Urinary Incontinence (UI) can happen for a variety of reasons, but in my practice I most commonly see it affect postpartum patients and those entering menopause. It can also be an issue during pregnancy itself; symptoms tend to increase with each trimester as pressure on the bladder and pelvic floor increases. Those who have had previous pregnancies also have a higher risk for UI. In postpartum patients, those who delivered vaginally have a higher risk for postpartum UI compared with surgical delivery, and those who experienced 3rd or 4th degree tear also have a higher risk.

The research really illustrates why it’s important not to ignore the issue- 3 months postpartum anywhere from 17-31% of new moms experience urinary incontinence, and if untreated 38% still had symptoms a whopping 12 years later (source). That’s the minority, but not by much! You can see why it’s so important to seek out help for the issue absolutely as soon as possible- the sooner you can get help after the issue the begins, the better your chances of overcoming it.

Why Does Postpartum Urinary Incontinence Happen?

Typically (but not always), it’s more common for postpartum patients to experience stress incontinence (with sneezing, coughing, jumping or other physical activity). A combination of issues can be responsible including:

• Damage to the pelvic floor during pregnancy and childbirth
• Hormonal changes which contribute to problems with urethral function, pelvic floor ligament laxity and pelvic floor musculature weakness

Why Do We Get Urinary Incontinence During the Menopausal Transition?

Declining estrogen levels can lead to a loss of elasticity of the urethra, bladder and vaginal tissues as well as weaker pelvic floor muscles. In this population, incontinence can be stress incontinence (with sneezing, jumping or other physical activity), urge incontinence (unable to control the flow when there is a strong urge) or a combination.

Click here for an excellent article by a local Pelvic Floor PT practice here in NYC that describes the types of urinary incontinence and why it happens.

What are My Treatment Options?

Typically you would be offered pelvic floor physical therapy, guidance on lifestyle modifications (such as avoiding caffeine) or in more severe cases injections, surgery or medications.

Acupuncture is another little-known treatment option. While we don’t have a large body of research around its use, we know that it is safe and seems to be promising. Many of my patients successfully use acupuncture alongside physical therapy and other treatment modalities.

How Might Acupuncture Help?

Through the lens of East Asian Medicine (including Traditional Chinese Medicine), there could be a disharmony in organs such as the kidney, urinary bladder, liver or heart (and more!) that could be aggravating the issue. Your acupuncturist will ask questions to learn more about your triggers for UI as well as other factors such as your stress level, aches and pains, your sleep quality and body temperature. These all come together to help us determine what might be out of balance. From there we can choose appropriate acupuncture points.

In addition to this holistic view, there are several acupuncture therapies which I feel beautifully integrate East Asian Medicine and western knowledge of physiology. These two methods have been studied in a few randomized controlled trials. Both send a message to regulate the nerves that innervate the bladder and pelvic floor, re-training them back to more normal functioning.

Baliao Points

The first method involves using acupuncture points (including one of the set of points called Baliao) along the sacrum (at the base of the spine), taking advantage of the nervous system connection between this area of the spine and the bladder and pelvic floor. A 2017 study in JAMA studied this technique in 504 women aged 40-75. The women received 18 sessions over 6 weeks of either electroacupuncture of “sham” electroacupuncture. After 6 weeks, the electroacupuncture group showed a statistically significantly improvement in the amount of urine leakage. Additionally, participants were surveyed and reported that they felt their symptoms were becoming less severe and that the treatment was responsible for that improvement. Side effects of treatment were mild and short-lived.

This method was studied again in 2023, comparing those who had electroacupuncture combined with PFMT (pelvic floor muscle training) against those who had “sham” electroacupuncture with PFMT. Again, there was a significant improvement for those who had received the true electroacupuncture + PFMT.

Kidney Meridian or Posterior Tibial Nerve Points

The second method involves stimulating specific points along the Kidney meridian- on the inner foot and lower leg. The posterior tibial nerve runs along this area and can influence bladder and pelvic floor function. Physicians and pelvic floor physical therapists often utilize this technique (termed Posterior Tibial Nerve Stimulation) as a second or third line treatment to help with bladder control. I find it very interesting that the points that these western medical professionals use correspond to kidney meridian points that may be used during an acupuncture treatment to treat the same issue. While an acupuncturist would not claim to be performing PTNS as it’s not in our scope of practice, I feel it is interesting to point out the overlap between a biomedical technique and an ancient Eastern one.

My Recommendations:

In addition to the techniques discussed above, we have many other acupuncture points and techniques to choose from that allow us to truly personalize treatment. While I recommend every patient suffering from UI get an evaluation and recommendations from a gynecologist, urogynecologist and/or Pelvic Floor Physical Therapist, you may want to consider acupuncture as an additional treatment or an alternative if first-line treatments haven’t been successful.

I recommend postpartum patients consider acupuncture if they have severe symptoms or if UI is still happening 4-6 weeks postpartum. If you are in menopause or transitioning into menopause, I recommend considering acupuncture if you are currently in pelvic floor PT or have already tried it or another therapy without much improvement.