Overactive Bladder

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An overactive bladder syndrome occurs when the bladder contracts suddenly without you having control and when the bladder is not full. There is no cause that can be found for the repeated and uncontrolled bladder contractions. Symptoms include sudden urgent desire to pass urine, going to the toilet often (more than 7 times a day), waking to go to the toilet more than once at night, leaking of urine before you can get to the toilet.

Conventional treatments for patients with overactive bladder syndrome are physiotherapy that incudes pelvic floor exercises and oral medications like anticholinergics or beta agonist. Behavior modification measures are limited. Oral medications are effective in 60% of these patients, but there are serious side effects. The side effects outweigh the benefits of the treatment, and can require patients to then undergo surgery.

Here are some top studies about the effectiveness of acupuncture on patients with overactive bladder syndrome.

 

Posterior Tibial Nerve Stimulation:

There are many studies about posterior tibial nerve stimulation for treatment symptoms of overactive bladder, has been published recently.

In 2012, a review of 30 studies of “percutaneous tibial nerve stimulation” demonstrated moderate to marked improvement of bladder symptoms. It reduced the number of urinations per day, episodes of leaking of urine, the number of urinations at night. It also increased the volume of urine. Percutaneous tibial nerve stimulation is a technique that involves insertion of acupuncture needle close to the tibial bone on the leg, which is in fact an acupuncture point Sp 6, innervated by posterior tibial nerve. After the insertion, the nerve is stimulated by an electric current for 30 minutes.

Between 2011 and 2013, in a clinical study conducted by a research team at Whipps Cross University Hospital and University College of London Hospital, acupuncture was proven to be effective and did not show any side effects for controlling overactive bladder syndrome, with the rate of 79% of patients in the study showing clinically significant improvements.

Pudendal Nerve Stimulation for Overactive Bladder.

Pudendal nerve is the major nerve that is responsible for the transmission of sensations (pain, touch, temperature) from the perineum to the spinal cord and supplies motor innervation to the muscles of the pelvic floor. It originates from sacral spinal nerves and enters the perineum through the lesser sciatic foramen to supply the perineal muscles and skin.

The external anal sphincter and the external urethral sphincter which are responsible for voluntary control of defecation and urination respectively are also supplied by the pudendal nerve. His sympathetic fibers play a significant role in ejaculation as well. Therefore, urethral and anal sphincters disturbances and erectile dysfunction can result from pudendal nerve damage.

What is pudendal nerve stimulation?

  • The patient lies prone and about 2 points on either side of buttock muscles and 2 additional points on a lower back are selected.
  • The acupuncture needles are inserted into these areas.
  • The electrodes are then connected to deliver the appropriate stimulation in terms of frequency, intensity and duration based on the type of the ailment being treated.

In a study where 120 females with urinary incontinence (resistant to medication) were treated with either pudendal nerve or transvaginal electrical stimulation, higher percentage of those that had pudendal nerve stimulation recorded complete symptom resolution (42.5% vs. 2.5%) with more than 50% of symptom improvement in the rest. The study therefore, concluded that pudendal nerve stimulation is an effective and better treatment modality for urinary incontinence in females.

 

Sourses:

  1. David R. Staskin et al. Percutaneous Tibial Nerve Stimulation: A Clinically and Cost Effective Addition to the Overactive Bladder Algorithm of Care. Curr Urol Rep. 2012 Oct; 13(5): 327–334. Published online 2012 Aug 15. Link
  2. Li C et al. Acupuncture in the management of overactive bladder syndrome. Link
  3. Siyou Wang, Jianwei Lv, Xiaoming Feng, Tingting Lv. Efficacy of Electrical Pudendal Nerve Stimulation versus Transvaginal Electrical Stimulation in Treating Female Idiopathic Urgency Urinary Incontinence. The Journal Of Urology. June 2017Volume 197, Issue 6, Pages 1496–1501 
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