---
title: "Overactive bladder and nocturia"
url: "https://acuiq.com/wiki/evidence/overactive-bladder-and-nocturia"
updated: 2026-10-11
last_verified: 2026-10-11
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-11"
reading_minutes: 10
sources: 15
---

# Overactive bladder and nocturia

_What two Cochrane reviews, later systematic reviews, sham-controlled and drug-controlled trials, and the AUA/SUFU, NICE and EAU guidelines report on acupuncture, electroacupuncture and percutaneous tibial nerve stimulation for overactive bladder and nocturia._

The International Continence Society defines overactive bladder (OAB) as urinary urgency, usually with frequent urination and nocturia, with or without leakage, and with no infection or other obvious cause, the definition the [2024 AUA/SUFU guideline](https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder) adopts. Nocturia is waking one or more times in the night to pass urine, in the words of the NOCTURNAL trial below. The trials for these conditions test two related methods: acupuncture and electroacupuncture, and percutaneous tibial nerve stimulation (PTNS), in which a fine needle near the ankle carries a current to the tibial nerve. Leakage on coughing or lifting, and the trials of electroacupuncture over the sacrum for it, are covered in [Urinary incontinence](/wiki/evidence/urinary-incontinence); this page reports on urgency, frequency and night-time voiding.

## The Cochrane review of acupuncture

The [2022 Cochrane review](https://doi.org/10.1002/14651858.CD013519.pub2) by Hargreaves and colleagues searched English and Chinese databases to May 2022 and included 15 studies with 1,395 adults: 14 randomised trials and one quasi-randomised. All raised some concerns about bias, and participants were blinded to their group in only 20% of them. GRADE, the scale Cochrane uses to rate confidence in a result from high to very low, rated the comparisons separately.

| Comparison | Outcome | Studies (people) | Result | Certainty |
| --- | --- | --- | --- | --- |
| Acupuncture vs no treatment | Cure or improvement | 1 | Very uncertain | Very low |
| Acupuncture vs sham | Cure or improvement | 3 (151) | Standardised mean difference −0.36, 95% confidence interval −1.03 to 0.31 | Very low |
| Acupuncture vs sham | Incontinence episodes | 2 (121) | Probably little or no difference | Moderate |
| Acupuncture vs medication | Cure or improvement | 5 (258) | Risk ratio 1.25 in favour of acupuncture | Low |
| Acupuncture vs medication | Daytime frequency | 4 (360) | Little or no difference | Low |
| Acupuncture vs medication | Nocturia episodes | 2 (80) | 0.5 fewer a night with acupuncture | Low |
| Acupuncture vs medication | Minor adverse events | 8 (1,004) | Risk ratio 0.34, fewer with acupuncture | Low |

Nocturia against sham came from one small study, with very low certainty. No study reported a major adverse event, and the authors note that the trials were too small to detect rare ones. They concluded that it is uncertain whether acupuncture differs from sham, and that their findings must stay tentative until larger trials with comparable outcomes report. [Sham acupuncture](/wiki/research/sham-acupuncture) sets out the kinds of control these trials use.

## Later reviews of acupuncture

A [2022 review](https://doi.org/10.3389/fneur.2022.985288) by Lee and colleagues at Kyung Hee University in Seoul searched English, Korean and Chinese databases and included 30 randomised trials, 25 of them run in China. Seven compared acupuncture with sham. Against sham, it reported OAB symptom scores 1.13 points lower and fewer voids a day, and no difference in incontinence; against drugs, similar symptom scores with fewer adverse events (risk ratio 0.38). It rated the evidence mostly low or very low, for risk of bias and small samples.

A [2025 umbrella review](https://doi.org/10.1080/20905998.2024.2400628) by Ma and colleagues assessed seven systematic reviews, searched to February 2024. On AMSTAR 2, a checklist for how a review was conducted, it rated six critically low and one low. Of 34 outcomes it graded, one was moderate certainty, five low and 28 very low.

## How PTNS relates to needling at the ankle

A [2017 review of PTNS](https://doi.org/10.2147/rru.s124981) by de Wall and Heesakkers at Radboud University in Nijmegen states that the technique derives from acupuncture and was first described in the early 1980s, and that Stoller and colleagues developed it, first in monkeys and then in people. A 34-gauge needle goes in about three finger breadths above the inner ankle bone, between the back edge of the tibia and the soleus muscle, with its tip close to the posterior tibial nerve. A stimulator delivers 20 Hz, usually for 30 minutes a session over 12 sessions. The authors place [`SP06`](/points/SP06) (Sanyinjiao) on the inner lower leg about four finger breadths above the same bone, and write that electroacupuncture at similar settings resembles PTNS; the difference they name is that PTNS targets a nerve where acupuncture describes a channel. A [2025 trial](https://doi.org/10.3389/fmed.2025.1579276) by Tan and colleagues at Xiyuan Hospital in Beijing describes the tibial nerve as running beneath SP06 and chose that point to stimulate it. The [European Association of Urology](https://uroweb.org/guidelines/non-neurogenic-female-luts/chapter/disease-management) (EAU) states that the stimulus reaches the spinal centre that controls voiding through the second to fourth sacral nerve roots.

Cochrane’s [2016 review](https://doi.org/10.1002/14651858.CD010098.pub4) of electrical stimulation with non-implanted electrodes, by Stewart and colleagues, counts PTNS among those methods, alongside vaginal and anal probes. Searched to December 2015, it included 63 trials with 4,424 people. Moderate-quality evidence showed more people reporting improvement with electrical stimulation than with sham (risk ratio 2.26; 677 people) or with drugs (1.20; 439 people). There was too little evidence to say which kind of stimulation worked best or whether benefits lasted after treatment stopped.

## The PTNS trials

The SUmiT trial, reported in [2010](https://doi.org/10.1016/j.juro.2009.12.036) by Peters and colleagues, randomised 220 adults with OAB to 12 weekly sessions of PTNS or a sham, double-blind. At 13 weeks, 54.5% of the PTNS group rated their bladder symptoms moderately or markedly improved, against 20.9% of the sham group. Voiding diaries showed fewer voids, fewer night-time voids, fewer urgent voids and fewer urge incontinence episodes with PTNS. No serious adverse event related to the device was reported. Of the people who responded, 50 entered the [STEP study](https://doi.org/10.1016/j.juro.2012.11.175), which continued treatment at about one session a month: 29 completed three years, night-time voids fell from a median of 2.7 to 1.7, and a statistical model estimated that 77% kept their improvement.

The earlier OrBIT trial, reported in [2009](https://doi.org/10.1016/j.juro.2009.05.045) by the same group, randomised 100 adults to 12 weeks of PTNS or extended-release tolterodine, an antimuscarinic bladder drug, at 4 mg a day. Of the participants, 79.5% with PTNS and 54.8% with tolterodine rated themselves cured or improved. Frequency, urge incontinence, urgency and night-time voids improved by similar amounts in both groups. The trial had no sham arm.

## Acupuncture and electroacupuncture trials

A [2020 trial in Hong Kong](https://doi.org/10.1186/s13020-020-00388-w) by Lin and colleagues randomised 100 people with OAB to 16 sessions over eight weeks of acupuncture at [`BL32`](/points/BL32) (Ciliao), [`BL23`](/points/BL23) (Shenshu), SP06, [`KD03`](/points/KD03) (Taixi), [`BL39`](/points/BL39) (Weiyang), [`BL28`](/points/BL28) (Pangguangshu) and [`CV04`](/points/CV04) (Guanyuan), or to blunt sham needles that retracted into the handle at the same points. Both groups improved from baseline, and the improvement lasted three months. The groups did not differ in urge incontinence or daytime frequency; night-time frequency fell more with real acupuncture, after adjusting for a higher starting level in that group. The authors wrote that the trial could not establish a specific effect of acupuncture.

A [2025 trial](https://doi.org/10.1177/09645284251399237) by Noh and colleagues in South Korea compared two frequencies of electroacupuncture, 2 Hz and 16 Hz, with manual acupuncture in 147 postmenopausal women, twice a week for six weeks at [`CV03`](/points/CV03) (Zhongji), CV04, [`GV20`](/points/GV20) (Baihui), KD03 and SP06. Voids per 24 hours, the primary outcome, did not differ between the three groups, and neither did night-time voids. In Tan’s trial, 68 women had electroacupuncture at [`BL33`](/points/BL33) (Zhongliao) and SP06 three times a week for four weeks, or tolterodine. Symptom scores did not differ at four weeks, and more of the electroacupuncture group were rated as responding (88.6% against 48.5%). [Electroacupuncture](/wiki/techniques/electroacupuncture) describes the method.

## Nocturia after prostate cancer

The NOCTURNAL trial, a pilot reported in [JAMA Oncology in 2025](https://doi.org/10.1001/jamaoncol.2025.1199) by Liou and colleagues at Memorial Sloan Kettering Cancer Center in New York, randomised 60 men treated for prostate cancer, who woke two or more times a night to urinate, two to one to acupuncture or a waiting list with usual care. The acupuncture group had 10 weekly sessions at points including BL23, BL28, [`BL31`](/points/BL31) (Shangliao), BL33, [`BL35`](/points/BL35) (Huiyang), [`BL40`](/points/BL40) (Weizhong), KD03, [`KD07`](/points/KD07) (Fuliu) and SP06, with current between points on the lower back and sacrum. At week 10, nocturia fell by 1.08 episodes a night with acupuncture and rose by 0.05 on the waiting list, a difference of 1.13; at week 14 the difference was 0.85. The authors list as limitations the small sample, one month of follow-up after treatment, a single site, and no placebo control or masking.

## What guidelines say

The [AUA/SUFU guideline](https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder) of the American Urological Association and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, published online in April 2024, says clinicians should offer sacral neuromodulation, PTNS or botulinum toxin injection into the bladder when drugs or behavioural therapy have not worked or were not tolerated (a moderate recommendation, evidence grade A). It lists acupuncture among minimally invasive therapies, which clinicians may offer to people unable or unwilling to have behavioural, non-invasive or drug treatment. Its discussion cites a meta-analysis that found acupuncture’s evidence uncertain against sham or no treatment and similar to drugs on low-certainty evidence.

NICE guideline [NG123](https://www.nice.org.uk/guidance/ng123/chapter/Recommendations), on incontinence in women, says not to offer transcutaneous tibial nerve stimulation for OAB, and not to offer PTNS unless a local multidisciplinary team has reviewed the case, medication has not worked adequately, and the woman does not want botulinum toxin or sacral nerve stimulation. It also says not to recommend complementary therapies for incontinence or OAB, without naming acupuncture. The EAU guideline on female lower urinary tract symptoms, in its 2026 edition, gives a strong recommendation to offer tibial nerve stimulation for OAB and urge incontinence, and a weak one to consider acupuncture for OAB symptoms. [Clinical guidelines](/wiki/evidence/clinical-guidelines) compares how other bodies treat acupuncture.

## What the reviews could not settle

For acupuncture, the two reviews that pooled sham comparisons reached different readings: very uncertain in Cochrane’s, favourable in Lee’s, and both drew on fewer than ten sham-controlled trials. The comparisons with drugs were not blinded. NOCTURNAL, the one trial above built around nocturia, compared acupuncture with a waiting list and ran at one site. For PTNS, the sham-controlled evidence rests on SUmiT, and its longer follow-up kept only people who had responded. The reviews above report PTNS and acupuncture separately, so none compares a needle placed at the tibial nerve with one placed at SP06. Cochrane’s review of electrical stimulation predates the trials published since 2016.

AcuiQ’s [overactive bladder](/symptoms/overactive-bladder), [nocturia](/symptoms/nocturia), [urge incontinence](/symptoms/urinary-incontinence-urgency) and [frequent urination](/symptoms/urination-frequent) pages list the protocols individual studies prescribed, each with its citation.

### Sources

1. Hargreaves E, Baker K, Barry G, Harding C, Zhang Y, Kandala NB, Zhang X, Kernohan A, Clarkson CE, Acupuncture for treating overactive bladder in adults, Cochrane Database of Systematic Reviews 2022, CD013519 — https://doi.org/10.1002/14651858.CD013519.pub2
2. Lee JJ, Heo JW, Choi TY, Jun JH, Lee MS, Kim JI, Acupuncture for the treatment of overactive bladder: a systematic review and meta-analysis, Frontiers in Neurology 2022 — https://doi.org/10.3389/fneur.2022.985288
3. Ma J, Ren F, Lu S, Ye Y, Xu L, Zhang P, Ma Z, Acupuncture therapy of overactive bladder: an umbrella review and meta-analysis, Arab Journal of Urology 2025 — https://doi.org/10.1080/20905998.2024.2400628
4. de Wall LL, Heesakkers JPFA, Effectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome, Research and Reports in Urology 2017 — https://doi.org/10.2147/rru.s124981
5. Stewart F, Gameiro LF, El Dib R, Gameiro MO, Kapoor A, Amaro JL, Electrical stimulation with non-implanted electrodes for overactive bladder in adults, Cochrane Database of Systematic Reviews 2016, CD010098 — https://doi.org/10.1002/14651858.CD010098.pub4
6. Peters KM, Carrico DJ, Perez-Marrero RA, et al., Randomized trial of percutaneous tibial nerve stimulation versus sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial, Journal of Urology 2010 — https://doi.org/10.1016/j.juro.2009.12.036
7. Peters KM, Carrico DJ, Wooldridge LS, Miller CJ, MacDiarmid SA, Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP study, Journal of Urology 2013 — https://doi.org/10.1016/j.juro.2012.11.175
8. Peters KM, Macdiarmid SA, Wooldridge LS, et al., Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial, Journal of Urology 2009 — https://doi.org/10.1016/j.juro.2009.05.045
9. Lin ZX, Chan NHT, Kwan YK, et al., A randomized controlled trial to assess the effectiveness and safety of acupuncture for overactive bladder: a study in Hong Kong population, Chinese Medicine 2020 — https://doi.org/10.1186/s13020-020-00388-w
10. Noh EJ, Choi SJ, Kim DI, Nam EY, Lim CY, Park JK, Sung WS, Effectiveness and safety of electroacupuncture and manual acupuncture in postmenopausal women with overactive bladder: a multicenter, randomized, controlled, parallel clinical trial, Acupuncture in Medicine 2025 — https://doi.org/10.1177/09645284251399237
11. Tan Z, Ding M, Li J, Luo R, Shen J, Effectiveness and safety of electroacupuncture in female overactive bladder: a randomized controlled trial investigating sacral and tibial nerve modulation, Frontiers in Medicine 2025 — https://doi.org/10.3389/fmed.2025.1579276
12. Liou KT, Carlsson S, Ajay D, et al., Acupuncture for nocturia in survivors of prostate cancer: the NOCTURNAL randomized clinical trial, JAMA Oncology 2025 — https://doi.org/10.1001/jamaoncol.2025.1199
13. Cameron AP, Chung DE, Dielubanza EJ, et al., The AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder, American Urological Association, published online 23 April 2024 — https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder
14. National Institute for Health and Care Excellence, Urinary incontinence and pelvic organ prolapse in women: management (NG123), published 2 April 2019, last updated 24 June 2019 — https://www.nice.org.uk/guidance/ng123/chapter/Recommendations
15. European Association of Urology, EAU Guidelines on Non-neurogenic Female LUTS: disease management, 2026 edition — https://uroweb.org/guidelines/non-neurogenic-female-luts/chapter/disease-management