| BackgroundUrinary Incontinence (UI) is a common disease, found mostly in female population, it happens in all age group, but more commonly found in elderly, the prevalence rate increases with age. In economic developed countries, Urinary Incontinence is more common than High Blood Pressure, Depression and Diabetics Mellitus, and the health care expenditures spend on it is far more than those spent on Coronary Heart disease, Osteoporosis and Breast Cancer. UI has become one of the five most common chronic diseases that threaten the health of women. In a large scale survey study made in2006, the prevalence rate of female UI in Hong Kong has largely increased to40.7%, two-fold of what has been reported ten years ago, the result was close to the findings in western countries such as France, Germany, and Britain. Urinary Incontinence is severely harmful to the health of the subjects physically, mentally and emotionally, resulting in immobility, failure to perform housework, affecting normal social activity, and causing psychological dysfunction such as withdrawal from the society, anxiety, depression, lonesome and loss of confidence etc.. Furthermore, it puts heavy financial burden to the family and the society. Therefore, there is an urgent need to find a better solution for treatment of urinary incontinence. Stress Urinary Incontinence is one of the most common female urinary incontinence. It is characterized by no leaking in normal circumstances but only when there is a sudden rise of intra-abdominal pressure (such as:coughing, sneezing, on effort or on physical exertion) there will be involuntary loss of urine through the urethra.In Western Medicine, SUI is treated by non-surgical intervention or surgical intervention, the previous one includes Medication, Behavior Modification, Exercise Therapy, Biofeedback Therapy and Functional Electrical Stimulation. Surgery will be recommended when conservative treatment fails. The period for medication is long and have more side-effect; the risk of surgery is comparatively higher and easy to cause complication, physical therapy has lesser side-effect and is commonly used as first-line of conservative treatment but the effect varies, thus there is a need to continue to find a better treatment for SUI. Treatment approach for female SUI in Hong Kong, is mainly from Western Medicine, patient seeking treatment from Traditional Chinese Medicine is extremely rare.Urinary Incontinence means "leaking urine" in Chinese Medicine, and its treatment had been recorded in ancient writings long time ago. Chinese medicine of our mother country believed that the cause and mechanism of urinary incontinence is deficient in Chi and Blood, deficient in Spleen and Kidney, treatment mainly base on nourishing the insufficient."Bun Jong Yih Chih Tang" originally from "Pei Wai Lun" written by the famous doctor Lee Tung Wun in Jin period. This formula has the effect of nourishing and mobilizing, nourishing without causing stagnation; nourishing and raising, raising the yang and lifting the descended; and also removing the internal heat by its sweet and warm quality. It is a representative formula for nourishing the Chi and raising the Yang as well as removing internal heat by its sweet and warm quality. However, there is no clinical research reported on application of Chinese traditional medicine on treatment for Hong Kong Female Stress Urinary Incontinence. Therefore, Bun Jong Yih Chih Tang was taken as the basic formula with additional of Ootheca Mantidis, Fun Pern Tzyy, Alpiniae Oxyphyllae, Ma Hwang, in order to nourish the Spleen and warm the Yang, strengthen the Kidney and Bladder, so that the bladder can regulate its emptying and storage function, thus maintain the continence mechanism.Purpose1. To summarize systematically the literatures in Western Medicine and Chinese Medicine on SUI, its epidemiology, pathophysiology, mechanism, clinical diagnosis and treatment.2. To investigate the clinical effect of Bun Jong Yih Chih Tang, by studying the difference in clinical outcomes of Bun Jong Yih Chih Tang and pelvic floor muscle exercise in treating stress urinary incontinence.3. To evaluate the clinical treatment outcomes of the "Bun Jong Yih Chih Tang"(TCM) in treating Hong Kong adult female SUI.Method1. Clinical data Select patients who received treatment at Sze Tak Chinese Medicine and Acupuncture clinic and Maisie Physiotherapy Studio from the period2010/11to2011/10with SUI diagnosed by Clinical Presentation and Urodynamic Studies, female adults in Hong Kong,58cases. Gullen Grading:Grade â… -27cases, Grade â…¡-25cases, Grade â…¢-5cases, Grade â…£-1case; the eldest person at age79, minimum41years old, an average of60.71±10.61years old; longest duration15years, minimum1year, an average of5.81±3.09years. Subjects were randomly asigned to group A or B, age, course of disease and body mass index (BMI) of the subjects in two groups has no significant differences (P>0.05). The distribution in pregnancy, number of births, multiparous history, Gullen index of the subjects in two groups has no difference (P>0.05).2. Methodology Both groups received two stages of treatment, Group A performs (â… )â†'(â…¡) testing sequence, the first stage is2weeks of exercise intervention (I), then take2weeks off for "wash out" and second stage is receiving Chinese herbal medicine intervention(â…¡). Group B performs (â…¡)â†'(â… ) sequence with either1or2courses of Chinese herbal medicine intervention(II), then take2weeks off for "wash out", and then receive2weeks of exercise intervention(â… ). Chinese Herbal Formula: Bun Jong Yih Chih Tang18g, Ootheca Mantidis1.5g, Fun Pern Tzyy1.5g, Alpiniae Oxyphyllae1.5g, Ma Hwang1.5g, Chair Hwu1.5g ldose per day divided into3times,6day as1course. Exercise Therapy follows the Pelvic Floor Muscle Exercise guidelines from Physiotherapy Department of Hospitals of Hong Kong Hospital Authority:φTraining muscle power and endurance;(?)Training co-ordination ability, exercise for10mins.,3times daily. Related index were collected after each stage, φ Subjective index:under the guidance of trained personnel, patients were to fill in the questionnaire and self evaluation form. Index include:Urinary Incontinence Questionnaire-Short Form (ICI-Q-SF), Urinary Incontinence Quality of Life Scale (I-QOL), Urinogenital Profile (UDI), Visual Analogue Scale (VAS), frequency of incontinence, severity of incontinence and frequency of Nocturia.â‘¡Objective index: cough test, stop test, pelvic floor muscle strength, pelvic floor muscle endurance, coordination ability.3. Statistic analysis:SPSS13.0software was applied. Around treatment were compared using the Paired-Samples T Test, inter-group comparsion using Independent-Samples T Test, considering the effects before treatment, inter-group comparsion using the analysis of covariance (ANCOVA); two classification data between groups were compared using Pearson2test, around treatment were compared with McNemar test, considering the effects before treatment, inter-group comparison using two classification of Logistic regression analysis; ranking data were compared by Wilcoxon rank sum test, before and after treatment were compared by Wilcoxon signed rank test, considering the effects before treatment, inter-group comparsion using the ordinal Logistic regression analysis; level of significance were P<0.05.Result1. Treatment effect of Bun Jong Yih Chih Tang in improving quality of life and incontinence symptoms After first stage of treatment, the before and after reading in the ICI-Q-SF score, I-QOL score, frequency of incontinence, intensity of incontinence and frequency of nocturia in the Bun Jong Yih Chih Tang treated group show significant difference (P<0.05); in the pelvic floor muscle exercises treated group, there is no difference only in the number of nocturia (P>0.05), otherwise all other indexes had a significant difference (P<0.05); post treatment reading in ICI-Q-SF score, I-QOL score, frequency of incontinence, intensity of incontinence and frequency of nocturia between the traditional Chinese medicine and pelvic floor muscle exercise treated group were different (P<0.05), Bun Jong Yih Chih Tang is superior than pelvic floor muscle exercises in increasing I-QOL score, reducing ICI-Q-SF score, frequency of incontinence, intensity of incontinence, frequency of nocturia. After second stage of treatment, the before and after reading in the Bun Jong Yih Chih Tang treated group had significant difference (P<0.05); in the pelvic floor muscle exercise treated group, the before and after reading in frequency of incontinence, intensity of incontinence, frequency of nocturia had no difference (P>0.05), the ICI-Q-SF score and I-QOL score differences are statistically significant (P <0.05); post treatment reading in ICI-Q-SF score, I-QOL score, intensity of incontinence and frequency of nocturia between the traditional Chinese medicine and pelvic floor muscle exercise treated group were different (P<0.05), frequency of incontinence had no no difference (P>0.05), showing that Bun Jong Yih Chih Tang is superior than the pelvic floor muscle exercise in increasing I-QOL score, reducing ICI-Q-SF score, severity of incontinence, frequency of nocturia.2. Effect of Bun Jong Yih Chih Tang in improving pelvic floor muscle performance and bladder control and its treatment effect on SUI After first stage of treatment, the UDI score, VAS score, cough test, stop test, pelvic floor muscle strength, pelvic floor muscle endurance and coordination capacity around treatment of Bun Jong Yih Chih Tang treated group were significantly different (P<0.05); the before and after reading of cough test in the pelvic floor muscle exercise treated group, had no difference (P>0.05), otherwise, all other indexes were statistically significant (P<0.05); post treatment reading in UDI score, VAS score, cough test between the traditional Chinese medicine and pelvic floor muscle exercise treated group were different (P<0.05), stop test, pelvic floor muscle strength, pelvic floor muscle endurance and coordination ability had no difference (P>0.05), indicating that Bun Jong Yih Chih Tang is superior than pelvic floor muscle exercise in reducing UDI score, VAS score, and increasing cough test score but its effect on increasing the stop test score, improving pelvic floor muscle strength, increasing pelvic floor muscle endurance and improving coordination ability is similar to that by pelvic floor muscle exercise. After Second stage of treatment, the before and after treatment reading of all indexes in Bun Jong Yih Chih Tang treated group showed significant difference (P <0.05); cough test in pelvic floor muscle exercise had no difference (P>0.05), otherwise, all other indexes had a significant difference (P<0.05); post treatment reading between the Bun Jong Yih Chih Tang group and pelvic floor muscle exercise group in UDI score, VAS score, cough test, had significant difference (P<0.05), stop test, pelvic floor muscle strength, pelvic floor muscle endurance and coordination ability had no difference (P>0.05), indicating that Bun Jong Yih Chih Tang is superior than pelvic floor muscle exercise in reducing UDI score, VAS score, and increasing cough test score, but its effect in the increasing the stop test score, pelvic floor muscle power, pelvic floor muscle endurance and coordination ability did not show any advantage.Conclusion1. Modified Bun Jong Yih Chih Tang and Pelvic Floor Muscle Exercise have noticeable curative effect for different grade of SUI of Hong Kong adult female sufferer. Both can effectively reduce the physiological and psychological symptoms of SUI, significantly improve the quality of life, and reduce suffering. Modified Bun Jong Yih Chih Tang showed better results when compare with pelvic floor muscles exercise, and can better improve the quality of life of the incontinence. However, one cannot conclude that it has better effect in improving the performance of the Pelvic Floor Muscles Exercise when compare with the exercise group2. The drawback of this study is that the number of subjects is not big and the control is not diversified, which may affect the results of comparison of curative effect. In addition, the cases in the study have less severe symptoms, and the therapeutic effect of modified Bun Jong Yih Chih Tang in more severe cases requires further investigation. |
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