Improvement of urge- and mixed-type incontinence after acupuncture treatment among elderly women — a pilot study

This pilot study investigated the effects of manual acupuncture in 15 elderly women (mean age 76.4 years) with urge or mixed urinary incontinence who had not responded adequately to conventional treatments. Participants were recruited from a specialized incontinence unit in Stockholm, Sweden, between 1992 and 1995. All had performed pelvic floor training for at least 2 months and most had used anticholinergic medication without satisfactory results. The protocol consisted of 12 manual acupuncture sessions, performed twice a week, using disposable needles at specific points.

The selected points included BL-31, BL-32, and BL-33 (sacral region), BL-23 (lumbar region), SP-6 and KI-3 (lower limbs), and LI-11 (elbow), chosen based on the segmental innervation of the bladder and related muscles. Treatment was performed until patients experienced the de-qi sensation, characteristic of traditional acupuncture. Assessments were performed before treatment, immediately after the last session, and at 1 and 3 months of follow-up. The instruments included subjective questionnaires on urgency and frequency of leakage, the objective Inco-test (48-hour leakage measurement), and the IQoLI quality-of-life scale.

Results showed significant improvements in nearly all parameters evaluated. Subjectively, there was a significant reduction in urgency intensity and type, frequency of urinary leakage, and nocturia. Objectively, urinary leakage measured by the Inco-test decreased from a median of 123 grams at baseline to 12.5 grams after 3 months (p = 0.018). Quality of life improved significantly, with the score increasing from 41 to 55 points on the IQoLI scale (p = 0.001).

Notably, 12 of the 15 women (80%) considered themselves improved at the end of treatment, and 8 (53%) still considered themselves much improved at 3 months. Improvements were more pronounced after 1 month, with partial maintenance of benefits at 3 months. No adverse events were reported during treatment. The authors discuss possible mechanisms of action, including somatovesical reflexes mediated by stimulation of somatic afferents, release of endorphins that may inhibit the pontine micturition center, and improvement of local circulation.

The choice of points was based on the correspondence between the segmental innervation of the bladder (T11-L2 sympathetic, S2-S4 parasympathetic) and the innervation of the acupuncture points used. This study provides encouraging preliminary evidence that acupuncture may be a useful adjuvant therapy for urinary incontinence in elderly women. The results are particularly relevant considering that these were patients refractory to conventional treatments, with long-standing symptoms (mean duration 3.7 years). Limitations include the absence of a control group, small sample size, and possible placebo effect.

The authors suggest that future controlled studies are needed to confirm these findings and determine optimal treatment protocols.