This blog is a review of a recent research article.
Let’s start with the conclusion! If you read research papers, you likely read the title, the conclusion, and THEN everything in between. So, here’s the conclusion:
“The reduction of urethral sphincter mechanism incompetency (USMI) clinical signs following low back pain (LBP) treatment suggests a relationship between these two conditions. Combined acupuncture, manual therapy, with or without photobiomodulation (PBM) was shown to be an effective treatment for USMI. By corollary, USMI incontinence should be considered a potential pain symptom.”
Urinary incontinence due to USMI is a common concern in dogs. It is more common in spayed female dogs and typically presents as leakage while the dog is sleeping or lying down. Other risk factors that increase the risk of USMI include having a docked tail, increased age, obesity, having a shorter urethral length, and having a bladder neck located caudally in the pelvic canal. Osteoarthritis and difficulty crouching also seem to be correlated.
In human medicine, multiple researchers have identified a relationship between urinary incontinence (UI) and lower back pain. Treatment of LBP with physiotherapy and exercises in women has also been shown to reduce UI symptoms. In animals, one researcher found a correlation between the existence of USMI, and reduced mobility of the third to fifth lumbar vertebrae. Human literature defines non-specific low back pain (NSLBP) as LBP not attributable to a recognizable, known specific pathology (e.g., infection, tumour, osteoporosis, fracture, structural deformity, inflammatory disorder, radicular syndrome, or cauda equina syndrome). Diagnosis of NSLBP in humans is made by a combination of pain on palpation, detection of asymmetry, and abnormal mobility of vertebral structures.
Treatment for NSLBP can include prescription medication, manual therapy, stabilization exercises, and other specific therapeutic exercises. Additionally, both acupuncture and photobiomodulation benefit humans UI patients. Similar techniques can be applied to dogs.
How was the research conducted?
This was a retrospective study, that examined the medical records of patients presenting to the one author’s veterinary services over a period of time. Patients with a history of acquired UI consistent with USMI were examined for evidence of clinical improvement following treatment for concurrent LBP.
Treatments included mobilizations or manipulation as required based on the physical examination (which included a spinal evaluation from cervical spine down to pelvis). Hypertonicity or myofascial trigger points were addressed by mobilization / manipulation, dry needling, and/or photobiomodulation therapy. PBM was applied using a Sepctravet Laser, and doses were applied for 40 seconds using either a superpulsed (904 nm, 50 mW average, 25 W peak, 18 J/cm2), or continuous wave (810 nm, 500 mW, 20 J/cm2) probe. Acupuncture was used on the following points: GV14, 8,4, BL 13, 19, 20, 21, 23, 60, ST36 bilaterally, GB34 bilaterally, and KI3. Needles were left in place for up to 10 minutes.
Thirty-nine patients qualified for the study. Multiple mixed and purebred dog breeds were represented. Body weight averaged 25.3 kg (range 2.7 to 48 kg), and age averaged 8.2 years (range 0.5 to 14 years). Of the qualified patients, 16 dogs were neutered males, 1 was an intact male, and the remaining 22 dogs were spayed females.
All patients showed some degree of lumbopelvic hypomobility as a physical examination finding. All patients received combined acupuncture and manual therapy (CAMT). Six patients did not receive PBM.
At the post-treatment stage, 38 owners (97%) were able to comment on whether the frequency of UI had changed. Of those, 29 (74%) reported a decrease in the frequency of UI, 9 (23%) reported no change in the frequency of UI, and 0 (0%) reported an increase in frequency. The degree of response varied: 12/38 (32%) reported a reduction but incomplete resolution of clinical signs; that UI episodes decreased in frequency but still occurred at least once a month. 10/38 (28%) reported UI episodes occurred less frequently than once a month, and 7 (18%) reported episodes happening less frequently than once a year. Follow-up assessment greater than a year following the start of treatment was available for only 16/38 (42%) of patients.
Despite not being able to comment on the volume voided per UI episode, 37/39 owners were still able to determine if the global volume of urine leaked changed over time. 27/39 (69%) of owners reported a decrease in urine volume leaked within 8 days of a second treatment, 9/39 (23%) reported no change in urine volume leaked, one owner (3%) reported an increase in urine volume leaked, and the remaining 2/39 (5%) were unable to make a determination.
All in all, we can end where we began, with the conclusion:
The reduction of USMI clinical signs following LBP treatment suggests a relationship between these two conditions. Combined acupuncture, manual therapy, with or without PBM was shown to be an effective treatment for USMI. By corollary, USMI incontinence should be considered a potential pain symptom.”
“Conclusion: The reduction of USMI clinical signs following LBP treatment suggests a relationship between these two conditions. Combined acupuncture, manual therapy, with or without PBM was shown to be an effective treatment for USMI. By corollary, USMI incontinence should be considered a potential pain symptom.”
So, why not try manual therapies, acupuncture, treatment for trigger points, and photobiomodulation as a first line of treatment for urethral sphincter mechanism incompetence and incontinence?