Management of Stress Urinary Incontinence with Electroacupuncture

Management of Stress Urinary Incontinence with Electroacupuncture
Urinary incontinence is the loss of bladder control which results in involuntary urine leakage. This can be embarrassing for patients, cause physical discomfort due to the development of rashes from the urine, and negatively impact the patient’s quality of life. Traditional treatment options are available, but the results may be limited. Therefore, some patients turn to complementary treatment options such as electroacupuncture.

There are different types of urinary incontinence, such as stress urinary incontinence, urgency incontinence, and overactive bladder. The causes and treatments of these vary. Urgency incontinence and overactive bladder are associated with spasms of the bladder muscle, which lead to a sudden, unpredictable need to urinate quickly. Stress urinary incontinence is different and occurs when movement or activity (such as coughing, laughing, sneezing, running, or heavy lifting) puts pressure on the bladder, causing urine to leak. Stress urinary incontinence is abbreviated as SUI and is named as such due to the physical stress (pressure) placed on the bladder. SUI is not caused by mental or emotional stress. SUI can be caused by weakening the pelvic floor muscles, the bladder muscle, and the valve-like sphincter muscle that holds the urine in the bladder.

SUI is much more common in women than in men. The prevalence in the United States is approximately 25%. Childbirth, especially vaginal childbirth for females, prostate surgery for males, illnesses with a chronic cough, obesity, and advancing age, can increase one’s risk for SUI.

Treatment options for SUI may include pelvic floor exercises, hydration, bladder training, weight loss, treatment of a chronic cough, devices, and surgery. There are no FDA-approved prescription medications available for SUI. Some patients become frustrated with the lack of results using behavioral therapy treatments but prefer not to resort to device implantations or surgery. A good option for these patients with SUI to consider is electroacupuncture.

How does electroacupuncture in the lower back (lumbar-sacral region) help treat SUI?
Electroacupuncture uses the same technique as acupuncture, inserting fine needles into the body’s acupuncture points. However, in electroacupuncture, a controlled low-frequency electrical impulse is applied to the fine needles, which stimulates the nerves, promotes blood circulation, and triggers the release of endorphins and other natural pain-relieving chemicals in the body. The nerves in the lumbar and sacral region of the lower back control the bladder and pelvic muscles. “Electroacupuncture involving the lumbosacral region could cause muscle contraction and simulate pelvic floor muscle training.” Electroacupuncture may “facilitate the reinnervation and strengthening of pelvic floor muscles, improving symptoms of SUI.” For studies to evaluate the effectiveness of electroacupuncture, sham acupuncture is used as the control group to try to eliminate the placebo effect. Sham acupuncture is a placebo procedure that mimics real acupuncture but does not stimulate the targeted nerves.

What does the medical literature show?
The following study is a randomized clinical trial of 482 women with stress urinary incontinence ages 40 – 75 years enrolled at multiple centers. The trial compared electroacupuncture to sham acupuncture, with participants receiving 18 sessions involving the lumbosacral region over six weeks. The results showed that those women who received electroacupuncture treatment had reduced urine leakage, with approximately 2/3 of the women having a decrease in leakage of 50% or more. The effects persisted 24 weeks after treatment. The “results of this study demonstrated that electroacupuncture had a clinically meaningful benefit in decreasing urine leakage in women with SUI.”

Effect of Electroacupuncture on Urinary Leakage Among Women With Stress Urinary Incontinence: A Randomized Clinical Trial | Complementary and Alternative Medicine | JAMA | JAMA Network
Liu Z, Liu Y, Xu H, et al. Effect of Electroacupuncture on Urinary Leakage Among Women With Stress Urinary Incontinence: A Randomized Clinical Trial. JAMA. 2017;317(24):2493–2501. doi:10.1001/jama.2017.7220

The following article is a systematic review of 15 articles that concluded that electroacupuncture was effective for stress urinary incontinence.
Is electroacupuncture safe and effective for the treatment of stress urinary incontinence in women? A systematic review and meta-analysis - PMC (nih.gov)
Lai X, Zhang J, Chen J, Lai C, Huang C. Is electroacupuncture safe and effective for the treatment of stress urinary incontinence in women? A systematic review and meta-analysis. J Int Med Res. 2020 Oct;48(10):300060520948337. doi: 10.1177/0300060520948337. PMID: 33045874; PMCID: PMC7570783.

Patients with SUI should not suffer embarrassment, social isolation, or physical discomfort. Patients with symptoms of urinary incontinence need to be evaluated by a healthcare provider to diagnose the type(s) of urinary incontinence so that the best treatment options, including electroacupuncture, can be considered to improve the quality of life.