Frankincense-based Herbal Product Effective as a Complementary Treatment to Reduce Frequency of Urinary Incontinence

by | Feb 9, 2023 | 2022, Bladder Health, Botanicals

Written by Taylor Woosley, Staff Writer. Results of between group analysis shows that FHP significantly reduced the mean frequency of urinary incontinence and improved the mean score of the ICIQ-UI SF questionnaire compared to the solifenacin group and placebo. 

Urinary incontinence (UI) in women is a highly prevalent health condition that affects approximately 50% of women over the age of 501. SUI is the most common type, along with urge urinary incontinence (UUI) and mixed urinary incontinence (MUI), and the prevalence and severity of UI increases with age2. UI is caused due to a lack of strength in the urethral sphincter muscles, pelvic floor muscles, connective tissues, and fasciae3.

Boswellia serrata is a medicinal plant that has historically been used to treat inflammatory conditions4. Boswellic acid, an important constituent of boswellia, has been reported to produce anti-inflammatory and analgesic properties5. Research has shown that boswellia may effectively deliver pain relief and ameliorate urinary symptoms without severe side effects6.

Karbalaiee et al. conducted a randomized, double-blind, placebo- and active-controlled study to access the efficacy of a frankincense-based herbal product (FHP) in women with MUI in comparison with the standard drug solifenacin (a muscarinic receptor antagonist used to treat overactive bladder) and placebo. Subject inclusion consisted of being a postmenopausal woman, aged 55-80 years, with clinically diagnosed MUI. The frankincense-based herbal product was composed of seven plants for each 650-mg tablet, with 100 mg/tablet each of frankincense (K), sedge (S), aucklandiae (Q), the thin inner woody hulls of oak fruits (J), and long pepper (D). Additionally, the tablet contained 40 mg/tablet of black pepper (F) and ginger (Z), with 58 mg of sucrose and 12 mg of magnesium stearate included. The total phenolic content of each FHP tablet was 90.42 ± 2.91 mg gallic acid equivalents. The solifenacin tablet consisted of solifenacin succinate at 1.2 mg/tablet, sucrose, and magnesium stearate 58 and 12 mg/tablet, respectively, and an equal amount of corn starch and barley flakes up to 650 mg.

Participants (n=101) were divided into three parallel groups: the FHP group (n=33), solifenacin group (n=34), or placebo (n=34), with each receiving 6 tablets daily (3 after breakfast and 3 after dinner). Primary outcomes included changes in the frequency of urinary incontinence and amount of leakage, which was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Secondary outcomes included changes in urinary incontinence scores and quality of life (QOL), assessed by a trained physician using ICIQ-IU SF and Incontinence Quality of Life (I-QOL) questionnaires, respectively. This data was collected at baseline, at the end of weeks 2 and 4, and 2 weeks after treatment (week 6) for follow up.

Analysis of variance and Chi-square tests were used to evaluate age, BMI, history of pelvic trauma, and duration of urinary incontinence among subjects. Kruskal-Wallis, Friedman and Wilcoxon-Mann-Whitney tests were utilized to statistically compare the frequency, amount of leakage, score of urinary incontinence, and QOL in the three groups at four different times (at time of registration, weeks two, four, and six). Significant findings of the study are as follows:

  • In the between group analysis, in both the FHP and solifenacin group a significant reduction in the mean frequency of urinary incontinence and amount of leakage was observed in week 4 compared to the placebo group. However, 2 weeks after stopping the treatment, this reduction was significant only in the FHP group.
  • The mean score of ICIQ-UI SF questionnaire in the FHP group in week 4 and 2 weeks after discontinuation of treatment significantly decreased compared to the placebo group. Furthermore, 2 weeks after discontinuation, this mean showed a significant decrease in the FHP group compared to the solifenacin group.

Results of the study show that FHP is effective in reducing symptoms of UI such as frequency of urinary incontinence and amount of leakage. Additionally, the FHP group had a much more significant improvement in their QOL compared to placebo and the solifenacin group. Study limitations include the monocentric nature of the study, with a short duration and follow-up period, along with solely focusing on subjects with MUI, with further studies needed to measure efficacy on other forms of UI.

Source: Karbalaiee, Mahbubeh, Azar Daneshpajooh, Narges Khanjani, Samira Sohbati, Mehrnaz Mehrabani, Mehrzad Mehrbani, and Mitra Mehrabani. “Efficacy of frankincense‐based herbal product in urinary incontinence: A randomized, double‐blind, placebo‐and active‐controlled clinical trial.” Phytotherapy Research (2022).

© 2022 John Wiley & Sons Ltd.

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Posted February 9, 2023.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

  1. McKinney JL, Keyser LE, Pulliam SJ, Ferzandi TR. Female Urinary Incontinence Evidence-Based Treatment Pathway: An Infographic for Shared Decision-Making. Journal of women’s health (2002). Mar 2022;31(3):341-346. doi:10.1089/jwh.2021.0266
  2. Åström Y, Asklund I, Lindam A, Sjöström M. Quality of life in women with urinary incontinence seeking care using e-health. BMC Womens Health. Sep 20 2021;21(1):337. doi:10.1186/s12905-021-01477-0
  3. Alouini S, Memic S, Couillandre A. Pelvic Floor Muscle Training for Urinary Incontinence with or without Biofeedback or Electrostimulation in Women: A Systematic Review. Int J Environ Res Public Health. Feb 27 2022;19(5)doi:10.3390/ijerph19052789
  4. Fatima M, Anjum I, Abdullah A, Abid SZ, Malik MNH. Boswellic Acids, Pentacyclic Triterpenes, Attenuate Oxidative Stress, and Bladder Tissue Damage in Cyclophosphamide-Induced Cystitis. ACS Omega. Apr 26 2022;7(16):13697-13703. doi:10.1021/acsomega.1c07292
  5. Al-Dhubiab BE, Patel SS, Morsy MA, et al. The Beneficial Effect of Boswellic Acid on Bone Metabolism and Possible Mechanisms of Action in Experimental Osteoporosis. Nutrients. Oct 18 2020;12(10)doi:10.3390/nu12103186
  6. Presicce F, Barrese F, Cantiani A, et al. Boswellia resin extract and propolis derived polyphenols in patients with type III chronic prostatitis/chronic pelvic pain syndrome: An Italian prospective multicenter study. Asian J Urol. Apr 2022;9(2):139-145. doi:10.1016/j.ajur.2021.09.002