Urinary incontinence can be divided in to different categories depending on the cause. Some of the types of urinary incontinence include: stress (caused by increased abdominal pressure and weakened pelvic floor muscles and urethral sphincter), urgency (overactive bladder), overflow (caused by blockage preventing flow of urine from bladder) and neurological/reflex (serious impairment in nerves causing bladder contraction without any warning or urge).
The most common form of urinary incontinence seen in the postpartum period is stress incontinence. Labour can lead to stretching and damage of muscles in the pelvic floor and nerves. Activities which increase abdominal pressure, such as, laughing, sneezing, physical activity or coughing put extra pressure on the bladder sphincter and cause urine leakage during these activities.
Acupuncture may be a valuable addition to the postpartum recovery period for Patients experiencing stress or urge incontinence, or a mix of both of these types of incontinence (referred to as mixed urinary incontinence).
A few studies have compared the use of newer acupuncture protocols against prescription medication and/or pelvic floor muscle training (PFMT). One study found that acupuncture alone was able to reduce urinary incontinence and the treatment efficacy was similar to the Patient control group that received PFMT and medication combined (72 hour incontinence episode frequency and 1 hour pad test had similar reductions from baseline).
A separate study found that acupuncture was more effective at reducing urine leakage when compared to medication. A third study found that acupuncture was able to reduce urine leakage, measured by a 24 hour pad test. However, the latter studies had small sample sizes and a high dropout rate, undermining the results of these studies.
All three studies were able to significantly improve quality of life for individuals with urinary incontinence (measured by ICIQ-SF score) and the changes in score were greater than 4 (the minimum clinically important difference) and this result was consistent with a previously published systematic review that included over 15 clinical studies.
How does Acupuncture Reduce Urinary Incontinence?
There are a few hypothesized mechanisms by researchers to explain the reduction in incontinence in Patients after receiving acupuncture treatment:
Strengthening the pudendal and sympathetic nerves: acupuncture in the lumbosacral region may reduce the increased contraction of the detrusor muscle in the urinary bladder and may help reduce urgency incontinence
It may strengthen the pelvic floor muscles and improve stability of pelvic floor to reduce stress incontinence
Conclusion:
There appears to be more evidence supporting use of acupuncture for the treatment of stress incontinence and limited research around mixed and urgency incontinence. Because of the high safety profile acupuncture has when provided by a regulated healthcare provider it should be considered as an adjunctive treatment option for stress incontinence, especially for Patients that are experiencing significant adverse effects from medication that have reduced compliance as a result with the medication.
A couple of the studies for acupuncture for mixed urinary incontinence had small patient groups and a high drop out rate from the study, undermining the results from two of these studies.
This article is being shared as educational content and is in no way a replacement for medical advice or medical care, it is advised that anyone concerned about their Health should speak with their Naturopathic Doctor. Please discuss with your healthcare provider and only make changes to your medications regimen if recommended by your doctor and under their guidance and supervision.
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