Transforming lives
They are excruciatingly embarrassing and distressing conditions, yet are increasingly common – affecting 5 million women and 2 million men in the UK. Not just related to age – according to some estimates 15-20% (1 in 5) women aged 20-39 have symptoms of bladder overactivity and 0.3% suffer from painful bladder syndrome.
They may be sniggered at but these bladder problems have an enormous impact on patient’s lives. The commonest symptoms are bladder pain, frequency (going to the loo very often,) and nocturia (having to get up at night, often frequently) but patients are more distressed by the depression, fatigue and anxiety that go with Overactive Bladder Syndrome (OAB). Other terms used are irritable bladder syndrome, irritative bladder syndrome, and painful bladder syndrome, and these conditions overlap with chronic prostatitis and chronic pelvic pain syndrome, and interstitial cystitis (IC).
Conventional medical treatments are not hugely successful and may have unpleasant side effects. Amitriptyline has been tried but has been shown to be no better than placebo and dropout rates are high because of side effects. Anticholinergic drugs may cause unacceptable dryness of the mouth, bladder instillations (Cystistat), hydrodistension (stretching) of the bladder and anticonvulsant pain killers such as gabapentin (Lyrica) have unpleasant side effects. Some of these patients even go on to have the bladder removed.
In a small study presented to the American Urological Association in 2009 acupuncture was tested against conventional treatments and won hands down (Success of acupuncture in the treatment of interstitial cystitis. Reeves, Chapple and Pullman: Journal of Urology 2009:181:23 Abst. 62). Before the study all patients had pain and frequency and 20% had pain on intercourse. Following a course of acupuncture all patents reported an improvement in their symptoms, and quality of life improved for an astonishing 86% (while only 8% had found hydrodistension helpful, only 36% had thought Cystistat helped and none had been helped by Lyrica). There have been many other small scale studies worldwide, both in the laboratory and with patients, for acupuncture treatment of bladder conditions, which have shown similar positive results.
For patients who are helped by acupuncture the effect may be life transforming and patients tell me they have “got their life back.”
How does it work?
Acupuncture produces many different effects in the body, some locally and some in the brain. Modern research into the causes of OAB and related conditions is now looking at the changes that occur in the brain and there is evidence from research studies that many of the improvements following acupuncture may be due to changes in brain activity. There will also be local effects which lower inflammation in the bladder area. For instance it has been shown that patients with IC and OAB have higher than normal levels of an inflammatory marker called nerve growth factor (NGF). A separate piece of research has shown that acupuncture can modify levels of NGF.
Most patients respond well to 6 sessions of treatment with acupuncture and electroacupuncture, and the effects are lasting, although some people need top up or maintenance treatments from time to time.
