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Chiropractic Adjustments Reduced Urinary Incontinence
John Zhang, MD, PhD, Phillip Haselden, DC,  
Rodger Tepe, PhD
Logan College of Chiropractic

Introduction:
Urinary incontinence, inability to control urine while awake or asleep, is a common illness in elderly. The National Association For Continence has sponsored epidemiological surveys of adults across the United States in order to quantify the prevalence of bladder control problems in the community. These studies have identified that urinary incontinence and related symptoms of overactive bladder are important causes of depression and a risk factor for nighttime falls. 6 The causes of urinary incontinence are often attributed to overactive bladder, low bladder capacity, or overproduction of urine at night (nocturnal polyuria), secondary to spinal injury. The treatment for patients with urinary incontinence is usually bladder relaxants for overactive bladder, and urinary pads to absorb urine.

Several authors have reported the effectiveness of chiropractic adjustments on elderly patients with urinary incontinence. Stude et al reported a case study of a fourteen year old female patient recovered completely from traumatically induced urinary incontinence using manual manipulation. Chiropractic adjustment seems to be effective in childhood enuresis and functional enuresis as reported in several studies. 11,12,13 This current study presents a Pro-Adjuster spinal adjustment approach to treat elderly and young patients with urinary incontinence that has not been reported previously. A search in the Pub-Med found no publications using Pro-adjuster for urinary incontinence.

Pro-Adjuster technique is a form of non-manual adjustment method that utilizes a hand held instrument controlled by a computer program to produce adjustable force and frequency. This study utilized a set of adjustment procedures developed and modified by the treating researcher to treat patients with urinary incontinence. Initial research began with patients who came to see the doctor for varying reasons, most often for low back pain care. In a few instances, after the patients received regular Pro-Adjuster adjustments, patients reported to him that their urinary incontinence was gone. This has lead to the routine inquiry of all patients seeking conventional chiropractic care about the presence of bladder control problems of any kind.   

It was hypothesized that the Pro-Adjuster treatment may positively influence the autonomic nervous system using the four cycles per second setting. This study is a retrospective case series of patients with urinary incontinence seeking chiropractic care for other reasons.

Methods:
This study was a case series of clinical observation of patients with urinary incontinence after to 1-8 weeks of treatment with Pro-Adjuster technique without any other additional drug and physical therapy treatment.

A total of 13 patients were included in this study with an average age of 65.7 ±12.9, range from 42 to 79 years old. Common complaints for seeking chiropractic care were lower back pain, neck pain, thoracic pain, SI joint pain and other chronic pains. Patients rarely confided any bladder problem. In the early cases, the patient reported regaining bladder control to the treating doctor. In the later cases, the doctor asked all patients if they had any bladder control problems. Specific treatment was given for patients with bladder control problems. All patients were treated in the doctor's office. Standard office procedure was used to document patient condition and consent for treatment.  

The Pro-A.N.S. Technique:
After finishing the routine Pro-Adjuster procedure and the Pro-Basic technique, (a pelvic balancing protocol taught in the advanced Pro-Adjuster class), set the computer to the 4 cps setting to impact the nervous system directly and 15 - 20 pound setting (depending on the size of the patient).  The contact is about one inch under the coccyx and directed upward into the Sacral Plexus and Ganglion of Impar.  Regarding the duration of contact, the doctor asks the patient to inhale slowly and hold the breath in for about 4 seconds and then have them to exhale slowly and hold for 4 seconds. The procedure is repeated twice, continuing the thrust for the entire time. The entire procedure takes only 25 - 30 seconds.

Results:
A total of 13 patients' data (6 female, mean ages of 65.7±12.9 years old) were included in the study. The main reasons for the 13 patients seeking chiropractic care were chronic low back pain, neck pain and leg pains, (11 patients), prostate and macular degeneration (1 patient), and auto accident (1 patient). Nine patients had chronic urinary urgency and frequency where they had to void at least 3 times at night. Before treatment, the average frequency of urination at night was about 3.8±1.17 times for all patients. The average history of urinary incontinence was 5±2.2 years from all subjects.

After 1-8 weeks of chiropractic adjustments, the urinary frequency at night was significantly reduced from 3.8±1.17 to once a night (P<0.001) (Figure 2). Three patients improved bladder control with only two adjustments. Two female elderly patients regained bladder control and no longer had to use urinary pads. All 13 subjects demonstrated reduction of urination frequency at night. 

Discussion:
This study demonstrates that patients with urinary incontinence and nocturia had significant reduction in nocturia with Pro-Adjuster treatment without behavioral therapy or drug therapy. The adjustment given to patient produced no side effects. The results provide evidence that Pro-Adjuster treatment with modified ANS technique may be used in chiropractic clinics for bladder-control treatment. Based upon results of a literature search, this is the first report showing benefit for people with incontinence using Pro-Adjuster treatment. Other treatment methods have shown nocturia reductions using physical therapy with women with predominantly stress incontinence and using acupuncture. Taken in context with these other results, there are statistically significant reductions in nocturia that can occur with treatment directed at other lower urinary tract symptoms.

Conclusion:
In conclusion, a Pro-Adjuster treatment program was found to reduce nocturia in some chiropractic patients including elderly men, women and child with urinary incontinence. These reductions in nocturia improved patients' quality of life. With regard to research, large controlled and randomized study should be conducted to confirm the beneficial effect of this type of adjustment in patients with bladder control problems. 

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