Urge Incontinence
急迫性尿失禁
• 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，
• 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。
Overactive bladder &
Urge incontinence
• Etiology and Pathogenesis
• UUI can be of neurological or nonneurological 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。
• 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。
• 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。
• 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。
• 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。
• 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。
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
involuntary
that resulted in void
contractions that
resulted in void
Detrusor Leak Point Pressure
• 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。
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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，
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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。
• 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。
• 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。
• 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。
• 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。
• 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。
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。
• 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）。
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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。
• 2 Acupuncture methods
• The treatment is given once every other day.
The two groups of acupoints are alternated.
The course of treatment depends on the
patient’s condition.
• 治疗隔日1次，两组穴位交替使用，治疗
次数视病情而定。