Acupuncture May Help Reduce Urinary Incontinence Episodes, Symptoms in Women

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

Various forms of acupuncture significantly reduced episodes of stress urinary incontinence (SUI, P<0.00001), episodes and symptoms of urge urinary incontinence (UUI, P=0.01 to P<0.0001), and resulted in higher rates of patient-reported SUI cure (P=0.0007). The benefits came from comparisons of acupuncture with sham procedures, pelvic floor muscle training (PFMT), and medication for incontinence.

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

"We recommend that future trials evaluating the effectiveness of acupuncture be of high quality, be adequately powered, follow experimental protocol for the acupuncture and sham groups, and abide by the CONSORT statement in reporting," the authors concluded.

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

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

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

According to Traditional Chinese Medicine theory, urinary incontinence results from a deficiency in the 'Qi' of the kidneys, Kannan and Bello continued. Acupuncture applied to acupoints on the bladder and kidney regulates Qi to promote recovery of bladder function and improve urinary incontinence.

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

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

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

The two moderate-quality studies of SUI 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 cure with electroacupuncture plus PFMT (RR 2.67, 95% CI 1.51-4.71). The evaluation of hand acupuncture results were similar to no treatment (P=0.77).

With respect to urge incontinence, the study of body acupuncture showed a mean reduction of 2.70 episodes of incontinence at 4 weeks versus sham (95% CI -4.86 to -0.54). The comparison of 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). The comparison of 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).

Neither of the studies of mixed incontinence showed a benefit of acupuncture versus control.

Published guidelines from 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," Christina Escobar, MD, of NYU Langone Health in New York City, told MedPage Today via email. "Mild electrical-like simulation is applied to this needle for 30 minutes using a special device. This therapy takes place once a week for 12 weeks. We usually then do a booster session monthly afterward if the patient would like to continue treatment. There are very few side effects to this therapy and studies show a success of this therapy around 60%."

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

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

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