Urge Incontinence 急迫性尿失禁

1. Urge Incontinence急迫性尿失禁

2. Urge urinary incontinence (UUI) is defined as involuntary loss of urine associated with a sudden, strong desire to void. • It happens in both men and women and more in the latter. • 急迫性尿失禁是指伴有强烈尿意的不自主漏尿。男、女均可发病，女性多于男性，

3. Its incidence increases with age. • It comes under the category of enuresis in TCM. • 发病率随年龄增长而增加。 • 属中医学遗尿范畴。

4. Overactive bladder & Urge incontinence

5. Etiology and Pathogenesis • UUI can be of neurological or non-neurological origin. • The former include stroke, Parkinson's disease, Alzheimer's disease, multiple sclerosis, brain injury and spinal injury. • 一.   病因和发病机理 • 引起急迫性尿失禁的原因可以是神经原性或非神经原性的。前者多由中风、帕金森氏病、老年痴呆、多发性硬化、脑损伤和脊髓损伤等疾病引起。

7. Etiology and Pathogenesis • The latter include urethral obstruction (chronic prostate hyperplasia), vesical inflammation (calculus, tumor) and stress urinary incontinence. • UUI can also be of idiopathic origin. • All the above causes can produce detrusor overactivity to result in urge urinary incontinence. • 后者由尿道梗阻（慢性前列腺增生）、膀胱炎症（结石、肿瘤）、压力性尿失禁等原因所致，另有些原因不明（特发性）。上述原因都可引起逼尿肌功能亢进，导致急迫性尿失禁。

8. Clinical manifestations • 1.  Symptom • Involuntary loss of urine associated with a sudden, strong desire to void. • 二.   临床表现 • 1.  症状 • 有突然、强烈的尿意时或之后尿液不自主地从尿道口流出。

9. Clinical manifestations • 2.  Signs • The observation of involuntary urinary loss from the urethra synchronous with an uncontrollable urge to void. • Positive pad test. • Perineal anesthesia. • Abnormal bulbocavernosus reflex. • 2.  体征 • 有不能控制的尿急时观察到尿液不自主地从尿道口流出。护垫试验阳性。会阴区感觉消失、球海绵体肌反射异常。

10. Laboratory examination • 1. Urinalysis, vesicourethral X-ray and endoscopy • Showing the non- neurological origins: inflammation, calculus, tumor and urethral obstruction. • 三.   实验室检查 • 1.   尿液检查、膀胱尿道X线和内窥镜检查 • 可发现急迫性尿失禁的非神经原性原因，如炎症、结石、肿瘤、尿道梗阻等。

11. Laboratory examination • 2. Urodynamic study • Involuntary detrusor contraction (detrusor overactivity). • A decrease in bladder capacity at the first desire for urination. • A decrease in maximum bladder capacity (incontinence with an uncontrollable desire to void). • Low bladder compliance. • 2. 尿动力检查 • 可见无抑制性逼尿肌收缩（逼尿肌功能亢进）、初始尿意时膀胱容量减小、最大膀胱容量减少（有不能忍受的强烈尿意时出现尿失禁）、 低顺应性膀胱。

12. Overactive Bladder:Urodynamics Normal Cystometrogram Pves (cmH20) Volume (mL) MCC — Maximum Cystometric Capacity Max Pdet — Maximum Detrusor Pressure Cystometrogram in patient with detrusor instability: AKA Overactive Bladder Pves (cmH20) Volume (mL) Two nonvoid involuntary contractions that resulted in void Involuntary contractions that resulted in void

13. Detrusor Leak Point Pressure

14. Dagnosis • Based on • The symptom (history) of urge incotinence • Positive pad test. • The results of imaging urodynamic study. • 四.   诊断 • 根据： 1. 急迫性尿失禁症状（病史）。 2. 护垫试验阳性。 3. 尿动力检查结果。

15. Treatment • Acupuncture treatment • 1. Therapeutic principle • According to TCM theory, it is caused by deficiency of kidney qi and failure of the bladder in restraining the urine discharge, • 五. 治疗 • 中医针刺治疗 • 1. 治疗原则 • 中医认为，尿失禁是由于肾气不足，膀胱不固引起，

16. Treatment • Acupuncture treatment • 1. Therapeutic principle • so the therapeutic principle is reinforcing kidney qi and improving vesical restraining function. • 因此治疗原则是补益肾气，固脬止遗。

17. 2. Point selection • The Back-Shu and Front-Mu points of the kidney and bladder are selected as the main acupoints • 2. 穴位选择 • 主穴是肾和膀胱的背俞穴和募穴。

18. 2. Point selection • The acupoints often selected are Shenshu (B 23), Pangguangshu (B 28), Zhongji (Ren 3), Guanyuan (Ren 4), Mingmen (Du 4), Huiyang (B 35), Sanyinjiao (Sp 6) and Zusanli (S 36). • 常用穴位有：肾俞，膀胱俞，中极，关元，命门，会阳，三阴交，足三里。

19. 2. Point selection • The kidney is exteriorly-interiorly related to the bladder, so the Back-Shu points of the kidney and bladder are applied. Zhongji (Ren 3) is the Front-Mu points of the bladder. The combined use of the above three acupoints contributes to reinforce kidney qi and improve vesical restraining function. • 肾和膀胱相表里，故选肾和膀胱的背俞穴。中极是膀胱的募穴。三穴合用有助于补益肾气，固脬止遗。

20. 2. Point selection • Guanyuan (Ren 4) and Mingmen (Du 4) are the sources of primordial qi and acupuncture of them can tonify primordial yang (kidney-yang). Huiyang (B 35) is the acupoint of the foot-taiyang meridian and acupuincture of it can invigorate the meridional qi of the bladder. • 关元、命门是元气之源，针之能补肾益元。会阳是足太阳经穴位，针之能振奋膀胱之经气。

21. 2. Point selection • Sanyinjiao (Sp 6) is the crossing point of the three foot-yin meridians and acupuncture of it can regulate the qi of the three foot-yin meridians. Zusanli (S 36) belongs to the yangming meridian, which is full of qi and blood, acupuncture of it can tonify qi to stop incontinence. • 三阴交是足三阴经交会穴，针之能调节足三阴经气。足三里属阳明经，阳明经多气多血，针之能补气止遗。

22. Electroacupuncture neurostimulation电针神经刺激疗法 • A combination of acupuncture in traditional Chinese medicine and electrical nerve stimulation in western medicine (including pudendal nerve stimulation, suprapubic transcutaneous electrical nerse stimulation and percutaneous tibial nerve stimulation). • 中医针刺疗法和西医神经电刺激疗法（阴部神经刺激，耻骨上经皮神经电刺激和经皮胫神经刺激）的结合。

23. 1. Acupoint selection • According to TCM theory and modern anatomy in combination with clinical practice, we sift out two groups of acupoints: (1) Four abdominal points (empirical) and (2) Four sacral points (empirical). • 1. 穴位选择 • 根据中医理论和西医解剖学，结合临床实践，筛选出二组穴位：（1）“腹四穴” （经验穴） ；（2） “骶四穴” （经验穴）。

24. 2 Acupuncture methods 1) Four sacral points (1) The upper two points: located by the two edges of the sacrum on a level with the fourth sacral foramina; 2 针刺方法 1）骶四穴 （1）上两针刺点：骶骨边缘旁，平第4骶后孔水平处（双侧）。 Four sacral points骶四穴

25. 2 Acupuncture methods 1) Four sacral points (1) The upper two points: use a long needle of 4 cun (100mm); puncture perpendicularly 3~3.5 cun in depth; make the needling sensation reach the urethra or anus. 使用4寸长针直刺，针刺深度为3-3.5寸，使针感达尿道或肛门。 Four sacral points骶四穴

26. 2 Acupuncture methods 1) Four sacral points (2) The lower two points: 0.5 cun bilateral to the tip of the coccyx; use a long needle of 4 or 5 cun (100 or 125mm); （2）下两针刺点： 尾骨旁开0.5寸（双侧），使用4寸或5寸长针， Four sacral points骶四穴

27. 2 Acupuncture methods 1) Four sacral points (2) The lower two points: puncture obliquely (laterally) towards the ischiorectal fossa, 3~4.5 cun in depth; make the needling sensation reach the urethra. 向外侧（坐骨直肠窝）斜刺，3-4.5寸深，使针感达尿道。 Four sacral points骶四穴

34. 2 Acupuncture methods 2) Four abdominal points (1) The two upper points: 2.5 cun bilateral to Guanyuan (Ren 4); 2 针刺方法 2）腹四穴 （1）上两针刺点：关元旁开2.5寸（双侧）。 Four abdominal points腹四穴

35. 2 Acupuncture methods 2) Four abdominal points (1) The two upper points: use a long needle of 4 cun (100mm); puncture obliquely 1~2 cun in depth; make the needling sensation reach the urethra or vulva. 使用4寸长针，斜刺，1-2寸深，使针感达尿道或外阴部。 Four abdominal points腹四穴

36. 2 Acupuncture methods 2) Four abdominal points (2) The two lower points: 1.5 cun bilateral to Zhongji (Ren 3); （2）下两针刺点：中极旁开1.5寸（双侧）。 Four abdominal points腹四穴

37. 2 Acupuncture methods 2) Four abdominal points (2) The two lower points: use a long needle of 4 cun (100mm); puncture obliquely 1~2 cun in depth; make the needling sensation reach the urethra or vulva. 使用4寸长针，斜刺，1-2寸深，使针感达尿道或外阴部。 Four abdominal points腹四穴

43. 2 Acupuncture methods • After the needling sensation reaches the above positions, an electroacupuncture instrument is connected. Used for electroacupuncture are continuous waves, a frequency of 90~150 times/min and an intensity that the patient is adaptable or feels comfortable. It lasts 60 min. The needling sensation must reach the above positions during electroacupuncture. • 针感达上述部位后接电针仪。电针采用连续波，频率90~150次/分，强度以患者能适应或感到舒适为准，每次持续60分钟。电针期间需保持针感达上述部位。