Acupuncture alleviates diabetic neurogenic bladder. Jiaozuo Hospital (Henan, China) researchers conducted a controlled investigation and concluded that acupuncture significantly improves bladder function and regulates blood glucose levels in patients with diabetic neurogenic bladder. This condition is a type of diabetic neuropathy that causes a variety of issues dependent upon the type of nerve damage involved. Dysfunction ranges from an overactive bladder to impairment of bladder contractility.

This disorder is caused, in part, by damage to the visceral afferent nerve fibers of the bladder resultant from diabetes. The bladder’s detrusor muscle may be affected. Often, there is a reduced desire to void the bladder and difficulty in initiating and maintaining urination. Patients may experience frequent urination in small amounts, decreased urination frequency, incomplete voiding of the bladder, urgent urination, loss of bladder control, overfilling of the bladder and leaking, decreased bladder sensations with the inability to feel when it is full, decreased bladder contractility, and urinary retention.

The researchers compared two groups. One group received warm needle acupuncture plus mecobalamin (vitamin B12) and the other group received only mecobalamin. The group receiving acupuncture experienced significantly greater improvements in bladder function, blood glucose control, and clinical symptoms compared with the mecobalamin monotherapy control group (p<0.05).

A total of 122 patients with DNB (diabetic neurogenic bladder) were recruited for the study and were assigned by random number table to the control group or the acupuncture group. The control group was comprised of 34 male and 27 female patients, ages 41–80 years (mean age 50.28 years), that been diagnosed with diabetes for 2–14 years (mean 9.12 years). The acupuncture group was comprised of 32 male and 29 female patients, ages 40–78 years (mean age 50.46 years), that had been diagnosed with diabetes for 1–16 years (mean 9.37 years). There were no statistically significant differences in baseline characteristics between the two groups at the initiation of the investigation (p>0.05).

Inclusion criteria for the study were as follows: meeting the diagnostic criteria for DNB, including the symptoms of inhibited urination, urinary retention, urinary incontinence, nocturia, fatigue, dry mouth, excessive thirst, pale tongue with a thin-white coating, a deep and fine or feeble pulse, a residual bladder volume of ≥100 mL, age ≤80 years, and ability to give informed consent. Exclusion criteria were as follows: other causes of urinary dysfunction, other types of diabetic diseases, allergies.

 

Treatment
The participants in both groups received lifestyle advice, including the topics of diet, exercise, and blood glucose control. In addition, all participants were prescribed mecobalamin tablets (0.5 mg, 3 times daily, 30 minutes after eating). Treatment was administered daily for a total of four weeks. Participants in the acupuncture group received identical treatment plus acupuncture at the following primary acupoints:

  • Qihai (CV6)
  • Guanyuan (CV4)
  • Zhongji (CV3)

Secondary acupoints, selected based upon individual presentations of the condition, were chosen from the following:

  • Zhibian (BL54)
  • Pishu (BL20)
  • Shenshu (BL23)
  • Yinlingquan (SP9)
  • Sanjiaoshu (BL22)
  • Sanyinjiao (SP6)
  • Taixi (KD3)

Patients were required to empty their bladders prior to treatment. Needles ranging from 1.0–3.0 cm were selected according to each patient’s body size and were inserted into the acupoints. The primary acupoints were utilized during every treatment, along with 4–6 of the secondary acupoints.

Warm needle acupuncture was administered at Zhongji. The needle was inserted to a depth of 0.5–1 cm and was manipulated to elicit a deqi needle sensation. After the patient experienced deqi, a 1 cm piece of moxa roll was attached to the needle handle and was ignited. After the moxa self-extinguished, the ash was removed and the needle was manipulated once more prior to removal. Treatment was administered daily for a total of four weeks.

 

Results
Outcome measures for the study included bladder function (urinary frequency, daily average urine volume, maximum urinary output, residual bladder volume determined by B-scan ultrasonography), blood glucose levels (fasting and 2-hour postprandial), and TCM symptom scores (dry mouth/thirst, fatigue, lumbar/knee pain, urinary frequency, urinary duration).

Mean pre-treatment urinary frequency (number of urinations per day) was 9.38 in the control group and 9.26 in the acupuncture group. After treatment, these figures fell to 7.82 and 6.74 respectively. Mean pre-treatment daily average urine volume was 189.17 mL in the control group and 192.84 mL in the acupuncture group. After treatment, this increased to 268.53 mL and 384.26 mL respectively.

Mean pre-treatment maximum urinary output was 235.32 mL in the control group and 232.24 mL in the acupuncture group. After treatment, this increased to 303.62 mL and 462.47 mL respectively. Mean pre-treatment residual bladder volume was 122.49 mL in the control group and 119.68 mL in the acupuncture group. After treatment, this reduced to 72.52 mL and 39.68 mL respectively. Participants in the acupuncture group experienced significantly greater improvements across all measures of bladder function (p<0.05).

Mean pre-treatment fasting glucose was 8.28 mmol/L in the control group and 8.17 mmol/L in the acupuncture group. After treatment, this was reduced to 6.92 mmol/L and 6.27 mmol/L respectively. Mean 2-hour postprandial glucose was 13.32 mmol/L in the control group and 12.97 mmol/L in the acupuncture group. After treatment, this was reduced to 9.47 mmol/L and 8.73 mmol/L respectively. Significantly greater improvements were experienced by the acupuncture group (p<0.05).

TCM symptom scores were rated from 0–6 according to their severity. Mean pre-treatment scores in the control group were 4.83 for dry mouth, 3.68 for fatigue, 4.21 for lumbar/knee pain, 4.87 for urinary frequency, and 4.59 for urinary duration. In the acupuncture group, respective scores were 4.67, 3.74, 4.17, 4.82, and 4.72. After treatment, these scores fell to 2.69, 1.42, 2.37, 2.32, and 2.14 in the control group and 2.18, 1.02, 2.02, 1.87, and 1.89 in the acupuncture group. Significantly greater improvements were experienced by the acupuncture group (p<0.05).

The results of this study indicate that acupuncture provides effective relief from diabetic neurogenic bladder by improving bladder function, regulating blood glucose levels, and alleviating related symptoms.

 

Reference:
Feng Wentao, Chen Gaijuan, Hou Xiaohui (2019) “Treatment of diabetic neurogenic bladder with warm acupuncture combined with western medicine, clinical symptoms, residual bladder volume” Asia-Pacific Traditional Medicine Vol.15 (8) pp.101-103.

 

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