Frequent+Urination,+Incontinence,+Enuresis

=Frequent Urination (Xiăo Biàn Pín Shuò), Urinary Incontinence (Xiăo Biàn Bù Jìn), and Nocturnal Enuresis (Yí Niào)= • Frequent urination refers to an obvious increase over a period of time in the need to urinate. • Incontinence refers to a lack of control over urination. Leakage of varying amounts of urine may occur without warning or immediately on perceiving the urge to urinate. The latter is termed urge incontinence. Leakage which occurs as a result of increased intra-abdominal pressure caused by sneezing, coughing, or jumping is called stress incontinence. • Nocturnal enuresis is urinary incontinence during sleep and is seen mostly in children. • The mechanisms for frequent urination, urinary incontinence, and nocturnal enuresis are essentially the same.

Relevant Biomedical Diseases/Conditions
• UTI • Prostatitis • Diabetes Mellitus/Insipidus • BPH • Hypothyroidism • MS • Post-menopausal atrophic changes in the bladder and urethral wall • Interstitial cystitis

Etiology and Pathology
• Exogenous Damp-Heat • Diet of greasy, spicy foods and alcohol can generate Damp-Heat. • Emotions • Constitutional vacuity • Aging • Excessive sexual activity • Chronic cough • Childbirth

• The pathology of frequent urination, urinary incontinence, and nocturnal enuresis is characterized by vacuity in most cases. Repletion patterns, when they occur, tend to be more common in children.

Damp-Heat in the Bladder

 * Main Symptoms:** frequent urination, urinary incontinence, or nocturnal enuresis with dark scanty urine, burning sensation during micturition, distention in the lower abdomen
 * Additional Symptoms:** bitter and sticky taste in the mouth, thirst with little desire to drink; constipation with incomplete defecation in some cases
 * Tongue:** red with yellow, greasy coating
 * Pulse:** slippery, rapid
 * Treatment Principle:** Clear Heat, drain Dampness
 * Herbal Treatment:** Ba Zheng San (Eight Corrections Powder)

Liver Qi Stagnation
[Chai Hu (9g.), Dang Gui (9g.), Bai Shao (9g.), bai Zhu (9g.), Fu Ling (9g.), Pao Jiang (6g.), Zhi Gan Cao (6g.), Bo He (3g.), Wu Yao (6g.)]
 * Main Symptoms:** frequent urination, urinary incontinence, or nocturnal enuresis accompanied by emotional stress, anger/irritability, or depression
 * Additional Symptoms:** distention and pain in the chest and hypochondriac regions
 * Tongue:** normal or dusky
 * Pulse:** wiry
 * Treatment Principle:** Soothe the Liver, regulate Qi
 * Herbal Treatment:** Xiao Yao San JiaWei (Free and Easy Wanderer Powder with Additional Flavors)

Kidney and Heart vacuity
[Sang Piao Xiao (9g.), Duan Long Gu (12g.), Fu Ling (9g.), Yuan Zhi (9g.), Shi Chang Pu (9g.), Ren Shen (12g.), Dang Gui (9g.), Zhi Gui Ban (15g.)]
 * Main Symptoms:** frequent urination, urinary incontinence, or particularly nocturnal enuresis accompanied by nervousness
 * Additional Symptoms:** palpitations, insomnia, dream-disturbed sleep, disorientation, forgetfulness
 * Tongue:** pale with white coating
 * Pulse:** thin, slow, weak
 * Treatment Principle:** Boost Qi, supplement the Heart and Kidney, astringe fluids
 * Herbal Treatment:** Sang Piao Xiao San (Mantis Egg Case Powder)

Lung and Spleen Qi vacuity

 * Main Symptoms:** frequent urination, urinary incontinence, or nocturnal enuresis which is worse with fatigue or exertion or when coughing or sneezing
 * Additional Symptoms:** fatigue, weakness, shortness of breath, spontaneous perspiration, weak voice, poor appetite, chronic loose stools or diarrhea
 * Tongue:** pale with thin, white coating
 * Pulse**: weak and thready
 * Treatment Principle:** Supplement the Lung and Spleen, boost Qi, ascend the clear Yang Qi
 * Herbal Treatment:** Bu Zhong Yi Qi Tang (Supplement the Center Decoction)

Kidney Yang Vacuity

 * Main Symptoms:** frequent urination with copious or scanty clear urine, urinary incontinence, or nocturnal enuresis; worse with exposure to cold and after prolonged lifting or standing
 * Additional Symptoms:** sore, weak low back and knees, cold limbs and body, pale complexion fatigue
 * Tongue:** pale and moist with white coating
 * Pulse:** deep, weak and thready, particularly in the chi position
 * Treatment Principle:** Warm and supplement Kidney Yang
 * Herbal Treatment:** Jin Gui Shen Qi Wan (Golden Coffer Kidney Qi Pill)

Kidney Yin Vacuity

 * Main Symptoms:** frequent urination with scanty dark urine and possible irritation or sensation of heat, urinary incontinence, or nocturnal enuresis, dribbling of urine
 * Additional Symptoms:** sore, weak low back and knees, dizziness, insomnia, dry throat, night sweats, tinnitus
 * Tongue:** red with little coating
 * Pulse:** thready and rapid
 * Treatment Principle:** Supplement the Kidney, nourish Yin, clear vacuity Heat
 * Herbal Treatment:** Zhi Bai Di Huang Wan

Acupuncture for Frequent Urination, Urinary Incontinence, or Nocturnal Enuresis

 * Damp-Heat:** CV 3, SP 6, SP 9, TB5, ST 28, BL 28
 * LV Qi stagnation:** LV 1, LV3, LV 8, LV 14
 * KI/HT vacuity:** HT 7, KI 3, BL 15, BL 23
 * SP/LU Qi vacuity:** SP3, BL20, CV 6 ST36, LU 9, BL 13, LU 7, GV 20
 * KI Yang vacuity:** KI 3, GV 4, GV 20, BL 23, CV4 + moxa
 * KI Yin vacuity:** KI 3, KI 6, KI 2, BL 23, CV 4

Clinical Tips for Treating for Frequent Urination, Urinary Incontinence, or Nocturnal Enuresis
1. Stress incontinence can be treated with special exercises, called Kegel exercises. These exercises help strengthen the muscles that control the bladder and can be done anywhere, any time. It may take 3 to 6 months to see an improvement so patients must be persistent and patient.

• To locate the right muscles, try stopping or slowing your urine flow without using your stomach, leg or buttock muscles. When you're able to slow or stop the stream of urine, you've located the right muscles. • Squeeze your muscles. Hold for a count of 10. Relax for a count of 10. • Repeat this 10 to 20 times, 3 times a day. • You may need to start slower, perhaps squeezing and relaxing your muscles for 4 seconds each and doing this 10 times, 2 times a day. Work your way up from there.
 * 2. Kegel exercises**

Some people who have urge incontinence can learn to lengthen the time between urges to go to the bathroom. You start by urinating at set intervals, such as every 30 minutes to 2 hours (whether you feel the need to go or not). Then gradually lengthen the time between when you urinate (for example, by 30 minutes) until you're urinating every 3 to 4 hours. You can practice relaxation techniques when you feel the urge to urinate before it is time to go to the bathroom. Breathe slowly and deeply. Think about your breathing until the urge goes away. You can also do Kegel exercises if they help control your urge. After the urge passes, wait 5 minutes and then go to the bathroom even if you don't feel you need to go. If you don't go, you might not be able to control your next urge. When it's easy to wait 5 minutes after an urge, begin waiting 10 minutes. Bladder training may take 3 to 12 weeks.
 * 3. Bladder training for urge incontinence:**