Urinary incontinence

Stress urinary incontinence (SUI) is leakage of urine during effort, such as coughing, lifting or running, as a 2025 review by Jiang and colleagues in Ningbo defines it. Mixed urinary incontinence (MUI) combines stress leakage with urgency incontinence, leakage that follows a sudden need to pass urine, in the words of a 2022 review by Cui and colleagues in Harbin. Most trials of acupuncture for either condition tested electroacupuncture, in which a small electric current runs between needles, at points over the sacrum, the triangular bone at the base of the spine. Cochrane last reviewed acupuncture for SUI in 2013 and found one eligible trial; the larger trials since then come mostly from one research group at Guang’anmen Hospital in Beijing.

The Cochrane review

The 2013 Cochrane review by Wang and colleagues searched English and Chinese databases to February 2013 for trials of acupuncture used without other treatments in adults with SUI. Of 17 possibly eligible studies, one met its criteria: a trial of 60 women comparing acupuncture with midodrine, a drug for low blood pressure. More women improved with acupuncture (73% against 33%), but the share whose incontinence resolved was low and did not differ significantly (13% against 7%). The reviewers rated the risk of bias high, because allocation was not concealed and outcomes were assessed by people who knew the groups, and concluded that the effect of acupuncture for SUI in adults was uncertain.

Later reviews

Reviews since 2013 draw on trials published after it, nearly all run in China. Their comparisons differ, so the table keeps them apart. Sham electroacupuncture is a control procedure made to look like the real one, usually with needles that do not pierce the skin and no current; Sham acupuncture covers the kinds in use. Pelvic floor muscle training (PFMT) is a programme of exercises that strengthen the muscles supporting the bladder.

Against sham, Jiang’s review found 4.69 g less leakage on the 1-hour pad test and scores 2.61 points better on the ICIQ-SF, a symptom questionnaire, with no more adverse events (risk ratio 1.08; 3 trials). Added to PFMT, acupuncture was associated with 1.91 g less leakage than PFMT alone, but the six trials differed widely in their results and the authors rated them low in quality; manual acupuncture without current showed no significant effect in that comparison. Lai’s review reported less leakage and better questionnaire scores with electroacupuncture, from analyses that mixed sham, exercise and drug controls.

Cui’s review of MUI found less pad weight and better ICIQ-SF scores with electroacupuncture than with drugs plus PFMT, and no significant difference in how often leakage happened over 72 hours. The authors called for trials with a sham electroacupuncture arm to confirm the placebo effect. A 2024 overview by Song and colleagues in Tianjin graded seven reviews of acupuncture for incontinence in women and rated their evidence moderate to very low in certainty; the most common reason for downgrading was that the reviews reused the same original trials.

Urgency is the other half of MUI. The 2022 Cochrane review of acupuncture for overactive bladder, a syndrome of urgency and frequent urination with or without leakage, by Hargreaves and colleagues in Newcastle, included 15 studies with 1,395 people. Against sham, moderate-certainty evidence showed little or no difference in episodes of incontinence (2 studies, 121 people). Against medication, low-certainty evidence suggested acupuncture may slightly increase the number whose symptoms resolved or improved (risk ratio 1.25; 5 studies, 258 people) and reduce minor adverse events.

The 2017 trial

The largest sham-controlled trial is a 2017 trial in JAMA led by Zhishun Liu at Guang’anmen Hospital and run at 12 hospitals in China. It randomised 504 women with SUI to 18 sessions of electroacupuncture or sham over 6 weeks. The real group was needled 50 to 60 mm deep at BL33 (Zhongliao), over the third sacral foramen, and BL35 (Huiyang), beside the tip of the coccyx, on both sides, with current. The sham group had blunt needles that did not pierce the skin, at sites about 20 mm to the side of each point, with no current. The primary outcome was the 1-hour pad test: each woman wore a weighed pad, drank 500 mL of water, did set activities such as climbing stairs and coughing, and the pad was weighed again.

• At week 6, leakage fell by 9.9 g with electroacupuncture and 2.6 g with sham, a difference of 7.4 g.
• Leakage episodes over 72 hours, counted in a bladder diary, fell by 1.0 more with electroacupuncture over weeks 1 to 6, by 2.0 more in weeks 15 to 18 and by 2.1 more in weeks 27 to 30.
• Adverse events linked to treatment occurred in 1.6% of the electroacupuncture group and 2.0% of the sham group, all mild.

The authors listed among the limitations that no clinically meaningful difference had been defined for the pad test, that leakage was not measured during the 24-week follow-up, and that blinding of participants was checked at only 2 of the 12 centres. Electroacupuncture describes the method, and Constipation covers this group’s trials in another condition.

Mixed incontinence and pelvic floor training

A 2019 trial in Mayo Clinic Proceedings by the same group randomised 500 women with moderate to severe MUI at 10 hospitals to 36 sessions of electroacupuncture over 12 weeks, or to PFMT with solifenacin, an antimuscarinic bladder drug, at 5 mg a day for 36 weeks. It tested whether electroacupuncture was no worse than the combination, within a margin of 15%. Over weeks 1 to 12, leakage episodes fell by 37.8% with electroacupuncture and 36.5% with PFMT and solifenacin, among the 467 women who completed treatment as planned, which met that test. The trial had no sham arm.

A 2023 trial in European Urology Focus by Tang and colleagues gave all 304 women with SUI 8 weeks of PFMT, and added electroacupuncture or sham electroacupuncture, at 4 hospitals in China. Leakage on the pad test fell by 9.8 g with real electroacupuncture and 5.8 g with sham, a difference of 4.0 g. The authors noted that leakage was not measured during follow-up.

After prostate surgery

Removing the prostate for cancer can leave men with incontinence. Chen’s 2023 review, from the Guang’anmen group, judged the evidence low in quality and inconclusive. A 2025 trial in JAMA Network Open by Niu and colleagues at one Nanjing hospital randomised 110 men who used 2 or more pads a day 4 to 6 weeks after robot-assisted surgery. One group had electroacupuncture at BL32 (Ciliao), BL33 and BL34 (Xialiao) on both sides, 3 times a week for 6 weeks; the other had flat-tipped needles that did not pierce the skin, at offset points. All were advised to do PFMT. At week 6, 43.6% of the electroacupuncture group and 21.8% of the sham group used no more than 1 pad a day (risk ratio 2.00). By week 20 the figures were 76.4% and 67.3%, a difference that was not significant.

What guidelines say

NICE’s guideline NG123 on urinary incontinence in women, published in April 2019 and last updated in June 2019, offers supervised PFMT for at least 3 months as first-line treatment for stress or mixed incontinence. It carries over a 2006 recommendation not to recommend complementary therapies for urinary incontinence or overactive bladder, without naming acupuncture. A July 2026 surveillance review looked at the surgical recommendations and decided not to update the guideline.

The European Association of Urology’s guidelines on non-neurogenic female lower urinary tract symptoms, in their 2026 edition, make a strong recommendation to offer electroacupuncture to women with SUI, resting on Lai’s 2020 review, and a weak recommendation to consider acupuncture for overactive bladder symptoms. The American Urological Association and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction’s guideline on female SUI, published in 2017 and amended in 2023, covers surgical treatment and does not discuss acupuncture. Clinical guidelines compares other bodies’ positions.

What the reviews could not settle

No Cochrane review has weighed the sham-controlled trials published since 2013, and the later reviews of SUI report no GRADE rating for them. The trials that carry most of the weight, in SUI, MUI and the review of men after surgery, come from one group in Beijing, and all 11 trials in Jiang’s review were run in China; Where the trials come from discusses what that tells a reader. The 2017 and 2023 trials stopped measuring leakage when treatment ended, and the gain in men after surgery was no longer significant at 20 weeks. The MUI trial compared electroacupuncture with active treatment and had no sham arm. The guidelines disagree: the EAU recommends electroacupuncture on the strength of a review that pooled sham and active controls, and NICE’s line on complementary therapies predates the trials. Trials for the opposite problem, a bladder that will not empty after surgery, childbirth or stroke, are in Urinary retention.

AcuiQ’s urinary incontinence, stress urinary incontinence and overactive bladder pages list the protocols individual studies prescribed, each with its citation.