I hear it often from my patients: ‘sometimes I pee a little when I laugh,’ ‘I wouldn’t dare try to do jumping jacks or it would be a mess,’ and ‘I just know that I have to use the bathroom before I leave to go anywhere or I might pee my pants.’ Overactive bladder, leakage and incontinence aren’t anything new, but in my practice I’ve gotten the impression that patients think that having these conditions is just a part of getting older, from giving birth or prostate enlargement and it’s something you just have to live with. Treatments for overactive bladder (OAB) leave a lot to be desired, patients don’t want to undergo invasive surgery, but medications have high rates of undesirable side effects which leaves most patients thinking there isn’t a viable treatment option and that urinary leakage is just something they’ll tolerate. While kegel exercises may provide some relief and help for many patients, not everyone notices a difference with doing them, pressing the point home again that OAB is just something we live with, untreated.
Overactive bladder (OAB) is a condition that affects adults and children worldwide and can be caused by numerous underlying factors or traumas like childbirth, prostate enlargement, poor pelvic floor muscle control, bladder prolapse and more. It goes without saying that this condition can create a significant psychological burden on patients and symptoms range from urinary urgency to incontinence, while this condition can be incredibly bothersome, surgery often seems a drastic approach and medications may have limited effect and side effects (de Wall, L. L., & Heesakkers, J. P. (2017.) So what’s the good news? Acupuncture is actually an incredibly effective treatment for OAB, working better than most medications with fewer side effects, it is so effective in fact, that medical doctors use acupuncture and electrostimulation in order to address the tibial nerve and improve its functionality which addresses the innervation of the bladder and helps with OAB, they call it Percutaneous Tibial Nerve Stimulation (PTNS). Studies on PTNS have shown improvement in bladder symptoms of over 50% improvement and up to 80% improvement in quality of life studies, this therapy is also minimally invasive and does not pose traditional risks or side effects associated with medications and surgeries (de Wall, L. L., & Heesakkers, J. P., 2017).
In my acupuncture practice in Oakland, California I provide patients PTNS treatments with acupuncture for with overactive bladder it is a simple adjusted acupuncture treatment to address the innervation of the bladder and improve the regulation of information from the brain to the bladder called Percutaneous Tibial Nerve Stimulation and Sacral Nerve Stimulation. While for some patients, the cause of OAB lies in the musculature of the pelvic floor, for many it can be an issue with the nerves that bring information from the bladder to the brain and vice versa, and no amount of kegel exercises will provide relief, for most it’s a combination of both! In addition to treating the issues of the bladder directly, as an Acupuncturist my aim is to always get to the root of an issue, and that doesn’t mean just what’s going on in the body as a cause of an issue, it also means the bigger picture in the body - mind - spirit connection. Acupuncture treatments for OAB will consist of a direct treatment to address the symptoms of overactive bladder and leakage, but also addressing the patient as a unique individual and their constitution so that they can embody more strength and health throughout all aspects of their life, not just the symptoms at hand.
Why Your Kegel Exercises Don't Always Work
Whether your OAB symptoms are caused by a past trauma, childbirth, prostate enlargement or loss of muscle tone due to age the ways that our bladder can become dysfunctional boils down to an issue with the musculature of the pelvic floor or some kind of damage or missignalling from the nerves. Damage to the muscles like with childbirth or surgery and muscles losing tone and mass with general aging are some ways that we might lose muscle tone in the pelvic floor. Kegel exercises are the obvious first choice of treatment for someone who’s dealing with a loss in muscle tone because it will help strengthen the pelvic floor muscles and improve the functionality of the bladder and urethra. But pelvic floor exercises won’t seem to help much for someone who’s dealing with a nerve issue, and this is where acupuncture comes in to play.
When the cause of OAB is rooted in the nerves, kegel exercises will prove minimally effective but acupuncture treatments addressing the percutaneous tibial nerve and sacral nerve roots will likely be very effective. Usually when a patient experiences OAB the root cause is a combination of the two causes - muscle and nerve related which is why a proper treatment protocol will address both aspects of the issue.
The tibial nerve innervates the sacral plexus at the base of the spine which controls the bladder and pelvic floor and is responsible for its function, this nerve runs down the medial side of the leg along the Spleen and Kidney channels into the foot. PTNS utilizes acupuncture and electro-stimulation to stimulate the nerve and sacral plexus, this electro-stimulation of the nerve helps to correct the misinformation travelling between the brain and bladder thus decreasing overactive bladder symptoms and episodes.
With acupuncture treatments we can address the root causes of this condition, often tonifying the Kidney and Urinary Bladder systems and addressing sinking Qi (often related to prolapse), when combined with PTNS treatments patients find a great relief in symptoms, sometimes immediately.
Acupuncture Treatments for Overactive Bladder
A typical treatment protocol for Overactive Bladder and PTNS therapy is 12 consecutive 30 minute treatments given 1-3 times per week. Your Acupuncturist will do a thorough intake of your health history and current complaints, take your pulse and a look at your tongue to make their Chinese Medicine diagnosis, then proceed with a treatment. You can usually expect around 10-15 needles to be placed during an acupuncture session, which are chosen to help treat any underlying or other issues you’re working with and to help treat your constitution as a whole. For the PTNS treatment 4 needles will be placed in the lower leg, two near the achilles tendon on the medial side of the leg and the other two about a palm-width up the leg on the calf, these acupuncture points are Kidney 3 and Spleen 6 respectively. Once inserted the Acupuncturist will attach electrode clips to the points and slowly turn on the electro-stimulation machine, this sounds a little scary but it’s a common treatment and is actually quite pleasant for most patients; it feels like a mild tapping or twitching sensation. This current will run the duration of your treatment, approximately 30 minutes, the Acupuncturist will return and remove the needles and you’ll be free to go, hopefully also feeling a bit more at peace and relaxed as you get up from the table.
Patients typically notice an improvement in symptoms as early as after a single treatment depending on the severity of the problem. Completing a series of sessions results in lasting changes, although patients may opt for routine follow ups to prevent any reversal of the treatment due to aging. As a general rule of thumb for how you might respond to treatment, if you haven’t had any trauma and symptoms are relatively mild you could expect results to come on faster and last longer, and if this is a condition you’ve been suffering from for a long time, is quite severe or due to extensive trauma it may take more treatments at a higher frequency to see results.
If patients find the treatment is effective but results don’t last, it may be a good idea to check in with your Urologist or Primary Care Provider because there are also medical devices developed that can be implanted into the patient permanently for cases that require more consistent management.
Side Effects of PTNS Acupuncture vs Medications
Adverse events with PTNS treatment are no greater than typical adverse events associated with acupuncture and electro-acupuncture. Adverse events are reported as mild, transient and uncommon at 1-2%, including bruising or bleeding at the needle site, tingling and mild pain. Adverse events of typical treatments for overactive bladder with medications range from 9.7 - 63% including constipation, dry mouth, impaired urination and urinary tract infections. The high rate of adverse events with traditional medications is considered likely a reason why there is a high rate of discontinuance of therapy after one year. (Staskin, D. R., Peters, K. M., MacDiarmid, S., Shore, N., & de Groat, W. C., 2012).
Contraindications for PTNS treatment are identical to those with electro-acupuncture, and not used on patients with a history of epilepsy or seizures, severe heart disease, strokes, or on patients with pacemakers. If a patient has a difficult time tolerating needling then adjustments should be made and then consideration of discontinuance of treatment if no alleviation of discomfort during treatment can be found.
Are You Ready to Say YES to Relief from OAB?
If you're in the greater San Francisco Bay Area we encourage you to give us a call or email to see if Dr. Kim Peirano, DACM, LAc may be a good fit for you! If you're ready to come in for a treatment please book online now!
REFERENCES:
de Wall, L. L., & Heesakkers, J. P. (2017). Effectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome. Research and reports in urology, 9, 145–157. doi:10.2147/RRU.S124981 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565382/
Staskin, D. R., Peters, K. M., MacDiarmid, S., Shore, N., & de Groat, W. C. (2012). Percutaneous tibial nerve stimulation: a clinically and cost effective addition to the overactive bladder algorithm of care. Current urology reports, 13(5), 327–334. doi:10.1007/s11934-012-0274-9
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