Rebecca G. Rogers, MD
University of New Mexico Health Sciences Center
Albuquerque, New Mexico
Emmons SL, Otto L. Acupuncture for overactive bladder. A randomized controlled trial. Obstet Gynecol. 2005;106(1):138-143.
Complementary and alternative medicine (CAM) includes a wide range of therapies not presently considered part of conventional medicine. Approximately 30% of general gynecologic patients and 50% of women with pelvic floor dysfunction use CAM therapies regularly; the number of pelvic floor disorders (incontinence and/or prolapse) and history of prior failed conventional therapy is associated with increased uptake.1 Despite widespread use, the literature investigating the efficacy of CAM therapies in treatment of pelvic floor dysfunction is limited, particularly with regard to treatment of overactive bladder symptoms. Two studies have examined the use of hypnotherapy to treat OAB; a case series that showed modest effect and a pilot randomized trial showing improvement among women who underwent hypnotherapy compared to those who underwent behavioral therapy.2,3 Another trial investigated whether reflexology was effective in the treatment of overactive bladder symptoms and showed improvement among women who underwent reflexology compared to those who underwent non-specific foot massage.4 Acupuncture has been used for a variety of gynecologic treatments including treatment of pelvic pain, dysmenorrhea, and uterine fibroids. Case series have shown some efficacy among children with nocturnal enuresis, as well as older women with overactive bladder symptoms.
This is a randomized controlled trial of women assigned to either acupuncture which had been previously described as effective in the treatment of overactive bladder or to acupuncture designed to increase relaxation. Eligible women had frequency ≥ 8 voids in 24 hours, urgency, and at least two urgency urinary incontinence episodes measured during a three-day voiding diary. Patients received 4 weekly acupuncture treatments. At baseline and 2-4 weeks after the 4 acupuncture treatments, patients completed 3-day voiding diaries (number of voids, number of incontinence episodes, and volume voided), underwent cystometric testing, and completed the urinary distress inventory and incontinence impact questionnaires. The primary outcome measure was the number of urgency urinary incontinence episodes on voiding diary at conclusion of the treatment period.
- Eighty-five women were enrolled; 44 in the OAB-directed acupuncture (intervention) group and 41 in the placebo group. Of those enrolled, 38 women completed follow-up in the intervention group and 36 completed in the placebo group.
- At the end of treatment, no significant difference was found in the number of incontinent episodes on three day voiding diaries between treatment groups; compared with baseline, the number of incontinent episodes decreased by 59% in the OAB acupuncture treatment group and by 40% in the placebo group (P = 0.71)
- Women in the intervention group reported significantly greater improvement in frequency compared with placebo treatment (14% vs 4% decrease from baseline, respectively, P = 0.03) and incontinence impact questionnaire scores when compared to placebo (52% vs 23% reduction in mean scores, respectively, P = 0.004).
- No significant adverse events were experienced secondary to either OAB-directed acupuncture or placebo acupuncture
CAM use is popular among urogynecologic patients. This trial investigated the efficacy of acupuncture for the treatment of overactive bladder symptoms in the short term among patients with urgency urinary incontinence and found that OAB-directed acupuncture showed modest improvement in overactive bladder symptoms when compared to placebo acupuncture. These modest results are consistent with conventional therapies that show modest symptom improvement following medications, behavioral therapy or physical therapy. Comparative effectiveness trials comparing CAM therapies to medications are warranted.
- Slavin SL, Rogers RG, Komesu Y, et al. Complementary and alternative medicine (CAM) use in women with pelvic floor disorders: a cohort study. Int Urogynecol J. 2010;21(4):431-437.
- Freeman RM , Baxby K. Hypnotherapy for incontinence caused by the unstable detrusor. Br Med J. 1982;284:1831-1834.
- Komesu YM, Sapien RE, Rogers RG, Ketai LH. Hypnotherapy for treatment of overactive bladder: a randomized controlled pilot study. Female Pelvic Med Reconstr Surg. 2011;17(6):308-313.
- Mak HL, Cheon WC, Wong T, Liu YS, Tong WM. Randomized controlled trial of foot reflexology for patients with symptomatic idiopathic detrusor overactivity. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(6):653-658.