Clinical Roundup: Selected Treatment Options for Overactive Bladder

Jane Hart, MD

Case Western Reserve University School of Medicine

Cleveland, OH

Evidence-Based Yoga Therapy

OAB is a common condition of urinary urgency, with or without urge incontinence. Usually, it is accompanied by an increase in urinary frequency and nocturia in the absence of urinary tract infections or other diseases. ¹ Moreover, it has been observed that OAB increases with age and affects quality of life. ² The current medical treatment modalities available for OAB are often characterized by lack of efficacy, poor compliance, low patient satisfaction, and side effects. ³ Previous research findings reported effectiveness and tolerability of complementary and alternative medicine (CAM) for OAB. ⁴ Yoga is a widely used CAM for health promotion, disease prevention, and as a possible therapy for OAB. ^5,6 An effective evidence-based yoga therapy module for treating patients with OAB may include the following yoga practices ⁷ :

Āsana (postures): Slow practice of Suryanamaskāra (salutations to the sun) with awareness focused at the Swādhisthana Chakra (sacral energy center), Tādāsana (palm tree pose), Tiryaka Tādāsana (swaying palm tree pose), Kati Chakrāsana (waist rotating pose), Vajrāsana (thunderbolt pose)

Prānāyāma (breathing techniques): Bhastrikā Prānāyāma (bellows breath)

Bandha (contraction): Moola Bandha (perineum contraction)

Mudrā (gesture): Vajroli Mudrā (thunderbolt attitude)/Sahajoli Mudrā (spontaneous attitude)

Dhyāna (meditation): Yoga Nidrā (deep relaxation technique)

Precautions: Some individuals should avoid strenuous Āsanas, inverted Āsanas, or Shatkarmas

References

1.

Hsu FC, Weeks CE, Selph SS, et al. Updating the evidence on drugs to treat overactive bladder: A systematic review. Int Urogynecol J 2019;1:1–15.

2.

Sultan AH, Monga A, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction. Neurourol Urodyn 2017;36:10–34.

3.

Olivera CK, Meriwether K, El-Nashar S, et al. Nonantimuscarinic treatment for overactive bladder: A systematic review. Am J Obstet Gynecol 2016;215:34–57.

4.

Vecchioli-Scaldazza C, Morosetti C, Maruccia S, et al. A randomized, multicenter, controlled study, comparing efficacy and safety of a new complementary and alternative medicine (CAM) versus Solifenacin Succinate in women with overactive bladder syndrome. Arch Ital Urol Androl 2017;89:296–300.

5.

Wieland LS, Shrestha N, Lassi ZS, et al. Yoga for treating urinary incontinence in women. Cochrane Database Syst Rev 2019;2:CD012668.

6.

Baker J, Costa D, Guarino JM, Nygaard I. Comparison of mindfulness-based stress reduction versus yoga on urinary urge incontinence: A randomized pilot study with 6-month and 1-year follow-up visits. Female Pelvic Med Reconstr Surg 2014;20:141–146.

7.

Satyananda S. Asana Pranayama Mudra Bandha. Munger, India: Yoga Publications Trust, 2008.

Tikhe Sham Ganpat, PhD, NET

Sanchi University of Buddhist-Indic Studies

Barla, Madhya Pradesh, India

Yoga

OAB affects quality of life for people who suffer from this condition. There are limitations for pharmacologic interventions due to inconsistency in results. ¹ Many alternative and complementary therapies are showing efficacy in OAB management. ²

Yoga originated in India as a holistic way of living and has gained its popularity as a mind–body therapy in recent times due to its efficacy in management of noncommunicable disorders. ³ Hatha yoga techniques are useful in management of symptoms of OAB by strengthening pelvic floor muscles. ^4,5 Studies show yoga practices as feasible, safe, and effective in management of urinary incontinence. ^6,7 Based on the evidence of yoga research and practical application of yoga techniques for patients with symptoms of OAB, the following yoga module can be used among these patients for 60 minutes a day:

Kriya (cleansing technique): Kapalbhati (skull shining breathing)

Surayanamaskara (sun salutation)

Sitting Āsana: Bhadrāsana (gracious pose), Ustrāsana (camel pose), Mandukāsana (frog pose)

Supine Āsana: Setubandhāsana (bridge pose), Viparita Karani (inverted pose), Pavanmuktāsana (wind releasing pose)

Bandhas (energy locks): Moola bandha (root lock), Uddiyana bandha (abdominal lock)

Prānāyāma (yoga breathing techniques): Nadishuddi prānāyāma (alternate nostril breathing), Bharmari (bee breath)

Deep relaxation technique

References

1.

Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU Guideline Amendment 2019. J Urol 2019;30:10–97.

2.

Vecchioli-Scaldazza C, Morosetti C, Maruccia S, et al. A randomized, multicenter, controlled study, comparing efficacy and safety of a new complementary and alternative medicine (CAM) versus Solifenacin Succinate in women with overactive bladder syndrome. Arch Ital Urol Androl 2017;89:296–300.

3.

Field T. Yoga research review. Complement Ther Clin Pract 2016;24:145–161.

4.

Ripoll E, Mahowald D. Hatha Yoga therapy management of urologic disorders. World J Urol 2002;20:306–309.

5.

Wieland LS, Shrestha N, Lassi ZS, et al. Yoga for treatment of urinary incontinence in women. Cochrane Database Syst Rev 2019;2:CD012668.

6.

Huang AJ, Jenny HE, Chesney MA, et al. A group-based yoga therapy intervention for urinary incontinence in women: A pilot randomized trial. Female Pelvic Med Reconstr Surg 2014;20:147–154.

7.

Patil NJ, Nagaratna R, Garner C, et al. Effect of integrated Yoga on neurogenic bladder dysfunction in patients with multiple sclerosis—A prospective observational case series. Complement Ther Med 2012;20:424–430.

Shivaji V. Chobe, BAMS, MD (Y&R)

P. Meenakshi, BAMS, MD (Y&R)

Central University of Rajasthan

Rajasthan, India

Acupuncture

OAB is a common disorder that negatively affects quality of life and carries a large socioeconomic burden. It is a clinical diagnosis that relies on history of urgency and frequency or nocturia. ¹ Previous literature reviews have shown that acupuncture is minimally invasive and causes few side effects. ² Clinical studies and reviews have found that acupuncture may reduce micturition and urgency episodes for 24 hours and improve quality of life in patients with OAB. ^{3 –6}

Based on the literature and our clinical experience, acupuncture management for OAB may use CV3, CV4, GV20, SP6, BL32, BL33, BL34, and ST36 acupoints. These acupoints appear to be an effective, safe, and minimally invasive complementary and alternative management method for OAB patients. It could become a second therapeutic option for OAB if further large multicenter studies with long-term follow-up confirm these beneficial effects.

References

1.

Leron E, Weintraub AY, Mastrolia SA, et al. Overactive bladder syndrome: Evaluation and management. Curr Urol 2018;11:117–125.

2.

Ernst E, White AR. Prospective studies of the safety of acupuncture: A systematic review. Am J Med 2001;15:481–485.

3.

Yang L, Wang Y, Mo Q, et al. A comparative study of electroacupuncture at Zhongliao (BL33) and other acupoints for overactive bladder symptoms. Front Med 2017;11:129–136.

4.

Yuan Z, He C, Yan S, et al. Acupuncture for overactive bladder in female adult: A randomized controlled trial. World J Urol 2015;33:1303–1308.

5.

Zhao Y, Zhou J, Mo Q, et al. Acupuncture for adults with overactive bladder: A systematic review and meta-analysis of randomized controlled trails. Medicine (Baltimore) 2018;97:e9838.

6.

Forde JC, Jaffe E, Stone BC, et al. The role of acupuncture in managing overactive bladder: A review of the literature. Int Urogynecol J 2016;28:1645–1651.

Yun Jin Kim, PhD

Xiamen University Malaysia

Sepang, Selangor, Malaysia

Noninvasive Laser Acupuncture

In the past two years, our outpatient clinic treated 68 patients (between 35 and 71 years of age) with overactive bladder syndrome (OABS) using laser acupuncture on the sacral area. We used noninvasive laser acupuncture instead of traditional needling due to concerns of safety and patients' acceptance.

Located on the dorsal sacrum, bilateral bladder meridian (BL) points 31–34 are commonly used in acupuncture treatment for OABS. Most acupuncture textbooks state that the placements of BL points 31–34 overlap the sacral foramina. Anatomically, there is considerable variability in the relative location of the sacral foramina. ¹ The foramina are also covered by muscular and connective tissues, so precise acupoint placement is challenging even by experienced hands. We used eight adhesive laser emitters at the top of the skin for acupoints BL 31–34. The laser beam radius was 10 mm. Targeted acupoints were laser stimulated without difficulty while the patient was in side-lying position. The laser parameters were 660 nm, 50 mW, and 5 Hz (Konftec, Taiwan or 3B Scientific, Germany). Each treatment lasted for 30 minutes and was repeated twice a week for 8 weeks.

After the eight-week treatment, the majority of patients reported considerable improvements in OABS symptoms, with median percentage improvements of 71% for urgency, 63% for daytime frequency, 55% for nighttime frequency, and 43% for urge urinary incontinence. No adverse events were reported. However, because of the limited sample size, lack of sham and control groups, and other quantitative measurements such as ultrasonic bladder scan for residual urine volume, further studies are required to confirm our clinical findings.

References

1.

Miller AN, Routt ML. Variations in sacral morphology and implications for iliosacral screw fixation. J Am Acad Orthop Surg 2012;20:8–16.

Yiu Ming Wong, PhD

Health Science Unit (PEC)

Hong Kong Physically Handicapped and Able-Bodied Association

Sham Shui Po, Kowloon, Hong Kong

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