Nocturnal enuresis

Bedwetting, or nocturnal enuresis, is the involuntary emptying of the bladder during sleep in a child older than five. As Ton and colleagues summarise the International Children’s Continence Society (ICCS) definition, it is monosymptomatic when the child wets only at night and has no other lower urinary tract symptoms; bedwetting with daytime symptoms is nonmonosymptomatic. The 2011 Cochrane review of complementary treatments puts it at 15% to 20% of five-year-olds and up to 2% of young adults. The trials below used needle acupuncture, warm acupuncture, moxibustion, acupoint injection and, most often, laser acupuncture, in which a low-power laser stimulates the points without a needle.

The Cochrane review, last updated in 2011, found one sham-controlled trial of needle acupuncture, which favoured acupuncture, and concluded that the evidence was weak and came from single small trials. Three meta-analyses published since favoured acupuncture or laser acupuncture over a mix of drug, herbal and sham controls, and found no difference against desmopressin, the antidiuretic drug the guidelines below offer first, or against drugs alone; the two that applied GRADE rated their evidence very low in certainty. Of the two sham-controlled laser trials, one in Turkey favoured laser acupuncture and one in Slovakia found no difference in wet nights. NICE’s 2010 guideline names acupuncture only as a research priority.

Is there a Cochrane review of acupuncture for bedwetting?

Yes, as one part of a broader review. Huang and colleagues’ review of complementary and miscellaneous interventions for nocturnal enuresis in children, published in December 2011 with searches to June 2010, updated an earlier version by Glazener, Evans and Cheuk. It included 24 randomised or quasi-randomised trials with 2,334 children, covering hypnosis, psychotherapy, acupuncture, chiropractic, diet, faradization and medicinal herbs, and judged their quality poor: 5 were quasi-randomised, 5 showed differences between groups at baseline and 17 lacked follow-up data. Four trials included acupuncture:

• In Mao’s 1998 trial, against a sham procedure, 26 of 56 children were still wet after acupuncture ended and 38 of 55 after sham (risk ratio 0.67, 95% CI 0.48 to 0.94). The reviewers noted unclear allocation concealment, no blinding and no stated follow-up.
• In Jiang’s 2000 trial, warm acupuncture had a lower failure rate than a combination of meclofenoxate, oryzanol and thiamine (risk ratio 0.31, 95% CI 0.21 to 0.45), which the reviewers doubted for the trial’s quality and its lack of a placebo group.
• Two small trials, against imipramine and against desmopressin, had too few children to show whether the treatments differed.

The reviewers concluded that the evidence for hypnosis, psychotherapy, acupuncture, chiropractic and medicinal herbs was weak, and that current evidence does not support their use until proper randomised trials have shown their effect. Where alarms have failed or cannot be used, they wrote, these therapies might be considered after careful discussion with parents, preferably within a randomised trial. Cochrane lists no later version of the review.

Systematic reviews

Bower and colleagues measured outcome as the change in wet nights and found marked heterogeneity when one form of acupuncture was compared with another. They called the evidence tentative and said it could not show which parameters of acupuncture matter.

Lv and colleagues counted needling, moxibustion, acupressure, electroacupuncture, acupoint injection and laser acupuncture together as acupuncture. Their pooled comparison set these against drugs such as meclofenoxate, desmopressin, imipramine and oxybutynin, and against Chinese herbal medicines, and the trials disagreed with one another more than chance allows (heterogeneity of 54%). Against desmopressin alone the odds ratio was 1.57 (95% CI 0.38 to 6.57). The only two placebo-controlled trials, both of laser acupuncture, were not pooled because their results were inconsistent and one did not report cure rates. The authors found no reports of adverse events and wrote that the benefit might be overstated because of the trials’ low quality.

Kannan and Bello grouped trials by method: manual acupuncture, laser acupuncture or electroacupuncture, acupoint injection and moxibustion. Their abstract reports each pooled result as a p-value only, and calls the comparison of laser acupuncture with desmopressin inconclusive.

Ton and colleagues, in Taiwan, defined full response, as ICCS does, as at least 90% fewer wet nights, and partial response as at least 50% fewer. Partial response did not differ between laser acupuncture and controls (9 trials), and among the five trials with six months of follow-up the difference in full response was not significant (ratio 2.46, 95% CI 0.92 to 6.52). They rated every pooled result very low in certainty for publication bias and indirectness, found that only one trial clearly concealed allocation and none reported clearly whether its assessors were blinded, and noted that none measured the children’s expectations. The points used most often were SP06 (Sanyinjiao), CV04 (Guanyuan), CV03 (Zhongji), BL23 (Shenshu), BL28 (Pangguangshu), ST36 (Zusanli), BL32 (Ciliao) and KD03 (Taixi), on the lower abdomen, lower back, sacrum and legs, with red (632 to 670 nm) or infrared (808 to 905 nm) light.

Selvi and colleagues looked only at children whose bedwetting had not responded to first-line treatment. They judged the reports on electroacupuncture, furosemide, botulinum toxin injections and the herbal medicine shokenchuto unreliable for that group, although those reports described improvements, and found that the evidence for every second- and third-line option was too weak to support a treatment sequence.

Trials

Laser acupuncture against placebo light

• Turkey, 2011. Karaman and colleagues randomised 91 children with primary monosymptomatic enuresis, mean age 8.6 and previously untreated, to laser acupuncture three times a week for four weeks or the same programme with a non-laser light on the same points, in a single-blind design. Six months after treatment the laser group averaged 1.7 wet nights a week and the placebo group 3.1, and complete dryness and partial improvement were both more frequent with laser. Lv’s review, which analysed 83 of the children, counts 31 of 57 completely dry after laser and 3 of 26 after placebo.
• Slovakia, 2011. Radvanska and colleagues randomised 31 children with at least three wet nights a week and a small bladder capacity for their age to five weeks of active laser acupuncture, placebo red light with skin contact, or placebo red light without contact. Laser acupuncture changed neither the number of wet nights, nor maximal voided volume, nor night-time urine production; average daytime voided volume rose. The authors called laser acupuncture safe but inefficient for this group, with subtle effects on how much the bladder holds.

Laser acupuncture against desmopressin

• Austria, 2001. Radmayr and colleagues randomised 40 children with normal bladder function and high night-time urine production to desmopressin or laser acupuncture. At least six months later 75% of the desmopressin group and 65% of the laser group were completely dry, with no significant difference. This is one of the two acupuncture trials the Cochrane review found too small to compare.
• Egypt, 2014. Moursy and colleagues randomised 186 patients aged 10 to 21, mean 15.7, whose bedwetting had persisted through earlier treatment, to three months of laser acupuncture, desmopressin, or both. Cure was reported in 33, 35 and 46 of the 62 in each group, a significantly higher rate with the combination, and bladder capacity increased only in the two groups given laser acupuncture.
• Egypt, 2017. Alsharnoubi and colleagues randomised 45 children aged 5 to 15 to desmopressin, laser acupuncture, or both, all with behavioural therapy, and reported cure in 73.3% of the laser group. Ton’s review judged this trial at high risk of selection bias, because children with daytime symptoms may have been enrolled in a control group.
• Egypt, 2024. Botla and colleagues randomised 60 adolescent girls to desmopressin with or without laser acupuncture three times a week for 12 weeks, and found bladder capacity increased more with the added laser. There was no sham laser. The authors note that the evidence available in the literature is of very poor quality.

Needle acupuncture

The sham-controlled needle trial is Mao’s, reported above through the Cochrane review. In Japan, Honjo and colleagues needled BL33 (Zhongliao), over the third sacral foramen, on both sides for 10 minutes in 15 patients with monosymptomatic enuresis. Wet nights fell by half or more in 6 just after treatment and in 7 two months later, and in the 6 early responders night-time bladder capacity rose from 201 mL to 334 mL. There was no control group.

Harms

The Cochrane review judged the adverse effects of the complementary therapies it covered generally mild. Lv’s review found no adverse events reported in its acupuncture trials. Ton’s review rated eight of its 11 laser trials unclear on adverse effects: five did not report them clearly and three did not report them accurately. Honjo’s needle study recorded no side effects. Acupuncture for children covers needling in children more generally.

What the guidelines say

NICE’s guideline CG111, Bedwetting in under 19s, was published in October 2010 and last reviewed in November 2018, and it is current. Its recommendations cover assessment, fluid and toileting advice, rewards, alarms, desmopressin, anticholinergics, tricyclics and training programmes, and do not mention acupuncture. Among its recommendations for research it asks how effective complementary therapies are, used alone or with conventional treatment, and says acupuncture and hypnotherapy should take priority. NICE’s 2018 surveillance decision found new evidence on acupuncture and electrical nerve stimulation, which the guideline does not cover, and judged it based on small studies and insufficient to change the guideline, so NICE did not update it.

The ICCS’s 2020 standardisation document on management, by Nevéus and colleagues, recommends active treatment from age six, with desmopressin or the alarm first in monosymptomatic enuresis, then anticholinergics, and antidepressants on expert advice. Its abstract does not mention acupuncture; the full text could not be opened for this page.

The Chinese Medical Doctor Association’s paediatric nephrology committee published an expert consensus in 2026, agreed by Delphi vote among 42 panellists in paediatric nephrology, urology, child health and paediatric Chinese medicine. It names desmopressin and the alarm as first-line treatment. Its recommendation 17, fully agreed by every panellist, says Chinese medicine therapies including herbs, acupuncture, massage and medicinal patches may improve enuresis-related symptoms when chosen by syndrome differentiation, and may be combined with Western medicine. Clinical guidelines sets these positions beside other bodies’.

What the reviews could not settle

Only three trials compared acupuncture or laser acupuncture with a sham: Mao’s needle trial, which the Cochrane reviewers judged of suboptimal quality, and the two 2011 laser trials, which disagreed. Lv’s and Ton’s meta-analyses did not pool the sham-controlled trials separately, so their pooled results mix sham, drug and herbal controls and cannot say how much of any difference is specific to the stimulation; Sham acupuncture sets out the problem. Against desmopressin the trials found no difference, but the Cochrane reviewers found the one such trial they had too small to show whether the treatments differed, and the later pooled comparisons rest on three to five small trials. Lv’s review notes that most trials did not separate monosymptomatic from nonmonosymptomatic bedwetting, and 5 of Ton’s 11 trials followed children for six months, which Ton’s review calls the standard period for judging response and relapse. The research NICE asked for in 2010, on acupuncture used alone or with conventional treatment and measuring self-esteem and quality of life, had not changed its guideline by the 2018 review.

AcuiQ’s nocturnal enuresis page lists the protocols individual studies prescribed, each with its citation.