within a framework which interprets them as blockages and changes in the flow of energy.

The great strength of Chinese medicine is that if places these disturbances in the context of the overall pattern of energy. This causes what many western physicians find problematic, the same disease being treated in as many different ways as there are patients. This means that the symptoms are seen as alarm bells that the whole system is out of balance, and rather than simply treat what appears to be wrong, Chinese medicine tries to address the underlying causes.

This means that in practice we find it quite difficult to say 'yes it will ' or 'no it won't' without seeing the patient in whom the condition manifests. We are not alone in this; the great Canadian physician William Osler often said 'The good physician treats the disease; the great physician treats the patient who has the disease'. This is, we believe, the way to achieve lasting change.

The best advice we can give, then, is that you visit a BAcC member local to you and see if they can offer you a brief chat about whether they think that acupuncture treatment would be beneficial for you. Most are happy to give up a little time without charge to prospective patients, and it means that someone can make a properly informed choice about what to do.

 

There is no doubt that the treatment which you have already been prescribed, oestrogen in pessary form, has been consistently shown to help prevent recurrent UTIs in post-menopausal women. As such, we would be unlikely to recommend acupuncture treatment as an immediate alternative, but there may be some scope in discussing with your GP what happens if the oestrogen brings the UTIs under control. Using acupuncture alongside the other treatment may improve the overall results and may facilitate a safe withdrawal from long term medication use.

Whenever we receive an enquiry we look through all the research databases to see what, if any, research exists. Most acupuncture research is undertaken in China and not translated, so restricted funding and the problems of assembling suitable cohorts of patients can mean not a great deal exists. However, there are two studies from Bergen in Norway


https://www.ncbi.nlm.nih.gov/pubmed/9612877

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447293/


which showed some very promising results. Both of these are cited on reviews of the treatment of recurrent UTIs, and the following two

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931387/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749018/

are worth a look because they spell out all of the options and are generally very positive about the treatment which you have been recommended to have.

There are obviously ways of treating UTIs from a Chinese medicine perspective; they are not a recent invention! The theoretical basis of Chinese medicine is entirely different, and the manner in which the condition presents will point to specific patterns of imbalance which may be reflected in other systemic problems. It is not often that a symptom stands in isolation, and our basic premise of treating the person, not simply the condition, tries to make sense of a symptom within its overall context. This can sometimes mean treating the overall patterns without specific reference to the individual problems, which can be quite confusing to a patient. However, if it works...!

Our one concern in cases like this is that people often get caught up with treatment regimes which it is quite difficult to unravel. The Trospium and Lansoprazole may not be entirely necessary if the oestrogen takes effect, but a practitioner would not be able to make that call, only the GP who prescribed them. This can make the clinical picture a little more confusing, but a properly trained practitioner will be able to assess the impact of medications on the system and allow for them.

Trospium is often prescribed for an over-active bladder, and if that is one of the manifestations of the UTIs you have been experiencing, there is some good evidence that acupuncture may have be of benefit. These three studies 

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

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

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

all make interesting reading.

However, the best advice that we can give is that you drop in to see a local BAcC member to discuss what may be best for you. Complex presentations are always best advised on face to face, and most of our members are very happy to give up some time without charge to prospective patients to ensure that acupuncture is the best option for their problems. This also gives you a good chance to meet them and see where they work before committing to treatment.

We are sorry to hear that you are experiencing what sound like very unpleasant side-effects from a treatment.

We are not sure from your email what the provenance of your practitioner is. The technique you describe is called percutaneous posterior tibial nerve stimulation, about which you can read here:

https://www.nice.org.uk/guidance/ipg362/chapter/1-Guidance

It is not really an acupuncture technique as such, at least it certainly is not a part of the ancient traditional Chinese medicine which we all practise. It is a modern technique using needles as electrodes which, as is often the case in modern developments of acupuncture, is described as working 'by a mechanism which is not yet properly understood.' It may well be that a traditional acupuncturist has decided to add this to their repertoire, but it is not a part of our core training.

As far as your strange symptoms are concerned, in conventional medicine it might be possible to make a case for some of the local ones, i.e. pain or tingling in the immediate area of the electrodes, because there may have actually been irritation of the nerves or small bruises which have consolidated to generate the symptoms from which you suffer. However, there would be very little that western medicine could do to explain why that should be generating sensations in your left arm and in your head.

From a traditional acupuncture perspective it might just be possible that the stimulation has had an effect on the channels of energy, and there are certainly internal connections between hand, foot and head which might explain what is going on. However, the mystery here would be what was causing the connection to be made several days after the treatment. If there are after effects or adverse effects after treatment they are generally immediate and subside within the first 48 hours. It is rather unusual for something to kick in three or fours days after the event and then to generate something which we call propagated needle sensation at this stage. This kind of effect takes a great deal of work to generate, and it is difficult to see what could be replicating this so long after a session.

Of course, we do have to bear in mind that there are sometimes occasions when a new symptom arises after, but not because of, a treatment. With four million treatments a year this can always be a possibility. The first thing we always advise, and what applies especially in your case, is to seek medical advice to find out exactly what is happening. This may take a referral to a neurologist, but since it sounds like a neurological effect getting advice here may well establish causation, i.e. whether the treatment actually caused what it happening. In an event this will point the way towards making it go away.

It might also be worthwhile talking to the practitioner about what they have done. They will know better than anyone else what points and techniques they have used, and may be able to make sense of what has happened to you.

It may be comforting to be aware that very few serious adverse events take place each year, and where these do happen from acupuncture treatment it is usually from penetration of an organ or direct physical damage. The remainder tend to be short-lived and transient, and we are confident that if this is really an effect of treatment it will subside relatively quickly. 



Q:  I've had a small epididymal cyst (spermatocele) in each testicle for a few years now and while they cause constant mild discomfort I'm hesitant to look into surgical options. I've been checked out by my GP and had diagnostics to rule anything else out.  Do you think acupuncture could be of help and, if so, would it likely just treat the symptoms, ie. the discomfort, or is there any evidence to suggest it could help shrink the cysts themselves?

A:  This is the first time we have been asked about epididymal cysts. We have trawled the research literature for any evidence of research trials but there is nothing of consequence except for a few studies of epididymitis, which isn't close enough to warrant citing. Even acupuncture sites do not offer a great deal. We suspect that there are probably Chinese studies, but only a minute fraction of these are translated each year.

However, from a Chinese medicine perspective all cysts are simply accumulations of fluid which indicate a weakness of flow, either in a specific channel of energy or more systemically in one of the Organs responsible for the free flow of fluids (note the capital letter - Organ in Chinese medicine is not the same as organ in western medicine). If this is the case, then there should be some clear diagnostic signs pointing to the weakness or imbalance, and a practitioner might feel fairly confident that this would point to a potential change.

Even were this not to be so clear cut, Chinese medicine was and remains premised on the simple belief that a system in balance corrects itself, and we have seen many many cases over the years where there has been no clear diagnostic patterns but where problems have been resolved, even sometimes when no-one in conventional medicine knew what they were. Quite disturbing when no-one, western or eastern, can tell you what you used to have, but in then end gone is gone.

However, the danger with treating problems like yours where there isn't a substantial volume of case work to show that it might resolve is that treatment can sometimes extend much longer than is warranted by the returns. It is very useful to have some kind of measurable outcomes, and to review any progress on a regular basis (every four or five sessions) to keep an eye on how much the treatment.

The first step, though, is to see a local BAcC member for a brief informal assessment of what may be possible. Most are more than happy to spare a few moments without charge to see whether there are clear diagnostic signs which would underpin a slightly more precise assessment than we can give at this range.


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