Urge Incontinence

急迫性尿失禁

• 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.

• 急迫性尿失禁是指伴有强烈尿意的不自主漏尿。男、女均可发病，女性多于男性，

• Its incidence increases with age.

• It comes under the category of enuresis in TCM.

• 发病率随年龄增长而增加。• 属中医学遗尿范畴。

Overactive bladder & Urge incontinence

Overactive bladder & Urge incontinence

• 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.

• 一 .   病因和发病机理• 引起急迫性尿失禁的原因可以是神经原

性或非神经原性的。前者多由中风、帕金森氏病、老年痴呆、多发性硬化、脑损伤和脊髓损伤等疾病引起。

• 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.• 后者由尿道梗阻（慢性前列腺增生）、膀胱炎

症（结石、肿瘤）、压力性尿失禁等原因所致，另有些原因不明（特发性）。上述原因都可引起逼尿肌功能亢进，导致急迫性尿失禁。

• Clinical manifestations

• 1.  Symptom

• Involuntary loss of urine associated with a sudden, strong desire to void.

• 二 .   临床表现• 1.   症状• 有突然、强烈的尿意时或之后尿液不自

主地从尿道口流出。

• 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.   体征• 有不能控制的尿急时观察到尿液不自主地从尿

道口流出。护垫试验阳性。会阴区感觉消失、球海绵体肌反射异常。

• Laboratory examination• 1. Urinalysis, vesicourethral X-ray and endoscopy• Showing the non- neurological origins:

inflammation, calculus, tumor and urethral obstruction.

• 三 .   实验室检查• 1.    尿液检查、膀胱尿道 X 线和内窥镜检查• 可发现急迫性尿失禁的非神经原性原因，如炎症、

结石、肿瘤、尿道梗阻等。

• 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.• 2. 尿动力检查• 可见无抑制性逼尿肌收缩（逼尿肌功能亢进）、

初始尿意时膀胱容量减小、最大膀胱容量减少（有不能忍受的强烈尿意时出现尿失禁）、 低顺应性膀胱。

Overactive Bladder:Urodynamics

NormalNormalCystometrogramCystometrogram

Cystometrogram in Cystometrogram in patient with patient with detrusor instability:detrusor instability:

AKA Overactive AKA Overactive BladderBladder

Pves(cmH20)

Pves(cmH20)

Volume (mL)MCC — Maximum Cystometric CapacityMax Pdet — Maximum Detrusor Pressure

Volume (mL)Two nonvoidinvoluntary

contractions that resulted in void

Involuntary contractionsthat resulted in void

Detrusor Leak Point Pressure

• Dagnosis

• Based on

• The symptom (history) of urge incotinence

• Positive pad test.

• The results of imaging urodynamic study.

• 四 .   诊断• 根据：1. 急迫性尿失禁症状（病史）。2. 护垫试验阳性。3. 尿动力检查结果。

• 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,

• 五 . 治疗• 中医针刺治疗• 1. 治疗原则• 中医认为，尿失禁是由于肾气不足，膀

胱不固引起，

• Treatment

• Acupuncture treatment

• 1. Therapeutic principle

• so the therapeutic principle is reinforcing kidney qi and improving vesical restraining function.

• 因此治疗原则是补益肾气，固脬止遗。

• 2. Point selection

• The Back-Shu and Front-Mu points of the kidney and bladder are selected as the main acupoints

• 2. 穴位选择• 主穴是肾和膀胱的背俞穴和募穴。

• 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).

• 常用穴位有：肾俞，膀胱俞，中极，关元，命门，会阳，三阴交，足三里。

• 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.

• 肾和膀胱相表里，故选肾和膀胱的背俞穴。中极是膀胱的募穴。三穴合用有助于补益肾气，固脬止遗。

• 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.

• 关元、命门是元气之源，针之能补肾益元。会阳是足太阳经穴位，针之能振奋膀胱之经气。

• 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.

• 三阴交是足三阴经交会穴，针之能调节足三阴经气。足三里属阳明经，阳明经多气多血，针之能补气止遗。

Electroacupuncture neurostimulation电针神经刺激疗法

• 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).

• 中 医 针 刺 疗 法 和 西 医 神 经 电 刺 激 疗 法（阴部神经刺激，耻骨上经皮神经电刺激和经皮胫神经刺激）的结合。

• 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).

• 1. 穴位选择• 根据中医理论和西医解剖学，结合临床实

践，筛选出二组穴位：（ 1 ）“腹四穴” （经验穴） ；（ 2 ） “骶四穴” （经验穴）。

Four sacral points骶四穴

• 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;

• 2 针刺方法• 1 ）骶四穴• （ 1 ）上两针刺点：骶

骨边缘旁，平第 4 骶后孔水平处（双侧）。

Four sacral points骶四穴

• 2 Acupuncture methods• 1) Four sacral points• (1) The upper two

points: use a long needle of 4 cun (100mm); puncture perpendicularly 3~3.5 cun in depth; make the needling sensation reach the urethra or anus.

• 使用 4寸长针直刺，针刺深度为 3-3.5寸，使针感达尿道或肛门。

Four sacral points骶四穴

• 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);

• （ 2 ）下两针刺点： • 尾骨旁开 0.5寸（双侧），使用 4寸或 5寸长针，

Four sacral points骶四穴

• 2 Acupuncture methods• 1) Four sacral points• (2) The lower two

points: puncture obliquely (laterally) towards the ischiorectal fossa, 3~4.5 cun in depth; make the needling sensation reach the urethra.

• 向外侧（坐骨直肠窝）斜刺， 3-4.5寸深，使针感达尿道。

Four abdominal points

腹四穴

• 2 Acupuncture methods• 2) Four abdominal points• (1) The two upper points:

2.5 cun bilateral to Guanyuan (Ren 4);

• 2 针刺方法• 2 ）腹四穴• （ 1 ）上两针刺点：关

元旁开 2.5寸（双侧）。

Four abdominal points

腹四穴

• 2 Acupuncture methods• 2) Four abdominal points• (1) The two upper points:

use a long needle of 4 cun (100mm); puncture obliquely 1~2 cun in depth; make the needling sensation reach the urethra or vulva.

• 使 用 4 寸 长 针 ， 斜刺， 1-2寸深，使针感达尿道或外阴部。

Four abdominal points

腹四穴• 2 Acupuncture methods• 2) Four abdominal points• (2) The two lower points:

1.5 cun bilateral to Zhongji (Ren 3);

• （ 2 ）下两针刺点：中极旁开 1.5 寸（双侧）。

Four abdominal points

腹四穴

• 2 Acupuncture methods• 2) Four abdominal points• (2) The two lower points:

use a long needle of 4 cun (100mm); puncture obliquely 1~2 cun in depth; make the needling sensation reach the urethra or vulva.

• 使 用 4 寸 长 针 ， 斜刺， 1-2寸深，使针感达尿道或外阴部。

• 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 90~150 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.

• 针感达上述部位后接电针仪。电针采用连续波，频率 90~150 次 /分，强度以患者能适应或感到舒适为准，每次持续 60分钟。电针期间需保持针感达上述部位。

• 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 patient’s condition.

• 治疗隔日 1次，两组穴位交替使用，治疗次数视病情而定。