Alternative Therapies for Urinary Urgency Incontinence: Acupuncture and Herbology

Abstract

Urinary urgency is defined by the International Continence Society as a sudden and compelling desire to pass urine that is difficult to defer [1] . In both sexes the symptoms tend to increase as one ages, but in women they are more often associated with urge urinary incontinence (UUI). The overactive bladder syndrome (OAB) is defined as urgency usually accompanied by urinary frequency and nocturia, with or without UUI, and is widely prevalent among women, affecting nearly 17% of the overall female population [2] . Symptoms and signs of urgency and UUI become more evident after menopause, increasing with advancing age [3] . It is estimated that the number of American women aged 65 years and older will double in the next 25 years to more than 40 million women by 2030 [4] , which will further increase the already high cost of OAB to society and impairment of quality of life for the individual [5] . Up to 39% of new admissions to long-term care facilities report having urinary incontinence, of which nearly two thirds had objectively documented involuntary bladder contractions [6] . Effective first-line treatments for the OAB syndrome are nonsurgical, such as pharmacotherapy, behavioral therapy, and pelvic floor electrical stimulation. Behavior modification includes fluid and dietary changes, bladder drill entailing scheduled voiding to restore normal cortical control over micturition, and exercises to strengthen the pelvic floor muscles for patients with mixed incontinence. The combination of these behavioral treatment modalities may improve symptoms by 75–80% [7] . Antimuscarinic pharmacotherapy has become the mainstay for persistent OAB symptoms [5] . Goode et al. [8] found that objective bladder capacity improved significantly with antimuscarinic therapy compared to a group receiving behavioral therapy [8] , but nocturia was better treated by combined behavioral therapy and pharmacological treatment [9] . There is evidence that the placebo effect plays a major role in the treatment of UUI [10] . Overall reduction in UUI with placebo alone is believed to reach about 40% [11] . As effective as antimuscarinic drugs may be, they fail to adequately resolve symptoms in a substantial number of cases, and their use is frequently limited by side effects. The elderly are especially susceptible to serious anticholinergic CNS side effects such as significant memory impairment and hallucinations [12] . Although significant CNS reactions are not common, it generally is encouraged to avoid prescription of antimuscarinic medications that cross the blood–brain barrier in the elderly whenever possible [13] . For nonresponders to these interventions, and as first-line therapy for selected cases, a variety of nonpharmacological alternatives with documented efficacy have been developed. The potential benefits of complementary therapies are that they have few, if any, adverse effects compared with antimuscarinic pharmacotherapy [14] . Acupuncture generally is well tolerated and is Chapter 16 Alternative Therapies for Urinary Urgency Incontinence: Acupuncture and Herbology