Volume 1, Number 1 | Spring 2006

Clinical Report 1 (Japan)
Acupuncture for Overactive Bladder
Naoto Ishizaki1)
Hiroshi Kitakoji2)
Department of Clinical Acupuncture and Moxibustion I1)
Department of Clinical Acupuncture and Moxibustion II2),
The Chief of Acupuncture Center
Meiji University of Oriental Medicine, Kyoto, Japan

Introduction
Lower urinary tract symptoms (LUTS), including
increased urinary frequency, urgency, urinary
incontinence, urinary weak stream, interruption andresidual feeling after micturition, are common
problems in elderly people1). Our previous study
showedthat
acupuncture
relieved
urinaryincontinence, increased urinary frequency, urgency
and nocturnal enuresis2-4).
In 2002, the International Continence Society (ICS)
identified “overactive bladder” (OAB) as a symptom
syndrome defined as urgenct, with or without urge
incontinence, and usually with frequency andnocturia5).
This report presents a successful clinical case studyof an individual with overactive bladder treated byacupuncture using the current definition of thesymptoms associated with OAB.

periosteum (50 to 60 mm), and then the bilateralneedles were maneuvered up and down manually for
10 minutes. The treatment was repeated once a week.
To assess the symptoms before and after acupuncture,
the International Prostate Symptom Score (IPSS) andIPSS quality of life index (IPSS QOL index) were used.
The IPSS questionnaire is used by the American
Urological Association symptom index6). The score ofeach symptom of the IPSS, including 4 voiding
symptoms (incomplete emptying, intermittency, weakstream and hesitancy) and 3 storage symptoms(frequency, urgency and nocturia), ranged from 0 to 5
points. A total IPSS score was obtained by summing up
each score (0 to 35) and categorized into 3 groups of theseverity as mild (0 to 7), moderate (8 to 19) or severe (20to 35). Assessment of quality of life (QOL) by urinary
symptoms was ranged from 0 (delighted) to 6 (terrible).
Additionally, urinary frequency and voided volume were
estimated from a frequency volume chart (FVC).

Zhongliao（BL-33)

Case Report
This case study is based on an 81 year-old man who
underwent acupuncture treatment for refractory
symptoms of increased urinary frequency (voiding 8 ormore times), nocturia (awakening 3 or more times atnight to void), urgency and urge incontinence due tobenign prostate hyperplasia. He had previously failedalpha-1 blocker and underwent acupuncture treatment.
Acupuncture was performed using a disposable
stainless steel needle (0.3mm in diameter, 60mm inlength, SEIRIN Kasei, Shimizu, Japan) with thepatient in the prone position. Acupuncture needles
were inserted into the bilateral Zhongliao points(BL-33, as standardized by the World HealthOrganization), on the skin of the third posterior sacralforamina in the cranial direction (Fig. 1). The needle
was inserted into each side of the foramina sufficiently
deep for its tip to be placed close to the sacral

12Fig. 1: Schematic diagram showing acupuncture points inbilateral Zhongliao (BL-33)

Baseline FVC showed a maximum voided volume of
120 ml with postponing micturition as long as possible.
Additionally, assessment of quality of life where urinary
symptoms were terrible, were assessed by the
self-administered questionnaire using International
Prostate Symptom Score quality of life index (IPSS QOL
index) before acupuncture. After the 4th treatment a
maximum voided volume was 200 ml with tolerable topostpone voiding written in FVC, however, assessment of
QOL was unchanged. After the 8th treatment a maximum
voided volume was 330 ml and assessment of QOL wassatisfied. Urgency and urge incontinence disappeared
after the 8th acupuncture treatment (see Table 1).

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Number 1 | Spring 2006

Beforeacupuncture

After 4th
acupuncture

After 8th
acupuncture

daytimefrequency

886nocturia

3

3

1

maximum
voidedvolume (ml)

120

200

330

17
(moderate)
6(severe)16(moderate)
6(severe)5(mild)
1(satisfied)IPSS
QOL index

Table 1: IPSS: International Prostate Symptom Score, QOL
index: quality of life index

Comment
Overactive bladder (OAB) is a symptom complex
that includes urinary urgency with or without urge;
incontinence, urinary frequency and nocturia,
identified by the International Continence Society(ICS) in 2002 (Fig 2) 5). OAB is an empiric diagnosis
used as the basis for initial management after
assessing lower urinary tract symptoms (LUTS),
physical findings, urinalysis, and the other indicatedevaluations. In addition, OAB is defined based on
symptoms.

Overactive bladderUrge
incontinenceStressincontinence

Urgency
Increased urinary
frequency
Nocturia

Mixedincontinence(Urge+Stress)

Fig. 2 Symptomatology of overactive bladder

OAB is highly prevalent worldwide. In the U.S., astudy showed that the prevalence of OAB was 16.0% in
men and 16.9% in women aged 18 years or older7).
Therefore, OAB might affect 34 million individuals in
the U.S. In Europe and Scandinavia, a study showedvirtually the same prevalence of OAB (16.6%) in
individuals, men and women aged 40 years or older,selected from the general population in France,
Germany, Italy, Spain, Sweden and the United

Kingdom8). In Japan, the prevalence was 12.4% in men
and women aged 40 years or older9). The total cost of
OAB is estimated to be $12.6 billion (year 2000 dollars)in the U.S. Still, the vast majority of OAB sufferers
remain untreated.
In our previous study, it was shown that
acupuncture might be beneficial in the treatment of
OAB2-3). We applied acupuncture to Zhongliao points
on the skin of the third posterior sacral foramina as inthis study with 11 patients with urge incontinence orurgency and found an improvement of the symptoms
in 9 (82%)2). The treatment induced increase in bothmaximum cystometric bladder capacity and bladdercompliance, with statistical significance. It is therefore
conceivable that acupuncture stimulation might
increase bladder capacity by inhibiting bladdercontraction or urinary sensation. Additionally,
acupuncture has been reported to inhibit detrusor
hyperreflexia in 13 patients with spinal cord injury3).
In the study, incontinence disappeared in 2 (15%) anddecreased to 50% or less incontinence volume ascompared to the baseline in 6 (46%), resulting insatisfactory therapeutic effects obtained in 8 (62%).
These results indicate the possible mechanism ofneurological (such as spinal segmental) inhibition
through which bladder contraction might besuppressed by acupuncture. In this report the patient
had suffered from urgency, urge incontinence,increased urinary frequency and nocturia. Because thesymptoms might be in accord with OAB, acupuncture
was performed for relieving the symptoms. The
urgency and urge incontinence were relived after
acupuncture.
To ask the patient to record micturitions andsymptoms for a period of days provided individual
information. Frequency volume chart (FVC) was used
for the record of the volumes voided as well as the timeof each micturition, day and night, for at least 24 hours(Fig 3). The following measurements could be
abstracted from FVC: daytime frequency, nocturia,
24-hour frequency, 24-hour urine production, polyuria,
nocturnal urine volume, nocturnal polyuria andmaximum voided volume. In particular, daytime
frequency, nocturia and maximum voided volume are
intimately concerned with OAB. Daytime frequency is

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

13

Volume 1, Number 1 | Spring 2006

the number of voids recorded during waking hours andincludes the last void before sleep and the first void
after waking and rising in the morning. Nocturia is thenumber of voids recorded during a night’s sleep: eachvoid is preceded and followed by sleep. Maximum
voided volume is the largest volume of urine voided
during single micturition and is determined either
from FVC. FVC has the advantage that the maximum
voided volume is obtained without invasive procedures.
In this report the maximum voided volume of thepatient increased from 120 ml baseline to 330 ml after
8th acupuncture. This result supports our previous
study concerning with acupuncture for urge
incontinence or urgency.
time

examplesConclusion
Acupuncture could be an
conventional therapies for OAB.

1.

2.

3.

3:00
4:00

100 ml

5.

5:00
6:00

Waking up

7:00

100 ml
150 ml

10:00
11:00

6.

170 ml

12:00
13:00

American Urological Association Symptom Index
for benign prostatic hyperplasia, J Urol 1992; 148:

200 ml1549-57
Stewart WF, Van Rooyen JB, Cundiff GW, Abrams
P, Herzog AR, Core R, Hunt TL, Wein AJ:

7.

15:00

Prevalence and burden of overactive bladder in
the United States. World J Urol 2003; 20: 327-36

17:00
18:00

130 ml

8.

19:00
20:00
22:00

120 ml

23:00

Going to
bed

Total

1410

ml

Milsom I, Abrams P, Cardozo L, Roberts RG,
Thuroff J, Wein AJ: How widespread are thesymptoms of an overactive bladder and how are
they managed? A population-based prevalence
study, BJU Int 2001; 87: 760-6

140 ml

21:00

9.
ml

ml

Fig. 3 Example of frequency volume chart

14

standardization
sub-committeeoftheInternational Continence Society, Neurourol
Urodyn 2002; 21: 167-78
Barry MJ, Fowler FJ Jr, O’Leary MP, Bruskewitz
RC, Holtgrewe HL, Mebust WK, Cockett AT: The

150 ml

14:00
16:00

2000; 65: 190-5
Honjo H, Kawauchi A, Ukimura O, Soh J,
Mizutani Y, Miki T: Treatment of nocturnal
enuresis by acupuncture, a preliminary study, Int
J Urol 2002; 9: 672-6
Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P,
Ulmsten U, van Kerrebroeck P, Victor A, Wein AJ:

The standardization of terminology of lower
urinary tract function, Report from the

8:00
9:00

Kitakoji H, Terasaki T, Honjo H, Odahara Y,
Ukimura O, Kojima M, Watanabe H: Effect ofacupuncture on the overactive bladder. Nippon
Hinyokika Gakkai Zasshi (Japanese Journal of
Urology) 1995; 86: 1514-9 Japanese
Honjo H, Naya Y, Ukimura O, Kojima M, Miki T:

Acupuncture on
clinical
symptoms andurodynamic measurement in spinal-cord-injured
patients with detrusor hyperreflexia. Urol Int
4.

2:00

Diokno AC, Brock BM, Brown MB, Herzog AR:

Prevalence of urinary incontinence and otherurological symptoms in the non-institutionalized
elderly. J Urol 1986; 136: 1022-5.

///(Month/Day) (Month/Day) (Month/Day)

150 mltoReference

0:00
1:00

alternativeml

Homma Y, Kakizaki H, Gotoh M, Takei M,
Yamanishi T, Hayashi K: Epidemiologic survey onlower urinary tract symptoms in Japan. Nippon
Hainyokino Gakkaishi (Journal of Neurogenic
Bladder Society) 2003; 14: 266-77 Japanese.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 1, Number 1 | Spring 2006

Introduction of University
Meiji University of Oriental Medicine, located in
the central part of Kyoto Japan, was founded in 1978
as Meiji Junior College of Oriental Medicine as a partof Meiji Institute of Oriental Medicine. The origin of
the institute dates back to 1925 as the Yamazaki
School of Oriental Medicine in Osaka, which developed
into Meiji School of Oriental Medicine, another part of
Meiji Institute of Oriental Medicine.
Meiji Junior College of Oriental Medicine had been
accredited by Educational Ministry as the first
four-year college of oriental medicine in Japan byadding a Western medical hospital in 1983. The course
for doctor of science in acupuncture and moxibustion,accredited in 1994, is the one that the school can boast
to the world. In 2002, the school added a course for
Judo-Seifuku therapist, Japanese traditional bone
fixing technique, changing the name ‘College’ to‘University’. A four-year course for Judo-Seifuku(2004) and the nursing (2006) was added. The school
currently

consistsofafour-year

coursefor

acupuncture and moxibustion, a four-year course of
Judo-Seifuku, a four-year course of nursing, has aclinic of oriental medicine and a western medical
hospital (see diagram below). The school has also been
providing postgraduate training course in the western
medical hospital for over 18 years.

The mission of Meiji University of Oriental Medicine
is to train therapists who are qualified to provide
traditional oriental medical treatment which is
supported with western medical knowledge, to provide
highly qualified integrative care of western andtraditional oriental medicine, and to investigate themechanism of the effect of acupuncture andmoxibustion and Judo-Seifuku therapy. The school has
produced over 2,700 graduates, including 111 masters,
47 doctors of acupuncture and moxibustion for over the
past 28 years, who are widely accepted as highly
qualified leaders in the field in Japan.
The Western medical hospital, equipped with highquality technology including one of the most powerful
MRI instruments in the world, has an outstanding
medical staff of Internal Medicine, Surgery,
Orthopedics, Urology, Neurosurgery, Anesthesiology,
Dentistry,
Otolaryngology,
Ophthalmology
andGynecology to provide high quality integrative care andeducation. It has a primary goal, to accumulatescientific evidence on the value of traditional oriental
medicine by collaborating with the professional
traditional therapists.
Basic research to investigate the mechanism of
traditional therapies are also made possible bycollaboration with departments of Physiology, Anatomy,
Immunology, Chemistry, Biology and Physics. The results
are reflected in curricular decisions to ensure the program
reflects the latest in medical theory and practice.

Faculty of Acupunctureand Moxibustion
Faculty of
Judo-Seifuku
Meiji University ofOriental Medicine

Faculty of
Nursing
Graduate School of
Acupuncture and Moxibustion
General Hospital

Meiji Institute ofOriental Medicine

Medical MR Center
Acupuncture Center
Research center ofOriental Medicine
Library
Meiji School ofOriental Medicine

Meiji University of Oriental Medicine, Kyoto Japan

Organization of Meiji Institute of Oriental Medicine

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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