Welcome to my blog, discover acupuncture with Dr Maggie Ju

Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.

Friday, 29 July 2022

How to get rid of bladder pain?

Bladder is located in the lower abdomen and it is for storing urine. As the urine goes into the bladder, bladder muscles relax so that it can expand. As the bladder empties during urination, the muscles contract to squeeze the urine out through the urethra.

Some condition can cause bladder pain. It is very painful as urinate. The most common condition causing urination pain is interstitial cystitis. Interstitial cystitis (IC) is a chronic condition in which the bladder becomes inflamed and irritated. The inflammation stiffens the bladder wall, and makes it difficult for the bladder to fully expand when filling with urine. Patients with IC have painful urination and have to urinate more frequently and have a feeling of urgency to urinate, though there is no much urine each time. The main symptom of IC is pain which is generally located in the lower back, abdomen or groin region. Bladder pain is often recurring.

Acupuncture is effective for interstitial cystitis/bladder pain syndrome

Interstitial cystitis (IC)/bladder pain syndrome (BPS) is a chronic bladder condition. It is a feeling of pain and pressure in the bladder area and the symptoms have lasted for more than 6 weeks, without having an infection or other clear causes. Symptoms range from mild to severe. For some patients the symptoms may come and go, and for others they don't go away. The pain may be worse when the bladder is full and may be temporarily relieved after urination. The pain could be worse during periods or after having certain foods or drinks. IC/BPS is not an infection, but it may feel like a bladder infection. Women with IC/BPS may feel pain when having sex. Some patients feel pain in other areas, such as the urethra, lower abdomen, lower back, or the pelvic or perineal area (in women, behind the vagina and in men, behind the scrotum). Women may feel pain in the vulva or the vagina, and men may feel the pain in the scrotum, testicle, or penis. This condition is poorly understood.

Apart from the pain, it is also accompanied with problems of urination. Another common symptom is urinary frequency. Frequency is the need to pass urine more often than normal. A patient with IC/BPS often has to urinate frequently both day and night, more frequent urination than normal, pain when passing water, waking up quite a few times during the night to urinate. The average person urinates no more than 7 times a day and does not have to get up at night more than once to use the bathroom. Urgency to urinate is also a common IC/BPS symptom. Some patients feel sudden, strong urges to urinate and an urge that never goes away, even right after voiding. Physical or mental stress can make the symptoms worse.

The exact cause of interstitial cystitis isn't clear. Unlike other types of cystitis, there's no obvious infection in the bladder and antibiotics don't help.

The European Society for the Study of Interstitial Cystitis/Bladder Pain Syndrome in 2008 defined bladder pain syndrome (BPS) as pelvic pain, pressure or discomfort perceived to be related to the bladder, lasting for at least 6 months, and accompanied by at least one other urinary symptom. Urinary symptoms include the persistent urge to void or frequency, in the absence of other identifiable causes. The International Urogynaecological Association (IUGA) and the International Continence Society (ICS) produced a joint report on terminologies by Haylen et al. in 2010, defining bladder pain as a complaint of supra pubic or retro-pubic pressure, discomfort or pain, associated with the bladder, generally aggravated by bladder filling. The symptom may persist or alleviate after voiding. An estimated 400,000 people in the UK suffer from BPS, the majority being women. There is no definitive evidence to support an autoimmune, inflammatory, structural or infectious aetiology. Consequently, treating these patients is often challenging.

Acupuncture can effectively treat IC/BPS syndrome. This is studied by many researchers.

For example, recently research studied the effect of acupuncture for IC/BPS syndrome. In this study, 12 female patients with IC/BPS syndrome received 10 sessions of acupuncture. The visual analog score (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), O'Leary-Saint symptom score (OSS), Patient Health Questionnaire (PHQ9), Pelvic pain and urgency & frequency patient symptom scale tests (PUF) and maximum voided volume (MVV) was completed in 1st, 3rd, 6th and 12th months following the treatment. The result has shown that there was a statistically significant decrease in all of the scores evaluated at first month compared with the baseline. While the change in VAS score in 1, 3, 6 and 12th months were found statistically significant. Response to treatment for the first three months after acupuncture application was (100%). They concluded that acupuncture appears to be an effective, useful, non-invasive method in IC/BPS patients. A study reviewed a recent research papers and found that acupuncture significantly reduces the 24-h urinary frequency and pain score.

A recent research studied the effect of acupuncture for bladder pain. 12 female patients with bladder pain received 10 sessions of acupuncture twice a week.

The following signs were monitored including visual analog score (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), O'Leary-Saint symptom score (OSS), Patient Health Questionnaire (PHQ9), Pelvic pain and urgency & frequency patient symptom scale tests (PUF) and maximum voided volume (MVV) was completed in 1st, 3rd, 6th and 12th months following the treatment. The results have shown that t here was a statistically significant decrease in all of the scores evaluated at first month compared with the baseline. While the change in VAS score in 1, 3, 6 and 12th months were found statistically significant, measurements of ICSI, OSS and PUF scores and MVV values in the 6th and 12th months. The results of this study suggest that acupuncture appears to be an effective, useful, non-invasive method in IC/BPS patients. It can be used as an appropriate treatment method not only in refractory but also in IC patients since it is rather advantageous compared to other treating agents.

Another recent research has investigated the effect of acupuncture for the treatment of bladder pain, urinary freaquency and urgency caused by interstitial cystitis.

In this study 10 patients (1 male, 9 females) suffering from the symptoms due to interstitial cystitis were treated by acupuncture. The treatment was repeated once a week for 4 weeks for the initial treatment (1st to 4th acupuncture). All patients recorded a frequency volume chart as well as IPSS-QOL questionnaire for 1 week before treatment as a baseline, and again after the 4th acupuncture. All patients with complaining of pain recorded visual analogue scale of pain for 1 week before treatment as a baseline, and again after the 4th acupuncture. Acupuncture has improved the clinical symptoms of urinary frequency and urgency and QOL scores, accompanied with increase of bladder capacity as well as with possible inhibition of the sensitivity of C-fiber dysfunction. This study suggested that acupuncture is a safe promising therapeutic alternative for the difficult-to-treat patients with overactive bladder and/or suspicious pelvic pain syndrome.

Recurrent urinary tract infections, acupuncture can help

Acute lower urinary tract infections (UTIs) are common in adult women, and as many as 6% of members of the adult female population experience 3 or more episodes during a given year. Women with frequently recurrent cystitis may need prophylactic antibacterial treatment, however if the infection is recurring and this causes development of antimicrobial resistance. Acupuncture is used to treat UTIs. Recently there was a research from Norway which studied the effect of acupuncture on recurring UTIs in women. In this study, it included women aged 18-60 year old who had to have had 3 or more episodes of distal urinary symptoms (i.e., dysuria and frequent urination or suprapubic discomfort) during the previous 12 months, and at least 2 of these episodes had to have been diagnosed and treated as acute lower UTIs by a medical doctor. Acupuncture was offered twice a week for 4 weeks. Following treatment, 73% of women in the acupuncture group were free of UTIs during the 6-month observation period. Several episodes of acute distal urinary symptoms were noted in which bacterial cultures either were not obtained or were negative. One third as many episodes per person-month occurred in the acupuncture group as in the control group. Women in the acupuncture group experienced a 50% reduction in residual urine after 6 months relative to baseline, whereas women in the untreated group exhibited no significant change in residual urine. This study indicated that acupuncture treatment may be effective in preventing recurrent lower UTIs .

Overactive bladder, acupuncture can help

Overactive bladder is a condition in which the increased urination frequency with other symptoms are found. The symptoms include more frequent urination in the day and night; urine urgency which is sudden, strong need to urinate and leak urine. It could be painful, when one pass the urine.

Overactive bladder is one of the most common urinary tract problems in women. Women have to go to bathroom frequently, feeling severe urge to urinate and feeling fullness of the bladder. This condition is not life threatening, but it affects quality of life in women. At minimum, 11 to 16 million women in the United States cope on a daily basis with symptoms that include sudden strong urges to urinate, difficulty delaying voids, frequent urination, and in many cases involuntary loss of urine when urgency strikes. This causes much stress in women. However the treatments are not satisfactory. Studies have shown that acupuncture can help reducing the symptoms. A recent review from journal Medicine (Baltimore) assessed the efficiency and safety of acupuncture for overactive bladder. 794 patients with 10 randomised controlled trials were included in the study. The result has shown that acupuncture could decrease urination frequency and improve quality of life. Wang S et al studied long-term effect of acupuncture for overactive bladder. At least 5 years were evaluated. 106 patients participated the study. Evaluation was based on a questionnaire including questions on storage, voiding, and postmictutrition syndromes. The mean treatment sessions were 21.2. The results showed that complete resolution was 42.5% and 50% improvement was 85.5%. 62 patients were followed up for 5-10 years. 35 of these 62 patients maintained the posttreatment effect; 18 changed from better to complete resolution; 7 got back to less than 50% improvement; 4 changed less 25% improvement.

Acupuncture is effective for leaking urine

Urinary incontinence is the involuntary leakage of urine from the bladder. It affects 10% of the population. Women are more commonly affected. The most common types of leaking urine are stress incontinence and urge incontinence. Stress incontinence is when urine leaks out at times when the bladder is under pressure, such as coughing, sneezing, heavy lifting exercising and laughing. Stress incontinence is usually the result of the weakening of or damage to the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter. Urge incontinence is when urine leaks as a sudden, intense urge to pass urine is needed. Urge incontinence is usually the result of overactivity of the muscles, which control the bladder. It is also known as overactive bladder. Pelvic floor muscle training is one of the treatments used to treat this condition. Acupuncture is also used to treat this condition. Research on leaking urine with acupuncture treatment is emerging. For example

Recently Xu et al investigated the effectiveness of acupuncture on stress urinary incontinence. Before treatment a 72-hour bladder diary recorded by participants at baseline (week 0) and then acupuncture treatment was applied and the bladder diary was recorded during the treatment period (weeks 2, 4 and 6) and follow-up period (weeks 15–18 and weeks 27–30). In the bladder diary, the participants recorded in detail the time and frequency of UI, activity that occurred at the time of leak, and the type and volume of liquid intake.

80 women participated the study and they reported significant improvement after 6, 18, and 30 weeks acupuncture treatments.

References

Sonmez MG and Kozanhan B Ginekol Pol (2017) 88(2):61-67. doi: 10.5603/GP.a2017.0013.

Hartmann KE Evid Rep Technol Assess (Full Rep) (2009) 187:1-20

Wang S Int Urogynecol J 2013 [Epub ahead of print]

Liu Z et al Trials 2013 14:315

Alraek T et al Am J Public Health (2002) 92:1609

Xu et al PloS One ( 2016) 11(3):e0150821.

Zhao Y et al Medicine (Baltimore). 2018 Feb;97(8):e9838. doi: 10.1097/MD.0000000000009838.

Sonmez MG & Kozanhan B Ginekol Pol (2017) 88:61-67

Verghese TS et al Int Urogynecol J (2016) 27:1127-36

https://www.ics.org/Abstracts/Publish/43/000541.pdf

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