How Do You Treat Urinary Incontinence in Your Practice?

Urinary incontinence consists of the loss of bladder control, which may be considered according to five types consisting of stress, urge, overflow, functional, and emotional/anxiety incontinence. Urinary incontinence can often be attributed to one or a combination of six main causes. The muscles of the bladder may be either weak, or overactive, or there may be blockage of the urinary physiology, caused by enlargement of the prostate. Urinary incontinence may also result from spinal injury, because nerve damage produces weakness of the urinary bladder. Medical problems, such as Parkinson's disease, multiple sclerosis (MS), and bladder infections, also affect the regularity of bladder function. Finally, psycho-spiritual problems, such as anxieties, neuroses, fears, phobias, and spiritual disorders, may all contribute to urinary incontinence.

There are five recommendations in the treatment and management of urinary incontinence. Patients should practice bladder control training consistently, and supplement this training with an additional strengthening program, such as the Kegel series of pelvic-floor exercises. Nutritional and herbal therapies, including calcium, magnesium, vitamin C, Jian Kui Shen Qi Wan, and Gi Ji Kidney Nourishing tablets, are very helpful for regulating patients' urinary systems. Body stretching and mental and spiritual exercises, including yoga, Qigong, t'ai chi chu'an, and meditation, on a regular basis, offer patients extensive benefits for improving their quality of life (QoL). Certainly, medical acupuncture therapy is highly recommended for reducing a patient's urinary incontinence and restoring the regularity of bladder function.

The most effective medical acupuncture treatment involves syndrome differentiation according to the following four approaches: (1) The General Constitutional Approach; (2) The Specific Medical Condition Approach; (3) The Body, Mind, and Spirit Approach; and (4) The Wholistic Approach.

The General Constitutional Approach is threefold. First, improve the general body constitution, using the acupuncture points CV 4, CV 6, CV 17, GV 4, and GV 7. Second, strengthen the Lower Energizer, using the acupoints CV 5, CV 12, BL 22x2, BL 39x2, LR 13x2, and ST 43x2. Third, foster body, mind, and spirit alignment, with the acupoints EXHN 3, GV 4, PC 6x2, and TE 5x2.

The Specific Medical Condition Approach addresses six underlying etiological factors producing urinary incontinence. First, weak bladder muscles should be treated with the acupoints CV 3, CV 4, CV 12, BL 28x2, BL 40x2, BL 59x2 (Xi Cleft with Yang Qiao), BL 63x2 (Acute), and SP 9x2. Second, overactive bladder muscles can be soothed with the acupoints CV 12, GV 20, BL 40x2, BL 63x2, (Acute), LI 11x2, and SP 21x2. Third, weakness in Kidney Qi or Essence affecting sphincter control of the urethra can be treated with the acupoints GV 4, BL 23x2, KI 3x2 (Yin), KI 5x2 (Acute), KI 6x2 (Essence), KI 7x2(Yang), KI 9x2 (Xi Cleft with Yin Wei), and KI 10x2 (Qi). Fourth, blockage caused by an enlarged prostate can reduced with the acupoints CV 5, BL 57x2, ST 8x2, ST 40x2, and ST 43x2. Fifth, spinal injuries can be treated with the acupoints KI 3x2, KI 6x2, KI 7x2, KI 10x2, PC 6x2, SI 3x2 (Loo's Points), and SI 6x2, to improve QoL. Sixth, for additional medical conditions producing urinary incontinence in addition to the urinary incontinence acupoints discussed other acupoints can be added. For Parkinson's disease, the EXHN 1x4, GV 4, GV 20, KI 3x2, KI 6x2, KI 7x2, and KI 10x2 can be added. For MS, the acupoints GV 14, LI 11x2, SP 6x2, SP 9x2, SP 10x2, and ST 36x2 can be added.

The Body, Mind and Spirit Approach addresses four psycho-spiritual aspects of a patient with urinary incontinence. First, the physical body should be treated as above, according to the patient's general constitution and specific medical conditions. Second, the mind–emotion, or mental aspect, of the patient should be treated with the acupoints CV 14 (Heart Chakra), BL 14x2, BL 15x2, HT 3x2 (Chronic), HT 6x2 (Acute), HT 7x2 (Relaxation), PC 6x2, and TE 5x2. Third, the spiritual aspect of the patient should be treated with CV 14, BL 15x2, BL 17x2, BL 46x2, GB 41x2, and HT 5x2. Fourth, the patient's emotional fear should be addressed by grounding the Kidney, to promote better sphincter control, with the acupoints KI 3x2 (Yin), KI 5x2 (Acute), KI 6x2 (Essence), and KI 10x2 (Qi).

The Wholistic Approach addresses the constituent elements of the whole body in six ways. First, improve the body constitution with the acupoints CV 4, CV 6, CV 17 and GV 4. Second, restore the organ systems with the acupoint CV 12 and GV 9 for the Fu Hollow Organs and GV 7 and LR 13x2 for the Zang Solid Organs. Third, ensure the smooth flow of Qi with LR 3x2. Fourth, ensure the smooth flow of Blood with SP 10x2. Fifth, balance the whole body with LI 11x2 (Physical parameter), EXHN 1x4 (Mental parameter), and GB 41x2 (Spiritual parameter). Sixth, balance the Yin and Yang elements within the body with SP 21x2 (Meridian level).

To treat urinary incontinence successfully, it is important to also approach the mental and spiritual components of this disorder, beyond a patient's physical problem. For patients' continued stability, auricular acupuncture, scalp acupuncture, and hand and foot acupuncture are excellent microsystems for treating urinary incontinence. If auricular acupuncture is used, important acupoints include Shenmen, Brain, Brainstem, Sympathetic, Kidney, Bladder, and Occiput. For scalp acupuncture, MS 4, and Autonomic Nervous System lines are useful. For hand and foot acupuncture, Nocturea 1 and 2 are essential. While initially treating patients with body acupuncture points is effective, maintenance with microsystem acupuncture is very helpful.