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Urinary Incontinence

Incontinence: Bladder Control Problems

Many things can cause bladder control problems, or “urinary incontinence,” including an overactive bladder muscle, urinary tract infection, constipation, delirium, heart disease, diabetes, dementia, medication side effects, and difficulty getting to the toilet in time. Urinary incontinence can lead to problems such as falls, depression, and isolation.

Urinary incontinence may be caused by conditions of bladder or conditions outside the bladder.  In most cast incontinence can be cured or greatly improved with treatment.

The following are some common types of incontinence:

Incontinence due to medical conditions outside the bladder

  • Delirium/confusional state
  • Atrophic urethritis/vaginitis
  • Pharmaceuticals
  • Psychological, for example depression
  • Excessive urine output, for example hyperglycemia
  • Restricted mobility

Incontinence due to easily treatable medical conditions

  • Stool impaction
  • Urinary Infection

Established Urinary Incontinence

  • Urinary Incontinence due to Involuntary Bladder Contraction (detrusor overactivity): This disorder accounts for two-thirds of geriatric incontinence in both sexes, regardless of whether patients are demented.
  • Stress Incontinence: This disorder, the second most common cause of established incontinence in older women.
  • Urethral Obstruction: This disorder rarely presents in women. In men urethral obstruction is often due to prostatic enlargement, urethral stricture, bladder neck contracture, or prostate cancer. It is the second most common cause of established incontinence in older men.
  • Detrusor Underactivity: Whether idiopathic or due to sacral lower motor nerve dysfunction, this is the least common cause of incontinence.

Clinical Reasoning When Considering Acupuncture and Chinese Herbal Medicine

  • According to Acupuncture: review and analysis of reports on controlled clinical trials by World Health Organization 2002 female urethral syndrome, chronic prostatitis, recurrent lower urinary-tract infection, urolithiasis are conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed. When urinary incontinence presents in patients with those conditions, they are good candidates for acupuncture treatment.
  • For urinary incontinence due to outside bladder causes, the treatments for the underlying medical conditions should be given promptly. When pharmaceuticals are suspected as the causes of incontinence, adjustment of medications by the prescribing physicians is the most effective way to correct the problem. However when medications adjustment is not practical, acupuncture or herbal treatment may be given based on patients’ TCM patterns.
  • For urinary incontinence due to constipations and urinary infections, acupuncture and Chinese herbal treatments can be given to improve the bowel movement and help urinary infections.
  • For established incontinence due to urethral obstruction, surgical operation is often necessary. Acupuncture and herbs can be given postoperatively to promote the recovery.
  • Acupuncture and herbal medicine treatments provide certain releases for patients with established urinary incontinence due to involuntary bladder contraction and stress.
  • General behavioral techniques (bladder training, scheduled toilet trips, fluid and diet management) and pelvic floor muscle exercise should be recommended.
  • According to Chinese medicine theory two organs are primarily responsible for the urinary incontinence: Spleen and Kidney, particularly the Kidney. Commonly classified patterns include Kidney Qi deficiency and Spleen Qi deficiency.

Neutraceutical supplements and dietary modifications are also emphasized.

  • Cranberries product for controlling the symptoms of UTI and improve the incontinence related to the urinary infection.
  • Pumpkin Seed Extract for Overactive Bladder and Urinary Incontinence
  • Magnesium supplement reduces symptoms of urge incontinence 2.
  • Saw Palmetto Product: The suggested dosage of saw palmetto for urinary incontinence caused by prostate problems is 160 mg 2 times per day (National Center for Complementary and Alternative Medicine or NCCAM).
  • Increased risk of overactive bladder from higher carbonated drink intake, and lower risk with increased consumption of vegetables, bread and chicken.3 Risk of stress incontinence in women has been linked with higher intake of carbonated drinks and fat, and lower consumption of bread.4,5
  • Foods that are believed to help urinary incontinence according to TCM dietary therapy theory, including: Gorgon fruit, guava, dry plum, lotus seeds, hawthorn fruits, cherry, lamb, shrimp, chives, ginko nuts,  walnuts, and Chinese dates.

The effects of acupuncture and Chinese herbal medicines on urinary incontinence depends very much on the underlying causes of the problem. For patients with  female urethral syndrome, chronic prostatitis, recurrent lower urinary-tract infection, and urolithiasis, treatments of acupuncture and Chinese herbs are able to improve the symptoms effectively.  Acupuncture and herbal medicine treatments provide certain releases for patients with established urinary incontinence due to involuntary bladder contraction and stress although according to a recent review the effect of acupuncture for stress urinary incontinence for adults is uncertain and there is not enough evidence to determine whether acupuncture is more effective than drug treatment 6 .  Please contact Dr. Xie at 847-630-8798 for further information.

Reference:

  1. Clinical Observation of 65 Cases of Elderly Incontinence Treated with Bu Zhong Yi Qi Tang, Hu Bei Journal of TCM, No. 4, 2006
  2. Boschert S. Milk of magnesia may help ease urinary urge incontinence. Fam Pract News 2003; 33:46.
  3. Dallosso HM, McGrother CW, Matthews RJ, et al. The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women. BJU Int 2003; 92:69-77.
  4. Dallosso H, Matthews R, McGrother C, Donaldson M. Diet as a risk factor for the development of stress urinary incontinence: a longitudinal study in women. Eur J Clin Nutr 2004;58:920-6.
  5. Dallosso HM, McGrother CW, Matthews RJ, et al. The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women. BJU Int2003;92:69-77.
  6. Wang Y, Zhishun L, Peng W, Zhao J, Liu B. Acupuncture for stress urinary incontinence in adults, Cochrane Database Syst Rev. 2013 Jul 1;7:CD009408. doi: 10.1002/14651858.CD009408.pub2.