Research Group on Vesical and Anal Incontinence, First Hospital, Bethune Medical College
Vesical and anal incontinence caused by congenital spina bifida over the lumbosacral area is a painful disease. Since 1970, 500 cases have been treated by acupuncture in this hospital.
The acupuncture points were selected according to the principal symptoms. The patients were divided into 4 groups.
I. Dribbling of urine and no desire to void: Select Zhongji, Henggu, Sanyinjiao, combining with warm moxibustion therapy.
II. Enuresis: Select Jiaji points over lumbosacral segment, combining with the electrostimulation (use G6805 Electrostimulator).
III. Dysuria: Select Changqiang, Huiyin, Zhibian, combining with electroacupuncture.
IV. Anal incontinence: Selecting Changqiang, Huiyin, points around anus; combining with electroacupuncture.
Each course consisted of 10 treatments given once a day. Generally, each patient received 5-6 courses with an interval of 3-5 days.
Therapeutic effects were assessed according to the principal symptoms, volume of residual urine and uroflow rate etc. The treatment gave excellent results in 97 cases (19.4%), caused improvement in 327 cases (65.4%) and was ineffective in 76 cases (15.2%).
Electromyograph of external urethral and anal sphincteric muscles had been recorded since 1973, showing patterns of muscular atrophy due to lower motor neuron lesions in all cases. The residual urine volume and uroflow rate were monitored in 240 cases with sonolayergraph and electronic uroflow meter respectively. A decrease of residual urine volume and an increase of uroflow rate and the amount of each voiding were observed after the therapy. The results were analyzed statistically with P-values <0.01. All cases with clinical improvement showed corresponding changes in these parameters, with residual urine volume decreasing to 0 or ½ the original volume, and uroflow rate increasing to more than 5ml/sec. These objective findings suggested improvement of emptying ability and urinating function of the bladder following acupuncture therapy.
235 cases who had been improved on discharge were followed up for 1-9 years. The therapeutic effects have been persisted in 91 cases (38.9%), decreased in 70 cases (29.8%) and vanished in 67 cases (28.9). Six patients (2.4%) died during this period.
302 patients (60.4%) who had recieved surgical treatment without improvement ½-10 years prior to admission showed therapeutic effects following acupuncture. Eighty previously unoperated cases with unsatisfactory therapeutic effect after acupuncture, surgical treatment had to be given, but still acupuncture instituted following surgery for their post-operative vesical and anal incontinence. Patients complicated with urinary tract infection were treated with antibiotics and Chinese herb drugs accordingly. Attention was paid to the functional exercises of urination and defecation in the process of treatment in order to consolidate and promote the overall therapeutic effects.
Children below 6 years old, owing to lack of cooperation, are not included in this treatment.
Appendix: Criteria of therapeutic effects.
1. Items for judgement.
1) Desire to void ensued Achieved ()
2) Dribbling of urine stopped Partially achieved (±)
3) Enuresis ceased Not achieved (-)
4) Defecation essentially controlled
2. Recent results (on discharge)
1) Excellent: 3 items () and 1 item (±)
2) Improved: 2 items () and 2 items (±) or 1 item (-)
3) Ineffective: more than 2 items (-)
3. Remote results (follow up)
1) Effects persisted: Essentially the same as on discharge.
2) Effects decreased: 1 item () changed to (-) or 2 items () changed to (±)
3) Effects vanished: Reversed to the pretherapeutic state.
Vesical and anal incontinence caused by congenital spina bifida over the lumbosacral area is a painful disease. Since 1970, 500 cases have been treated by acupuncture in this hospital.
The acupuncture points were selected according to the principal symptoms. The patients were divided into 4 groups.
I. Dribbling of urine and no desire to void: Select Zhongji, Henggu, Sanyinjiao, combining with warm moxibustion therapy.
II. Enuresis: Select Jiaji points over lumbosacral segment, combining with the electrostimulation (use G6805 Electrostimulator).
III. Dysuria: Select Changqiang, Huiyin, Zhibian, combining with electroacupuncture.
IV. Anal incontinence: Selecting Changqiang, Huiyin, points around anus; combining with electroacupuncture.
Each course consisted of 10 treatments given once a day. Generally, each patient received 5-6 courses with an interval of 3-5 days.
Therapeutic effects were assessed according to the principal symptoms, volume of residual urine and uroflow rate etc. The treatment gave excellent results in 97 cases (19.4%), caused improvement in 327 cases (65.4%) and was ineffective in 76 cases (15.2%).
Electromyograph of external urethral and anal sphincteric muscles had been recorded since 1973, showing patterns of muscular atrophy due to lower motor neuron lesions in all cases. The residual urine volume and uroflow rate were monitored in 240 cases with sonolayergraph and electronic uroflow meter respectively. A decrease of residual urine volume and an increase of uroflow rate and the amount of each voiding were observed after the therapy. The results were analyzed statistically with P-values <0.01. All cases with clinical improvement showed corresponding changes in these parameters, with residual urine volume decreasing to 0 or ½ the original volume, and uroflow rate increasing to more than 5ml/sec. These objective findings suggested improvement of emptying ability and urinating function of the bladder following acupuncture therapy.
235 cases who had been improved on discharge were followed up for 1-9 years. The therapeutic effects have been persisted in 91 cases (38.9%), decreased in 70 cases (29.8%) and vanished in 67 cases (28.9). Six patients (2.4%) died during this period.
302 patients (60.4%) who had recieved surgical treatment without improvement ½-10 years prior to admission showed therapeutic effects following acupuncture. Eighty previously unoperated cases with unsatisfactory therapeutic effect after acupuncture, surgical treatment had to be given, but still acupuncture instituted following surgery for their post-operative vesical and anal incontinence. Patients complicated with urinary tract infection were treated with antibiotics and Chinese herb drugs accordingly. Attention was paid to the functional exercises of urination and defecation in the process of treatment in order to consolidate and promote the overall therapeutic effects.
Children below 6 years old, owing to lack of cooperation, are not included in this treatment.
Appendix: Criteria of therapeutic effects.
1. Items for judgement.
1) Desire to void ensued Achieved ()
2) Dribbling of urine stopped Partially achieved (±)
3) Enuresis ceased Not achieved (-)
4) Defecation essentially controlled
2. Recent results (on discharge)
1) Excellent: 3 items () and 1 item (±)
2) Improved: 2 items () and 2 items (±) or 1 item (-)
3) Ineffective: more than 2 items (-)
3. Remote results (follow up)
1) Effects persisted: Essentially the same as on discharge.
2) Effects decreased: 1 item () changed to (-) or 2 items () changed to (±)
3) Effects vanished: Reversed to the pretherapeutic state.
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