‘An empty and happy feeling in
the bladder...’: health changes
experienced by women after
acupuncture for recurrent
T. Alraek, A. Baerheim
Terje Alraek, BAc, Research Fellow. Anders Baerheim, MD, PhD, Section for
General Practice, Department of Public Health and Primary Health Care,
University of Bergen, Norway
reported by cystitis-prone females after having received prophylactic acupuncture
treatment for recurrent cystitis. Design: A qualitative study based on written free text
answers on the women’s own experience of changes related to health after completion
of TCM acupuncture treatment. Data were analyzed using Giorgi’s phenomenological
approach. Setting: Subjects living in the Bergen area, Norway, were recruited by
advertisement in local newspapers and included provided they had had three or more
episodes of lower UTI during the previous 12 months. Results: The main topics
reported were related to improved pressure during micturition and more complete
bladder emptying; more normal bowel movement and less abdominal discomfort; more
energy, reduced stress level, and better sleep. Only a few reported feeling worse.
Conclusion: The symptoms described as relieved by the women in our study seem to fit
TCM theory for diagnoses of their vulnerability to cystitis. Qualitative methods have a
role in TCM research that may enrich our knowledge in other ways than traditional
quantitative methods may.
Objective: The aim of this study was to explore changes in health as
C ?2002 Elsevier Science Ltd. All rights reserved.
Keywords: acupuncture, urinary tract infection, women, qualitative methods
It seems to be a common experience among
acupuncturists and their patients that acupuncture
treatment results in a positive effect on health in
general, in addition to its intended treatment ef-
fect. The overall effect of acupuncture treatment
may be to restore harmony as described in ‘The
web that has no weaver’.1This concept may be
implicit for patients in China and therefore taken
for granted as a natural result of a treatment given
patients without these preconceptions will experi-
ence similar changes.
uncommon, they seem to have received limited
BAc, Research Fellow,
University of Bergen,
Department of Public
Health and Primary Health
Care, Ulriksdal 8c, N-5009
Bergen, Norway, E-mail:
attention in published material, and little is found
on the topic in textbooks or research papers. One
recent article has addressed this topic. During
filled in at the end of each treatment session by
in 27% positive and 22% negative assessments.
Positive changes were mainly a pleasant feeling
of fatigue, calmness and improved sleep. Nega-
tive effects were mainly bleeding and haematoma.
This study focused on experiences at the end of
each acupuncture session.2To our knowledge no
study has explored more lasting experiences.
As the literature on changes in patients’
perceived health after receiving acupuncture
Complementary Therapies in Medicine (2001) 9, 219–223
C ?2002 Elsevier Science Ltd. All rights reserved.
doi:10.1054/ctim.2001.0482, available online http://www.idealibrary.com on
Complementary Therapies in Medicine
treatment is sparse, initial research on this theme
needs a broad approach. Qualitative research
methods are better suited to exploring the full
range of subjective experiences,3and may there-
fore be the method of choice when addressing
sparsely documented areas of knowledge.
The aim of this study was therefore to ex-
plore changes in health as reported by cysti-
acupuncture treatment for their recurrent cystitis.
Norway during a period of 27 months from May
1998. Criteria for inclusion were three or more
episodes of lower urinary symptoms (defined as
dysuria, urinary frequency, and/or suprapubic dis-
comfort) during the previous 12 months, provided
that at least two had been diagnosed and treated
as an acute cystitis by a medical doctor. Subjects
were excluded if they were pregnant, or known to
have any complicating illness (e.g. diabetes, can-
cer, obstruction or anomalies of the urinary tract).
The subjects were recruited for a study on
acupuncture treatment in the prevention of recur-
rent cystitis, the results of which will be published
elsewhere. Of 94 women included, 67 were ran-
tients was diagnosed simultaneously by two expe-
rienced acupuncturists. The diagnosis was based
on the mainstream principles found in Traditional
Chinese Medicine (TCM).1The treatment was
given twice weekly for four weeks, by one of two
acupuncturists. The main acupuncture points used
were St 36, Sp 6 and 9, LR 3, KI 3, Bl 23 and 28,
and other points according to the TCM diagno-
sis of the patients. The needles were inserted and
manipulated to obtain De Qi. Needles were left in
place for 20 minutes, with intermittent manipula-
tion if indicated.
In order to explore all possible reactions to the
treatment, an open-ended free text questionnaire
was used. Two weeks after the end of treatment,
46 of the subjects were sent a questionnaire by
‘We experience sometimes that people who re-
ceive acupuncture treatment may notice changes
in themselves after treatment. Therefore we ask
you to write down in your own words if you have
one way or other. Include everything, even though
you think it does not mean anything.’ Due to un-
envelopes to the doctor (AB) in this project. The
texts from the informants were short, matter-of-
fact, and often presented as lists. Median length
was 65 words, range 2–211 words. The study was
approved by the Regional Ethical Committee.
The resulting text elements were analyzed phe-
nomenologically using Giorgi’s approach.4The
analysis went through the following stages: 1)
in context in order to get a general sense of the
whole body of text, identifying themes. Descrip-
tions of fewer cystitis episodes were excluded, as
this was the main aim of the treatment in the orig-
inal quantitative study. 2) Discrimination of units
of meaning. We went back to the beginning and
read through the text once more with the specific
aim of discriminating units of meaning, using a
general health perspective as reference. Units of
under themes. 3) Transformation and abstraction
of units of meaning. We went through all the dif-
ferent groups of units of meaning expressing their
message in more general terms, within the spe-
cific perspective we had chosen. 4) Synthesis into
a consistent statement. The insights contained in
The procedure described under stage two is a
decontextualization of the original text, and the
procedures under stages three and four are the re-
contextualization of the message contained in the
different conceptual categories. The material was
analyzed separately by the two authors. One (AB)
(TA), who also was one of the two acupuncturists
who carried out the treatment, has been practicing
acupuncture for 19 years.
The 46 cystitis-prone women returning the ques-
tionnaires averaged 39.7 (range 19–61) years old.
Seven reported no changes at all. Consequently,
the present material consists of 39 free-text as-
sessments on experienced changes in health as
reported by cystitis-prone females two weeks af-
ter eight sessions of individualized acupuncture
Major experiences expressed by the women
were changes in urinary habits, digestion, energy
levels, stress levels, sleeping patterns and bodily
discomfort and pain.
The following conceptual categories were
Better pressure during voiding, and
more complete emptying of the
Many informants told of a normalization of the
voiding process. They reported increased pressure
Health changes after acupuncture for recurrent cystitis
during micturition, a feeling of a better emptying
of the bladder, and also less frequent toilet visits.
I felt a happiness and emptiness as if there was no
more pressure from the bladder. I do not go so often to
A reduced need of voiding both during the day
and the night were reported. This had a positive
influence on other aspects of their health, such as
to their toilet habits.
Earlier I used to go to the toilet many times during the
night, in some periods once every hour. Now I sleep
through the night... and I feel good in the morning.
Several women reported that, when they now
experienced warning symptoms that previously
would have indicated imminent cystitis, these
symptoms resolved without developing into an in-
A feeling that it should deteriorate again, but it is as if
the process is reversed. It has never been like this
Few women reported adverse affects, some ex-
sexual activity but without any actual urination.
Normalized bowel movements and
less abdominal discomfort
Several women described an overall better func-
tioning of the digestive system. Long-standing
problems with diarrhea and constipation were
normalized. A common experience was a more
comfortable feeling in the whole lower abdomen
together with less pressure in the bladder/lower
Usually diarrhea and problems with the stomach.
Believed that it was caused by food intolerance—
since it has gone I am not sure.
Feeling that the stomach/belly is much lighter, before
there was pressure or a feeling of discomfort all the
A few women described a greater tendency to
gas in the intestines, sometimes difficult to shift.
More energy, reduced stress level and
Many of the participating women reported better
mental health after acupuncture treatment. They
slept better and woke up feeling good. They felt
more energetic during the day, and less tired after
work, and needed less sleep. Some felt stronger
and less easily stressed. Their bodies felt more re-
laxed, and they felt a certain ‘peace inside.’ Their
mood was improved and they wanted to be more
going. A few reported more sexual energy.
I have had depression for a while. (My mother has
cancer.) After each treatment I felt a lift in my mood,
looking at life with a more bright light.
I felt I had more energy, wanted to do more, and my
body is more relaxed.
Many women reported improvements in painful
in the back, joints and other areas of the body.
For many years I have had bad attacks of pain which I
was told were due to adhesions. But now, which to me
is a miracle, after acupuncture this pain is nearly gone!
Several women reported less menstrual pain
and more free flow of menstrual blood. Other mis-
such as disappearance of acne, and stronger nails.
were related to normalized urination with better
pressure during voiding and more complete emp-
ergy, reduced stress level, and better sleep.
Negative experiences from the acupuncture
treatment were more or less absent in this study.
We did not specifically ask for negative effects,
but the opening text of the questionnaire allowed
for them, not stating whether positive or negative
how qualitative methods may be highly produc-
tive of a broad response. Our results give broad
descriptions of changes related to a better mental
status. In addition, we received many statements
on better digestion and voiding habits, changes
that we hardly could have foreseen in a closed
By using qualitative methods we may explore
the full range of subjective changes as perceived
by the patients.3These subjective changes may be
important to our patients and we gave them the
in the 100% response rate on our questionnaire.
Acupuncture is currently well known to the
public in the west. However, as far as we know,
knowledge that the treatment should induce a
whole set of changes related to overall health is
not common in the general population and prob-
ably not to our patients in the present study. We
are aware that acupuncture can be looked upon
as a procedural therapy involving an intentional
interaction between the practitioner and the pa-
tient. At the first TCM consultation, we asked di-
agnostic questions that reflected an understand-
ing of recurrent cystitis not related solely to the
bladder, which may have induced parallel expec-
tations in the patients. We find it, however, hard
to believe that such expectations should be capa-
ble of inducing the variety of statements that are
Complementary Therapies in Medicine
shown in our results. Rather, the informants’ free-
text descriptions probably reflect these women’s
genuine experiences of health changes after hav-
ing had acupuncture.
Our material was based on short written an-
swers, which usually do not give as rich data as
interviews. Less rich data require a more stringent
method of analysis.4We met this by deciding on
short and often matter-of-fact type of free-text we
had access to did pose restrictions in the recontex-
tualization stage of the analysis, giving our results
a more matter-of-fact flavor.
Our analysis of the women’s descriptions will
inadvertedly be colored by our preconceptions,
since in all research the researchers carry with
them preconceptions and a theoretical framework
which can create expectations of certain results.
turist (TA), analyzed this material, we have proba-
expected by the acupuncturist, and vice versa.
acupuncture has a place in the prophylaxis of re-
current cystitis in women.5Viewed from the per-
spective of western medicine, the first symptom
complex of the present study, better emptying of
more frequent voiding is a fair description of the
goal for bladder training, most often used in chil-
dren with unstable bladder.6Such training is ex-
pected to reduce residual urine and thereby the
recurrence rate of urinary tract infection.7We find
it interesting that acupuncture treatment, formerly
shown to reduce the recurrence rate,5leads to
symptom descriptions matching the normal work-
ing of the urinary bladder.
the body and include different organ systems and
may therefore reflect the ancient view of TCM as
stated in Kaptchuk: ‘The Chinese are interested in
discerning the relationships among bodily events
occurring at the same time. The logic of Chinese
medicine is organismic or synthetic, attempting to
organize symptoms and signs into understandable
configurations. The total configurations, the pat-
terns of disharmony, provide the framework for
treatment. The therapy then attempts to bring the
configuration into balance, to restore harmony to
the individual.1The vulnerability to cystitis of the
women in the present study may in TCM be called
between infections will be a part of the diagnosis
but the symptoms at an acute infection will add
treating women with an acute episode of cystitis
the syndromes and treatment would be different
than when treating between attacks as addressed
in our study.
In a former study8we found that women with
recurrent cystitis mainly fell into two patterns of
disharmony, Spleen and Kidney Qi/Yang xu and
the signs and symptoms of both Spleen and Kid-
ney Qi/Yang xu and Liver Qi stagnation include:
slight discomfort in the abdomen, frequent urina-
tion, loose stools/constipation, tiredness, lack of
will-power, feeling of cold, abdominal distension,
irritability and mental depression.9We find it in-
teresting how closely the patients of our study de-
scribe such symptoms as having disappeared after
individualized acupuncture treatment.
The reported changes in urinary habits seem to
be more related to Kidney. From TCM textbooks
give rise to weak Kidney Qi.9The Kidneys will
then not have energy available for the Bladder to
perform its Qi transformation upon the urine. The
weakened holding function will then give rise to
stream. Further, one study reported that acupunc-
in patients with irritative bladder symptoms.10
Many of our informants reported changes re-
lated to better functioning of the digestive system.
Many cystitis-prone women have been diagnosed
as having a Spleen Qi/Yang xu disorder.8Any
Spleen disharmony will influence the digestive
sion, lack of appetite, loose stools and lassitude.9
malization of the Spleen’s function of transporta-
tion and transformation of food and water. Again,
the statements of the informants seem to support
pects like feelings of frustration, repressed anger,
resentment and irritation. The relationship be-
tween emotion and organs is mutual in Chinese
Medicine. The Liver’s responsibility for the free
flow of Qi throughout the body, for example, also
has an important influence on the emotional state,
the Liver function. ‘Thus if the Liver is function-
state will be happy and free-going and the person
will be in good spirits and freely express his or her
emotions.’9Again this seems to be reflected in our
results under the heading ‘More energy, reduced
stress level and better sleep’, reflecting that some
The external validity of our results can only
be pragmatic, meaning that it depends on whether
other acupuncturists recognize our findings as
valid for their own patients.4The sample method
we used should make our results valid for how
most women with recurrent cystitis may feel a
Health changes after acupuncture for recurrent cystitis Download full-text
few weeks after acupuncture treatment. Other pa-
tients not vulnerable to recurrent cystitis, but hav-
ing Kidney and Spleen Yang/Qi xu or Liver Qi
of health more or less similar to those found in our
study. These patients could present symptoms not
necessarily related to the urinary system.
In conclusion, the symptoms described as re-
lieved by the women in our study seem to fit TCM
theory for diagnoses of cystitis-prone women.
Qualitative methods have a role in TCM research
that may enrich our knowledge in other ways than
traditional quantitative methods may.
We thank Norbert Cools as participating acupuncturist, Peter
Deadman for careful help on TCM theory and Kirsti Malterud
the Norwegian Research Council and Eckbos legacy for finan-
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