Prevalence of Overactive Bladder
Since approximately 1 in 5 people over 35 years old in Canada are affected by overactive bladder, acupuncture and overactive bladder is an important topic for acupuncturists to address. A survey comprising 16,776 interviews conducted in 6 European countries demonstrated that the prevalence of overactive bladder would be above 16% in the population aged 40 years and older. Elevated urinary frequency would be the most reported symptom (85%). This would be followed by urinary urgency (54%) and then incontinence caused by urinary urgency (36%). The prevalence of this condition would increase with advancing age. (1)
Symptoms of Overactive Bladder
Frequent urination, involving more than 8 bathroom visits per day, including 2 or more visits at night.
Urinary urgency, with difficulty or little chance of retaining urine.
Incontinence, involving urine leakage.
The majority, more than 60% of affected individuals, will not, however, experience incontinence even if they have overactive bladder. (2)
Effectiveness of Acupuncture in the Treatment of Overactive Bladder
Literature Reviews
First, the narrative review by Forde et al. published in 2016 including 6 comparative trials suggests that acupuncture has a role to play in the treatment of overactive bladder. (3)
Second, the systematic review by Zhao et al. (2018) comprising 10 randomized controlled trials, including 794 patients, concludes that acupuncture could reduce the number of voids, incontinence episodes, as well as nocturia (frequent nighttime urination). (4)
Third, Olivera et al. (2016), in their systematic review of non-pharmacological treatments for overactive bladder, emphasize that acupuncture would improve quality of life as well as the urodynamic profile of affected patients. (500168-X/fulltext))
Posterior Tibial Nerve Stimulation and Overactive Bladder
Neuromodulation of the Posterior Tibial Nerve (PTNS)
In the context of the research report by Wall & Heesakkers (2017) on percutaneous stimulation of the tibial nerve, one of the biostimulation sites used in electroacupuncture treatment of overactive bladder, it is noted that percutaneous stimulation of the tibial nerve could indeed modulate the bladder's urine emptying and storage functions, leading to subjective symptom improvement in 60% of patients and 47 to 56% improvement in frequency-volume chart parameters, with sustained long-term results. According to the authors, this would therefore be a good treatment option for refractory overactive bladder, or when medication would not be tolerated by the patient. (6)
Notable Randomized Controlled Trials
Notably, the randomized controlled trial by Lin et al. (2018) suggests that acupuncture has a beneficial effect in improving symptoms of overactive bladder, and that the effects of treatment could last at least 3 months. Furthermore, Lin et al. (2018) also demonstrated that acupuncture treatment is effective and safe. Indeed, it could reduce the frequency of incontinence as well as daytime and nighttime urinary frequency. (7)(8)
In Women
The randomized controlled trial by Yuan et al. (2014) demonstrates that acupuncture should be considered as an alternative clinical treatment for overactive bladder in adult women. (9)
Furthermore, Emmons and Otto, in 2005, already reported similar results, indicating significant improvements in bladder capacity, sensation of urgency, urinary frequency, as well as quality of life in patients suffering from overactive bladder. (10)
Patients Refractory to Anticholinergics
Moreover, Zhang et al. (2018) propose that electroacupuncture would be effective, safe, and minimally invasive in treating these women with overactive bladder. (11)
Acupuncture and Overactive Bladder
Patients Who Have Undergone Transurethral Resection of the Prostate
Particularly, Shen & Lin (2012) report that in patients who have undergone transurethral resection of the prostate, early prevention consisting of combining electroacupuncture and herbal medicine (Herbal Pharmacopeia 中药) following surgery would be superior to either treatment used alone. According to these authors, this would be a safe and effective method for treating patients who have undergone this surgical procedure. (12)
✨ Overactive Bladder & Laser Acupuncture
Incidentally, Chang et al. published in 2020 the first randomized controlled trial evaluating laser acupuncture in the treatment of overactive bladder. They propose that laser acupuncture could alleviate symptoms of overactive bladder, in addition to improving patients' quality of life. This would make laser acupuncture an effective and safe intervention in treating symptoms of overactive bladder. (13)
Furthermore, a Phase III study was published in 2022 regarding the efficacy and safety of photobiomodulation (LLLT, or low-level laser therapy) in the treatment of overactive bladder. Hwang et al. propose that low-level photobiomodulation would be useful and safe in treating overactive bladder. The device evaluated here was a photobiomodulation device used by the patient at home, at a frequency of 3X/day for 12 weeks. (14)
References
Prevalence & Symptoms
(1) How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study I. Milsom et al., BJU Journal, 12 January 2002
(2) Overactive Bladder vs Stress Incontinence, Foundation for the Assistance of Incontinent Persons, webpage accessed July 8, 2022
Literature Reviews
(3) The role of acupuncture in managing overactive bladder; a review of the literature, James C. Forde et al., International Urogynecology Journal, volume 27, pages 1645–1651, 2016
(4) Acupuncture for adults with overactive bladder, A systematic review and meta-analysis of randomized controlled trials, Yuwei Zhao, MM et al., Medicine (Baltimore), February 2018
(500168-X/fulltext)) Nonantimuscarinic treatment for overactive bladder: a systematic review, American Journal of Obstetrics & Gynecology, Cedric K. Olivera, MD, MS et al., Systematic Review, volume 215, issue 1, pages 34-37, July 2016
(6) Effectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome, Liesbeth L de Wall and John PFA Heesakkers, Research and Reports in Urology, 2017
Notable Randomized Controlled Trials
(7) A randomized controlled trial to assess the effectiveness and safety of acupuncture for overactive bladder: a study in Hong Kong population, Zhi-xiu Lin et al., Chinese Medicine, BMC, Part of Springer Nature, 2020
(8) Effectiveness and safety of acupuncture for overactive bladder: a randomised controlled trial (abridged secondary publication), ZX Lin et al., Hong Kong Medical Journal, 2022
(9) Acupuncture for overactive bladder in female adult: a randomized controlled trial, Zhengyong Yuan et al., World Journal of Urology, volume 33, pages, 1303–1308, November 2014, (2015)
(10) Acupuncture for overactive bladder: a randomized controlled trial
Sandra L Emmons, Lesley Otto, Clinical Trial, Obstetrics and Gynecology, July 2005
(11) Effects of Electroacupuncture on Overactive Bladder Refractory to Anticholinergics: A Single-Blind Randomised Controlled Trial, Jie Zhang et al., Acupuncture in Medicine 33 (5), June 2015
(12) Overactive bladder after transurethral resection of prostate treated with electroacupuncture therapy and tolterodine, Yong-Zhang Shen et al., Randomized Controlled Trial, Zhongguo Zhen Jiu, May 2012
Overactive Bladder & Laser Acupuncture
(13) Laser Acupuncture Alleviates Symptoms and Improves Quality of Life in Women with Overactive Bladder: A Double-Blind, Pilot Randomized Controlled Trial, Yu-Wei Chang et al., Evidence-based Complementary and Alternative Medicine, 2020
(14) Efficacy and safety of skin-adhesive low-level light therapy for overactive bladder: a Phase III study, Woo Yeon Hwang et al., International Urogynecology Journal, 2022
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