Efficacy of various forms of acupuncture for the treatment of urinary incontinence in women: a systematic review and meta-analysis

The most common type of urinary incontinence (UI) is stress UI (SUI), defined by the International Continence Society (ICS) as any involuntary urine leakage that occurs during physical exertion [1]. SUI is highly prevalent among women older than 18 years and greatly influences general health, overall well-being, and quality of life [2]. In addition to SUI, overactive bladder (OAB) is also prevalent among women and is defined by the ICS as urgency, with or without urge UI, often accompanied by urinary frequency and nocturia [3]. Population-based survey studies have reported that the prevalence of SUI ranges from 5% to 70% [4], whereas the prevalence of OAB ranges from 11% to 32.6% [5, 6].

Acupuncture is becoming increasingly popular in high-income countries and in the West, to treat a wide variety of chronic conditions, particularly those conditions that are difficult to treat with conservative, conventional therapies [7, 8]. Acupuncture comprises a range of therapeutic methods, including body acupuncture, hand acupuncture, Japanese meridian acupuncture, scalp acupuncture, fire needle acupuncture, auricular acupuncture, Saam acupuncture, laser acupuncture, elongated needle acupuncture, and electroacupuncture [8]. Body acupuncture is a common type of acupuncture that involves the insertion of needles into various acupoints on the body [8]. Hand acupuncture uses needles to stimulate specific points on the hands. The Japanese meridian acupuncture method utilizes thin needles and shallow insertion [9]. Scalp acupuncture refers to the application of acupuncture needles to the surface of the head, whereas auricular acupuncture involves the stimulation of acupoints in the auricle (ear) with needles [8]. Saam acupuncture refers to a form of Korean acupuncture, which utilizes four needles, two of which are used to sedate or reduce excess Qi (energy flow) in one organ system, while the other two needles ‘tonify’ or increase Qi in a second organ system [9, 10]. Fire needle acupuncture uses needles that are heated by an ethanol lamp until they are red and hot, and then they are used to prick the skin [8, 11]. Laser acupuncture is a therapeutic method that combines acupuncture with low-intensity, non-thermal laser irradiation [12]. Elongated needle acupuncture utilizes needles longer than 125 mm for stimulation [8]. Electroacupuncture combines acupuncture and electrical stimulation, with the electrodes of an electrical stimulator attached to the acupuncture needles [8].

The effectiveness of different acupuncture methods, including hand [13, 14], laser [15, 16], body [17, 18], and electroacupuncture [19,20, 21], for the treatment of mixed, urge, and SUI in women has been evaluated in several RCTs. However, limited empirical evidence exists regarding the effectiveness of alternative acupuncture methods, such as Saam [22], auricular [23, 24] fire needle [25], scalp [26, 27], and elongated needle [28] acupuncture, for the treatment of UI in women. Physiological studies have provided a credible basis for the effects of acupuncture to treat UI. Napadow et al. [29] identified an increased functional magnetic resonance imaging signal in humans in response to electroacupuncture and suggested that the activation in the limbic system is central to the clinical efficacy of acupuncture. In animal studies, induced bladder overactivity was decreased following sacral acupuncture, which may be due to the inhibition of the nociceptive afferent C-fibres thought to cause abnormal bladder sensation [8, 30]. Electroacupuncture reduced the biochemically mediated micturition center effects, in rats whose bladders were artificially irritated [31, 32]. According to Traditional Chinese Medicine theory, UI is caused by a deficiency in the ‘Qi’ of the kidneys, resulting in "bladder's failure” and the loss of urination control [8]. A 2013 Cochrane review of acupuncture for UI treatment reported that according to the ancient Chinese medical text [33] the bladder's failure to control the urine leads to UI [8]. Acupuncture applied to acupoints on the bladder and the kidney meridian regulates Qi, promotes the recovery of bladder function, and improves continence for the treatment of UI [8].

Current systematic reviews examining the use of acupuncture to treat UI in women require updating, due to previous inconclusive results [8, 34], and the availability of newly published studies examining the effects of acupuncture on UI. This review aimed to determine the efficacy of various forms of acupuncture for the treatment of UI in women.

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