• 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
• 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
• 急迫性尿失禁是指伴有强烈尿意的不自 主漏尿nce 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。
• 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).
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
• 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）、
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.
• 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,
• 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.
• 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).
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.
• 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.
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
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。
• 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，
• Treatment • Acupuncture treatment • 1. Therapeutic principle • so the therapeutic principle is reinforcing
• 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。
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.
• 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).
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.
Cystometrogram in patient with detrusor instability: