A TCM Approach to Stress Urinary Incontinence in Elderly Women

With age, estrogen levels decline and the pelvic floor muscles of elderly women atrophy and weaken. When a cough briefly raises intra-abdominal pressure, the lax pelvic floor can no longer support the bladder like a "hammock," and urine is squeezed out. This is the main cause of urinary leakage in elderly women, and it causes considerable distress.

In TCM this condition is called yiniaO or yini, attributed to kidney-qi deficiency and failure of the bladder to control urine; treatment should focus on tonifying the kidney. Representative formulas include Shenqi Wan (Kidney Qi Pill), Suoquan Wan (Stream-Restraining Pill), and Buzhong Yiqi Wan (Middle-Restoring Qi-Boosting Pill).

Among these, Shenqi Wan has three variants available: Jinkui Shenqi Wan, Jisheng Shenqi Wan, and Guifu Shenqi Wan. For severe yang deficiency with cold hands and feet, choose Guifu Dihuang Wan; if leakage is accompanied by dribbling urination, choose Jisheng Shenqi Wan; if there is only leakage with no other obvious symptoms, choose Jinkui Shenqi Wan. If Shenqi Wan alone is insufficient, combine it with Suoquan Wan. If there is shortness of breath and fatigue, combine it with Buzhong Yiqi Wan.

The condition can also be treated with external therapies. One of my teachers once taught me two. The first: chop fresh scallion white into a paste and apply it to the patient's navel. The second: take equal parts of the TCM herbs Yizhiren (Alpiniae Oxyphyllae Fructus) and Dahuixiang (Illicii Veri Fructus), grind them finely, mix with honey, and apply to the navel.

Both external applications are done at bedtime and the gauze removed on waking. Besides medication, patients themselves should do more Kegel exercises to strengthen the pelvic floor and improve cough-triggered leakage. If coughing is frequent and severe, respiratory medicine medications are also needed to treat the cough at its root.