The Liebell Clinic: Chronic Pain & Wellness Solutions

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Research Study References

Randomized trial of transcutaneous tibial nerve 

stimulation to treat urge urinary

 incontinence  in older  women

Schreiner, Lucas; dos Santos, Thaís Guimarães; Knorst, Mara Regina.

International Urogynecology Journal, 09/2010, Volume 21, Issue 9

Sustained effectiveness of percutaneous tibial nerve stimulation for overactive bladder syndrome: 2-year follow-up

of positive responders

Yoong, WA, Shah, P; Dadswell, R; Green, L. 

International Urogynecology Journal

24.5  (May 2013)

Percutaneous Tibial Nerve Stimulation

and Overactive Bladder

Sajadi, Kamran P; Goldman, Howard B,

Current Urology Reports,

09/2010, Volume 11, Issue 5

Posterior tibial nerve stimulation as neuromodulative treatment of lower

urinary tract dysfunction.

66(3):914-918. Van Balken MR, Vandoninck V, Gisolf KW, Vergunst H, Kiemeney LA, Debruyne FM, Bemelmans BL: 

The Journal of Urology


Sustained Therapeutic Effects of Percutaneous Tibial Nerve Stimulation:

24-month Results of the STEP Study

Kenneth M. Peters, Donna J. Carrico, Scott A. MacDiarmid, Leslie S. Wooldridge, Ansar U. Khan, Craig E. McCoy, Nicholas Franco, and Jason B. Bennett

Neurourology and Urodynamics
32:24–29 (2013) 

Conservative chiropractic management

of urinary incontinence using applied kinesiology: a retrospective

case-series report

Scott, C., Rosner A., ​

Journal of Chiropractic Medicine 
(2012) 11,49-57 

​​​Natural & holistic, whole-person, wellness-based Healthcare - Drug-Free & Non-Surgical Pain Relief


​Donald K. Liebell, D.C., B.C.A.O.

477 Viking Drive Suite 170

Virginia Beach VA 23452 
8:30AM - 6:30PM M,W,F 

(and by Special Appointment) 


You may be too embarrassed to even talk to your doctor about it…

but you really should… because you could be missing out on getting help now!

  Stress Urinary Incontinence

   By Dr. Donald Liebell

   It is a myth that urinary stress incontinence is due to age.  It is also a myth that one is destined to wear adult diapers.  This article will reveal to you how there is realistic … and how you may be able to naturally overcome urinary stress incontinence it with one or more holistic approaches.   

   Let’s explore…

 What is urinary stress incontinence?

   Urinary stress incontinence is minor leakage upon coughing, laughing, or any motion that stresses or puts too pressure on the bladder.  It is actually quite common. 20%-30% of young women, 30%-40% of middle-aged women, and up to 50% of older women have it to some degree.

   While urinary drip can increase with age, it is not aging itself that is the cause.  Bladder control problems can result from muscle weakness, spinal injuries, neurological disorders, infection, side effects of medications, constipation, diabetes, and stroke.  Certain foods and drinks may over-stimulate one’s bladder, which may increase volume of urine. This is known as a diuretic effect.  Alcohol, caffeine, some decaffeinated teas, coffee, carbonated drinks, and citrus fruits may contribute.

   A Weakened Foundation

   Pregnancy and hysterectomy are very common causes of weakening of the supporting pelvic floor muscles.  The pelvic floor muscles function like a hammock that supports a woman’s bladder, uterus, vagina, and rectum.  That is why stress urinary incontinence can occur at a young age.  Anything, including surgery that involves a woman's reproductive system (including hormones) can be a factor. 

   Buckling Under the Pressure

   If you are overweight, your belly itself may be pressing down on your bladder.  This can certainly contribute to your urinary leakage woes.  Being overweight can also cause excessive stretching and weakening of the pelvic floor muscles.  The same thing often happens during pregnancy.

   But… there’s realistic hope for improvement:

   A study published in the Journal of Urology found that every five-unit increase in body mass index (BMI) increases your risk of urinary incontinence by 20 to 70%.   BMI is a measure of body fat based on height and weight.

   Another study published in the Journal of Urology found that women who successfully lost weight decreased their weekly stress incontinence accidents by 65% after one year.

   That’s the good news. 

   The bad news is the part about having to lose weight!  Losing weight can be extremely challenging.  There are numerous obstacles and factors including thyroid problems, injuries, illness that impairs ability to exercise and/or its effectiveness. 

 This is why strengthening the pelvic floor muscles is a must for improving bladder control and strength.

   How does one strengthen the pelvic floor muscles?

   Are Kegel exercises the key?

   The answer is both yes and no.  Research does indeed reveal that up to 70% of women with urinary stress incontinence, who regularly exercised their pelvic floor experienced improvement.

   The intention of Kegel exercises is to strengthen the pelvic floor by strengthening the Pubococcygeus (PC) muscle.  The PC muscle is part of the levator ani muscle group.  These muscles are supportive structures involved in urinary control.  The levator ani group includes the pubococcygeus, as well as the puborectalis, and iliococcygeus muscles.

   The levator ani muscles commonly lose strength and function from childbirth, particularly with three or more children.  Women are instructed to get a feel for the muscles used to stop urination, and perform alternating squeezing and relaxing (not while urinating).

   Conventional wisdom has revolved around Kegel exercises for the PC muscle. 
However, doing only Kegel exercises can make things WORSE!! 

  Kegel exercises actually pull the sacrum (base of the spine) inward.  This can result in further weakness of the pelvic floor!


 If they’re NOT the right exercise, why then, are they promoted as the cure-all? 

   I do not know for certain.  However I do know that conventional wisdom is quite often wrong!

   I suspect one of the reasons is that Kegel exercises are a fairly quick and easy thing to explain and recommend.  They are much easier for patients to perform than the truly best exercise for the pelvic floor…


   Weak glutes are what makes the pelvic floor more susceptible to stress incontinence. 

   In other words...
Weaker Glutes + Too many Kegels = Pelvic Floor Dysfunction

 If we had to pick one exercise that would be as close to a “cure-all” for many problems…

   Squats are it!

   Squats promote a cellular-building environment
(anabolic).  This supports muscle building for your entire body.  Squats are perhaps the best functional exercise.  Functional exercises are the ones that make you stronger for real life activities.

   Squats also help you burn more calories
… even when you’re sitting still!  Squats build muscle… and for every pound of additional muscle you gain, your body will burn an additional 50-70 calories per day (even while you’re sitting still). 

 Squats are very helpful for injury prevention because they strengthen muscles, ligaments, and other connective tissues. 

   Squats can even help protect you against weight gain, heart disease, and diabetes
because they support regulation of blood sugar and metabolism of fats.  Squats can even help reduce cellulite!

 Squats improve detoxification and drainage of waste products from your organs and glands, and can even support bowel regularity.

   If we investigate many cultures where squatting is the norm, we see low rates of knee injuries and back pain.  Our ancestors used to perform many daily functions such as harvesting, gathering, hunting, cooking, eating, etc. in a full squat position.

   The bottom line (yes, pun intended) is that if you want a strong and highly-functional pelvic floor, and all of the health benefits it promotes…you must squat!  Proper technique is essential, so make sure to speak to a qualified health or fitness professional (Yes, I can teach you). 

 Most people have no clue of how to squat correctly. 

   I believe this could be the main reason women are instructed to do Kegel exercises only for urinary stress incontinence.  If you are doing lots of squats, Kegel exercises will be supportive.  I have to wonder how many doctors can or will show their patients correct squatting form (I certainly do for my patients, daily).

 A Whole Lot of Nerve

   A complex interaction exists between the nervous system, the bladder muscles, the urinary tube (urethra), the spinal cord (and its branching nerves), and the brain.  Therefore, any energetic disturbance to these systems may result in stress incontinence and other disorders.

   For many years, some urologists have been successfully treating patients with a method they call Percutaneous Posterior Tibial Nerve Stimulation (PTNS).
  It is also called Stoller Afferent Nerve Stimulation.  Several urological medical journals have reported lasting improvement for patients undergoing the treatment.    

Here’s what PTNS is all about:

   Once per week, for 3 months, the patient receives 30 minutes of electrical stimulation.  A special needle connected to the electrical device is inserted in the skin of the ankle area, along with an electrode patch.  During the treatment, the tibial nerve of the leg transmits the electrical signals to the sacral area of the spine. 

   There are many wonderful advantages to having PTNS.
  There are drugs involved, so no side effects or drug interactions are a concern.  No surgical intervention or anesthesia is necessary.

Why is a Chiropractor/Acupuncturist Telling You About PTNS?

   According to a paper published in the Journal of Obstetrics and Gynecology (February 2010), Chinese acupuncture is what inspired doctors to investigate this technique, way back in 1983.  They cited confirmation of a “60–80% positive response rate after 10–12 weekly treatments with percutaneous tibial nerve stimulation (PTNS).”

   Percutaneous Posterior Tibial Nerve Stimulation is performed by inserting an acupuncture needle into what is known as acupuncture point, Spleen 6 (SP6).  The conventional Western medical doctors do not disguise the fact that a 36-gauge acupuncture needle is used, or that it is inserted into SP6.  Between 1982 and 1999, several studies revealed significant improvements for patients with overactive bladder problems by providing electro-acupuncture at SP6.  Improvements were even observed after just one treatment.

   What’s the deal? 

   Did the MDs give a long-practiced acupuncture technique an impressive-sounding Western medical name… and stake a claim to its discovery?

   I don’t recall any major news reporting that acupuncture should no longer be considered alternative medicine.  Urologists were using it within their conventional Western medicine practices. 

   Research studies had been conducted.  Scientific papers were published. 

PTNS" is Acupuncture! 

   Electro-acupuncture specifically, was developed and introduced into the practice of acupuncture in China around 1934. One must wonder why acupuncture and acupuncturists didn’t get the credit for providing a proven, safe, and effective treatment for urinary stress incontinence.  Acupuncture’s effectiveness for stress incontinence has long been observed through Traditional Chinese Medicine (TCM) practices. 

   Here’s the difference:

   Prior to 2000, there was no commercially-marketed FDA-approved device designated for conventional medical treatment.
  Once a device was specifically designated and labeled as being for percutaneous posterior tibial nerve stimulation (PTNS)… it qualified as “new” medical innovation! 

   I will not even dignify mentioning the name of this medical device.
Practitioners who are licensed in acupuncture already have acupuncture needles and electrical stimulation devices.  I have had the necessary equipment for many years.

   I am not a urologist, nor do I claim to treat stress urinary incontinence in the sense of conventional Western medicine.  I do not use the strangely designated PTNS device. 
However, Percutaneous Posterior Tibial Nerve Stimulation, by every sense of its description and definition is electro-acupuncture.  

  I am licensed by the Virginia Board of Medicine to perform acupuncture and electro-acupuncture... including including point SP6!  It is safe and easy for you to have it done. Acupuncturists do not need a "special instrument."  

 More Nerve Support

   Another little-known holistic support option for overcoming urinary stress incontinence is chiropractic treatment.  If this sounds strange to you, fear not… it actually makes perfect sense.  The purpose of chiropractic treatment (spinal adjustments) is to reduce interference to nerve function by improving spinal joint movement.  The same nerves that are irritated resulting in the back pain can be involved with the pelvic floor muscles.

   Chiropractic treatment has the potential to restore normal nerve communication from the spinal cord to the bladder. A study published in 2012 revealed significant improvement for 21 patients receiving chiropractic treatment. 

   Nevertheless, the first step in addressing a bladder problem is seeing your medical doctor
Acupuncture and chiropractic are never a replacement for that.  You must be appropriately medically evaluated before considering these holistic supports.  Serious problems must be first ruled out.  Electro-acupuncture is not performed on those who have pacemakers or defibrillators. It should not be performed on people with clotting disorders, some neurological conditions, and pregnant women.

   If you would like an excellent chance at reducing or eliminating your urinary stress incontinence problem, I can provide the proven effective electro-acupuncture (1x/week, 30 minutes, 12 weeks).  I can teach you how to strengthen your pelvic floor muscles via squats (and Kegel exercises). Perhaps you will need some dietary changes, and some spinal support.  

​Dr. Donald Liebell