Overactive bladder (OAB) is defined by the International Continence Society as "urinary urgency, usually accompanied by frequency & nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology".
1 in 9 of the general adult population are effected by OAB, with slightly more women than men experiencing symptoms & increases with age.
For many, urinary incontinence severely restricts their routine activities & damages their quality of life & self-esteem.
This is another area where there has been a substantial increase in the quality of the research output from China in recent years, with landmark papers published in top Western medical journals. This was the case with Liu’s 2017 study, a large, multicentre RCT for women with stress incontinence. It showed that electroacupuncture, compared with sham electroacupuncture, resulted in less urine leakage after 6 weeks.
In the latest systematic review (Zhao 2018), acupuncture (in particular electroacupuncture) was more effective than sham in decreasing night-time incontinence, relieving voiding symptoms & enhancing patients' quality of life. Ten RCTs with 794 patients were included. The inclusion in future reviews of trials such as Liu’s, & others in the pipeline, will transform the evidence base.
The beneficial effects of acupuncture on OAB symptoms could be partially explained through signalling changes from the central nervous system to the bladder. Acupuncture has been shown to exert an effect on the autonomic nervous system, further endorsing the view that acupuncture can influence the human nervous system & therefore may affect symptoms arising from a disturbance in this system.
There are specific concerns & side‐effects linked to some treatments for OAB. The additive effect of anticholingeric medications, surgical treatments are invasive & may be contraindicated, as well as having a significantly higher risk when compared to acupuncture. In light of this, a systematic review by The Cochrane Library is currently underway to investigate alternative strategies for managing OAB & to provide high‐quality evidence, which is essential to allow patients to make fully informed decisions regarding their choice of therapies.