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Many studies show acupuncture in conjunction with electro-stimulation utilizing a procedure called PTNS can provide lasting improvement for urinary incontinence and overactive bladder in men and women.

And, yea! Because nothing is more annoying than throwing your head back to laugh in the moment and you end up peeing. Maybe just a little. But it also happened when you sneezed earlier. And maybe you have an app on your phone that tells you where the nearest bathroom is no matter where you are. Perhaps you've stopped socializing as much because the sense of urgency to pee can strike anywhere, anytime.

Different symptoms can arise with the bladder and urinary evacuation. Some dysfunction occurs with aging - up to 40% of postmenopausal women can suffer with symptoms, some occur postpartum, and others might arise postoperative or after nerve damage.

Overactive bladder syndrome (OAB) is a common condition defined as urgency to void, usually accompanying frequency, with or without urge urinary incontinence (UUI), in the absence of urinary tract infection or obvious pathology.

Mixed urinary incontinence (MUI) involves involuntary leakage of urine when sneezing, coughing, laughing, during exertion, and leakage associated with urgency, and accounts for approximately 30% of all women suffering from incontinence. Detruser hyperactivity may also be involved in MUI. (1)

The prevalence of patients affected is high, with those impacted often feeling anxiety, depression and social stigmatization around the condition. Women often accept the condition as their 'new normal' at some point, or explore options from medications to implants.

While the complete etiology of urinary incontinence is not clear, it is known that some peripheral nerves, as well as the central nervous system may be involved in muscle hypersensitivity and the reduced effectiveness of smooth muscle relaxation. (2)

Acupuncture has been described as a successful treatment for certain overactive bladder symptoms starting in the 1980s. Since then, many clinical trials have been carried out indicating that acupuncture may influence the autonomic nerve system. Percutaneous tibial nerve stimulation (PTNS) is derived from acupuncture used in Chinese traditional medicine - it is a neuromodulation technique used to modulate bladder function and facilitate storage.

Neuromodulation with acupuncture is minimally invasive - only requiring a few acupuncture points in conjunction with electro-stimulation. It is highly cost effective in comparison to other more invasive procedures or some medications, and does not have side effects.

The principle is the innervation of the lower urinary tract from nerves originating at L2-S4 - the network of both afferent and efferent fibers is formed after exiting the spinal cord, innervating all the pelvic organs. A distal branch of one nerve is the post tibial nerve.

"Neuromodulation is postulated to be the effect of cross-signaling between sympathetic and parasympathetic postganglionic nerve terminals and synapses, causing alteration of nerve signals involved in the voiding reflex. Stimulation of peripheral nerves and subsequent 'cross-talk' at the level of the postganglionic neuroeffector junctions can modulate transmission. This implies that stimulating one area of the innervations system seems to alter the nerve behavior of other systems, leading to alteration in bladder function by stimulating peripheral nerves. The pudendal nerve, the dorsal genital nerve, and the PTN nerve are examples of such peripheral nerves that can affect bladder behavior." (3)

I included this mouthful of a paragraph as it sets up some of the anatomy of why acupuncture works when an electric current is applied to the acupuncture needle, a technique called electrical acupuncture, or estim for short.

In my clinic, I apply a needle to an acupuncture point on the ankle that corresponds with access to this distal nerve. Estim is applied to this and one other point; the sensation is tingling that radiates outward from the needle location.

The beauty of treating with this protocol is it is still only one part of a comprehensive acupuncture treatment. You will be properly assessed according to Chinese medicine beyond your chief complaint, and receive acupuncture to treat the person as a whole. This might include other symptoms, related, or not, such as fatigue, sleep, anxiety and depression.

The treatment is well tolerated, most patients take a nap for 20 or 30 minutes - there is no pain associated with the treatment. This is a great time to hit the 'reset' button and recharge - a time just for you.

A series of twelve treatments is most common and recommended, but might not be necessary - I have had patients improve in one and two treatments. I don't have a great predictor if it will work in every case, and studies have not been able to pin this down either, but it is certainly a valid option when surgical implant of a device becomes the alternative. Some patients find the results hold, some have a slight relapse months later.

With her permission, I was able to use one patient as a case study during my time at AOMA; her case became an example of this treatment and its success. She went from not being able to evacuate her bladder (she was self-cathing to evacuate) due to nerve injury, to full evacuation unassisted in two treatments, confirmed by her urologist and ultrasound. Her surgery for insertion of a device was cancelled and she's maintained the results without further treatment. In this case, the impact on quality of life was high, with little treatment needed.

This treatment is often available at doctor's offices. In my experience, the training is by those manufacturing the device, and misses some of the finesse of placing the needle at the right position, angle and depth for best results. My patient's urologist confirmed they do not use the procedure as they found it to be hit or miss depending on who was giving the treatment. So of course my advice, find a licensed acupuncturist like myself that knows the treatment.

The treatment is not just for women, it can be effective for men in certain circumstances.

Basically no one likes peeing every time you laugh, or sneeze, or having any challenges in this area affecting your daily activities. If you're in Austin, give me a call to see if it's a fit for you.



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