Urge Incontinence ??????

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Urge Incontinence??????
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• Urge urinary incontinence (UUI) is defined as
  involuntary loss of urine associated with a
  sudden, strong desire to void.
• It happens in both men and women and more in the
  latter.
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• Its incidence increases with age.
• It comes under the category of enuresis in TCM.
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Overactive bladder Urge incontinence
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• Etiology and Pathogenesis
• UUI can be of neurological or non-neurological
  origin.
• The former include stroke, Parkinson's disease,
  Alzheimer's disease, multiple sclerosis, brain
  injury and spinal injury.
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• Etiology and Pathogenesis
• The latter include urethral obstruction (chronic
  prostate hyperplasia), vesical inflammation
  (calculus, tumor) and stress urinary
  incontinence.
• UUI can also be of idiopathic origin.
• All the above causes can produce detrusor
  overactivity to result in urge urinary
  incontinence.
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• Clinical manifestations
• 1.  Symptom
• Involuntary loss of urine associated with a
  sudden, strong desire to void.
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• Clinical manifestations
• 2.  Signs
• The observation of involuntary urinary loss from
  the urethra synchronous with an uncontrollable
  urge to void.
• Positive pad test.
• Perineal anesthesia.
• Abnormal bulbocavernosus reflex.
• 2.  ??
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• Laboratory examination
• 1. Urinalysis, vesicourethral X-ray and endoscopy
• Showing the non- neurological origins
  inflammation, calculus, tumor and urethral
  obstruction.
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• Laboratory examination
• 2. Urodynamic study
• Involuntary detrusor contraction (detrusor
  overactivity).
• A decrease in bladder capacity at the first
  desire for urination.
• A decrease in maximum bladder capacity
  (incontinence with an uncontrollable desire to
  void).
• Low bladder compliance.
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Overactive BladderUrodynamics
Normal Cystometrogram
Pves (cmH20)
Volume (mL)
MCC Maximum Cystometric Capacity Max Pdet
Maximum Detrusor Pressure
Cystometrogram in patient with detrusor
instability AKA Overactive Bladder
Pves (cmH20)
Volume (mL)
Two nonvoid involuntary contractions that
resulted in void
Involuntary contractions that resulted in void
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Detrusor Leak Point Pressure
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• Dagnosis
• Based on
• The symptom (history) of urge incotinence
• Positive pad test.
• The results of imaging urodynamic study.
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• Treatment
• Acupuncture treatment
• 1. Therapeutic principle
• According to TCM theory, it is caused by
  deficiency of kidney qi and failure of the
  bladder in restraining the urine discharge,
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• Treatment
• Acupuncture treatment
• 1. Therapeutic principle
• so the therapeutic principle is reinforcing
  kidney qi and improving vesical restraining
  function.
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• 2. Point selection
• The Back-Shu and Front-Mu points of the kidney
  and bladder are selected as the main acupoints
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• 2. Point selection
• The acupoints often selected are Shenshu (B 23),
  Pangguangshu (B 28), Zhongji (Ren 3), Guanyuan
  (Ren 4), Mingmen (Du 4), Huiyang (B 35),
  Sanyinjiao (Sp 6) and Zusanli (S 36).
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• 2. Point selection
• The kidney is exteriorly-interiorly related to
  the bladder, so the Back-Shu points of the kidney
  and bladder are applied. Zhongji (Ren 3) is the
  Front-Mu points of the bladder. The combined use
  of the above three acupoints contributes to
  reinforce kidney qi and improve vesical
  restraining function.
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• 2. Point selection
• Guanyuan (Ren 4) and Mingmen (Du 4) are the
  sources of primordial qi and acupuncture of them
  can tonify primordial yang (kidney-yang). Huiyang
  (B 35) is the acupoint of the foot-taiyang
  meridian and acupuincture of it can invigorate
  the meridional qi of the bladder.
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• 2. Point selection
• Sanyinjiao (Sp 6) is the crossing point of the
  three foot-yin meridians and acupuncture of it
  can regulate the qi of the three foot-yin
  meridians. Zusanli (S 36) belongs to the yangming
  meridian, which is full of qi and blood,
  acupuncture of it can tonify qi to stop
  incontinence.
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Electroacupuncture neurostimulation????????

• A combination of acupuncture in traditional
  Chinese medicine and electrical nerve stimulation
  in western medicine (including pudendal nerve
  stimulation, suprapubic transcutaneous electrical
  nerse stimulation and percutaneous tibial nerve
  stimulation).
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• 1. Acupoint selection
• According to TCM theory and modern anatomy in
  combination with clinical practice, we sift out
  two groups of acupoints (1) Four abdominal
  points (empirical) and (2) Four sacral points
  (empirical).
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Four sacral points???

• 2 Acupuncture methods
• 1) Four sacral points
• (1) The upper two points located by the two
  edges of the sacrum on a level with the fourth
  sacral foramina
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Four sacral points???

• 2 Acupuncture methods
• 1) Four sacral points
• (1) The upper two points use a long needle of 4
  cun (100mm) puncture perpendicularly 33.5 cun
  in depth make the needling sensation reach the
  urethra or anus.
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Four sacral points???

• 2 Acupuncture methods
• 1) Four sacral points
• (2) The lower two points 0.5 cun bilateral to
  the tip of the coccyx use a long needle of 4 or
  5 cun (100 or 125mm)
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Four sacral points???

• 2 Acupuncture methods
• 1) Four sacral points
• (2) The lower two points puncture obliquely
  (laterally) towards the ischiorectal fossa, 34.5
  cun in depth make the needling sensation reach
  the urethra.
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Four abdominal points???

• 2 Acupuncture methods
• 2) Four abdominal points
• (1) The two upper points 2.5 cun bilateral to
  Guanyuan (Ren 4)
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• 2)???
• (1)?????????2.5?(??)?

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Four abdominal points???

• 2 Acupuncture methods
• 2) Four abdominal points
• (1) The two upper points use a long needle of 4
  cun (100mm) puncture obliquely 12 cun in depth
  make the needling sensation reach the urethra or
  vulva.
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Four abdominal points???

• 2 Acupuncture methods
• 2) Four abdominal points
• (2) The two lower points 1.5 cun bilateral to
  Zhongji (Ren 3)
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Four abdominal points???

• 2 Acupuncture methods
• 2) Four abdominal points
• (2) The two lower points use a long needle of 4
  cun (100mm) puncture obliquely 12 cun in depth
  make the needling sensation reach the urethra or
  vulva.
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• 2 Acupuncture methods
• After the needling sensation reaches the above
  positions, an electroacupuncture instrument is
  connected. Used for electroacupuncture are
  continuous waves, a frequency of 90150 times/min
  and an intensity that the patient is adaptable or
  feels comfortable. It lasts 60 min. The needling
  sensation must reach the above positions during
  electroacupuncture.
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  ???60??????????????????

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• 2 Acupuncture methods
• The treatment is given once every other day. The
  two groups of acupoints are alternated. The
  course of treatment depends on the patients
  condition.
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Thanks