Incontinence

Compiled by John G. Connor, M.Ac., L.Ac., Edited by Barbara Connor, M.Ac., L.Ac.

TABLE OF CONTENTS
Introduction
Hara Visceral Work and Incontinence
Neurological Conditions
Goals of Mobilization
Treatment of Sphincter Deficiencies
Injuries Which Provoke Incontinence
Drugs That Can Cause Incontinence
Chinese Medical Explanation of Incontinence
Research on How Acupuncture Benefits Incontinence
Recommendations
References

INTRODUCTION
• I have written the following article to help you better understand the problem of incontinence and to let you know some of the natural remedies available to help you control it.  Barbara and I use a combination of craniosacral acupuncture, hara visceral work and herbs to treat this condition.

• Incontinence is the inability to control the voiding of urine. The urine is passed involuntarily; the person involved knows he or she is doing it, but cannot hold it back. In less severe cases, there may only be urgency of urination or difficulty in holding urine. Enuresis is involuntary discharge of urine without realizing it. This usually happens to children in nocturnal enuresis.

• In stress incontinence, loss of urine always occurs during some unusual stress, coughing, sneezing, muscular exertion, anything which increases bladder pressure and presses on the sphincters. A bladder which loses urine when there is no local stress demands careful attention. In that case one would look for causes such as tumors, neurological, or hormonal phenomena.

HARA VISCERAL WORK AND INCONTINENCE
• Turgor effect is the ability of an organ to occupy a maximal space within a given cavity, due to its elasticity and vascular pressure. The gas contained in the digestive organs contributes to turgor effect in the abdominal cavity. Gas contained in the small intestine influences the pelvic organs. It is easy to see how, for example, a spastic colon could push down on the bladder and stimulate the urethral sphincter.

• Bladder mobilizations have clearly beneficial effects on stress incontinence and should be among the treatments considered first for stress incontinence.

• It has been found that fibrosis, hypotonia or loss of elasticity in the tissues of the bladder/perineal region causes the sphincters to lose their occlusive ability.

• When suspension and support of the bladder are compromised, the fibers of the internal sphincter become incorrectly oriented and less functional. Faulty transfer of abdominal/pelvic pressure, however, is the factor having the greatest adverse effect.

• The bladder can adhere to any of the organs or tissues which surround it. These adhesions can change the functional position of the bladder (e.g. rotate or sidebend it) leading to pressure imbalances and possible incontinence.

• Adhesions of the superior surface of the bladder often result from surgery of the abdomen or pelvic area, sequlae of infections such as peritonitis, appendicitis and pelvic inflammatory disease.

NEUROLOGICAL CONDITIONS
• In stress incontinence, the patient remains continent unless there is some unusual stress on the bladder. In neurological incontinence, voluntary control of urination is not possible; urination is controlled solely by the autonomic nervous system. This condition is found with such illnesses as multiple sclerosis, cerebral tumor, atheroma, spina bifida and advanced Parkinson’s disease. Conditions such as diabetic neuropathy, chronic anemia and thyrotoxicosis can also impair nervous control of the bladder function.

GOALS OF MOBILIZATION
• The goals of urogenital visceral mobilization are:
1) To release the tissues from restriction
2) To restore normal physiology
3) To promote fluid circulation
4) To reduce inflammation and pain
5) To reinforce tonus of the abdominal wall6) To reinforce the occlusive functions of sphincters

TREATMENT OF SPHINCTER DEFICIENCIES
• Mobilization of the bladder has an undeniable local effect, but also a reflexogenic effect. Stretching stimulates various receptors in the bladder wall, leading to stimulatory effects on the detrusor and internal and external sphincters. This approach is often helpful in cases of ureterovesical reflux and sphincter hypotonia.

INJURIES WHICH PROVOKE INCONTINENCE
• Ligamentous sacrococcygeal restrictions
• Tiny restrictions of the trigone, bladder neck or proximal urethra.
• Bladder irritability.
• Bladder/urethral inflammation (from diverse infectious agents)
• Sclerosis or secondary fibrosis after surgery
• Intrapelvic visceral ptoses or prolapses.
• Intrapelvic visceral loss of mobility.  
• Essentially all lumbosacral traumas or restrictions adversely affect pelvic tonicity and sphincter control.

DRUGS THAT CAN CAUSE INCONTINENCE
• Antibiotics, atropine, benzodiazepines, beta-blockers, bupropion, diuretics, doxazosin, fluoxetine, levobunolol, lithium, misoprostol, nicardipine, nifedipine, prazosin, sleeping pills, spironolactone, terazosin and tranquilizers.

CHINESE MEDICAL EXPLANATION OF INCONTINENCE
• The natural decline of Qi (energy) which occurs with ageing may cause incontinence in the elderly. This is due to a decline not only of Kidney Qi, but also of Lung and Spleen Qi.  Also with age we see decreased tone and elasticity of muscles and connective tissue, vascular problems, etc,

• The pathology of incontinence and enuresis is always characterized by Deficiency. This may be a deficiency of the Lungs, Spleen or Kidneys. Lung Qi communicates downwards with the Bladder and the Lungs, which govern Qi in general, also provide Qi to the Bladder to control urine. Thus deficient Lung Qi is unable to control the Bladder and urine leaks out.

• Spleen Qi raises Qi in general and a sinking of Spleen Qi may be unable to control urine which leaks out. The Kidneys obviously control urination directly as the balance of Kidney Yang and Kidney Yin influence urination and also because Kidney Yang provides Qi to the Bladder to control and transform urine.

• According to Chinese Medical Pattern Discrimination we may see any one or a combination of the following patterns in incontinence:1) Lung Qi Deficiency 2) Spleen Qi Deficiency 3) Kidney Yang Deficiency 4) Kidney Yin Deficiency

• Barbara and I use acupuncture and herbs to treat incontinence based upon which of the above Chinese Medical Patterns might be present.

RESEARCH ON HOW ACUPUNCTURE BENEFITS INCONTINENCE
• The results of a study published in Int J Urol 2002 Dec;9(12):672-6 by Honjo et al entitled “Treatment of monosymptomatic nocturnal enuresis by acupuncture.  A preliminary study.” concluded that acupuncture may be beneficial in the treatment of nocturnal enuresis by increasing nocturnal bladder capacity; and provide a promising alternative to conventional therapies for monosymptomatic nocturnal enuresis.

• The results of a study (in Japanese) published in Nippon Hinyokika Gakkai Zasshi 1998 Jul;89(7):665-9 by Honjo et al entitled “Acupuncture for urinary incontinence in patients with chronic spinal cord injury. A preliminary report” concluded that acupuncture could be a promising alternative for conventional therapies for urinary incontinence caused by detrusor hyperreflexia in patients with chronic spinal cord injuries.

• The results of a study published in Neurologija 1990;39(3):179-84 by Roje-Starcevic entitled “The treatment of nocturnal enuresis by acupuncture” confirmed that acupuncture represents a new possibility of treatment of patients with enuresis.

RECOMMENDATIONS
• Avoid alcohol, caffeine, carbonated beverages, coffee, chocolate, refined or processed foods and simple sugars. Chemicals in food, drugs and impure water have an adverse effect on the bladder.

• Avoid certain foods such as asparagus, radishes and cabbage which irritate the bladder and worsen the odor associated with incontinence. Drink often, but not much at a time (to avoid overloading the bladder).

• Do pelvic exercises such as Kegel’s exercises. Daily exercises can strengthen pelvic muscles and improve bladder control.