Aug. 26, 2005 — Acupuncture may be effective therapy for overactive bladder, according to the results of a randomized study reported in the July issue of Obstetrics & Gynecology.

"Several studies support acupuncture as a potentially successful treatment of urinary urgency, frequency, and urgency incontinence," write Sandra L. Emmons, MD, and Lesley Otto, MD, from the Oregon Health and Science University in Portland. "These [previous] trials were neither randomized nor blinded. We hypothesized that acupuncture treatments directed at overactive bladder would reduce urinary incontinence, frequency, and urgency as reported by voiding diary, and would reduce the psychological distress of overactive bladder as captured by the urinary distress inventory and the incontinence inventory questionnaire."

In this trial, 85 women were randomized to receive an acupuncture treatment expected to improve their bladder symptoms, or to a placebo acupuncture treatment designed to promote relaxation. Before and after four weekly acupuncture treatments, these women underwent cystometric testing and completed a three-day voiding diary, urinary distress inventory, and incontinence impact questionnaire. The primary outcome was number of incontinent episodes over three days, and secondary outcomes were voiding frequency and urgency, cystometric bladder capacity, maximum voided volume, and scores on the urinary distress inventory and incontinence impact questionnaire.

Of the 85 participants, 74 completed the study. Both groups had significant decreases in number of incontinent episodes (59% for treatment, 40% for placebo) with no significant difference between groups. In the treatment group, there was a 14% decrease in urinary frequency ( P = .013), a 30% decrease in the proportion of voids associated with urgency ( P = .016), and a 13% increase in both maximum voided volume and maximum cystometric capacity ( P = .01).

Urinary distress inventory and incontinence impact questionnaire scores improved in both groups (54% decrease with treatment, 30% decrease with placebo; P = .001 for the difference in change between groups).

"Women who received four weekly bladder-specific acupuncture treatments had significant improvements in bladder capacity, urgency, frequency, and quality-of-life scores as compared with women who received placebo acupuncture treatments," the authors write.

Study limitations include 11 incomplete evaluations creating insufficient power to detect a 75% reduction in incontinent episodes; use of a three-day rather than a seven-day voiding diary; and lack of a good placebo for acupuncture.

"In this study, acupuncture had a significant short-term effect on overactive bladder, similar in scope to the improvement offered by drug therapy and physical or behavioral therapy," the authors conclude. "These results need to be confirmed with a larger sample, and extended to see whether the effect is sustained."

The Oregon Health Science Foundation supported this study in part.

Obstet Gynecol. 2005;106:138-143

Reviewed by Gary D. Vogin, MD