Urinary retention

Urinary retention is the inability to empty the bladder. After an operation it means being unable to pass urine despite a full bladder, as the 2010 Cochrane review by Buckley and Lapitan defines it; it usually passes, but it can lead to urinary tract infection and lasting bladder damage, and the usual remedy, a catheter passed into the bladder, carries risks of its own. After childbirth, a 2025 trial in Jakarta defined it as being unable to pass urine 6 hours after delivery with at least 200 mL left in the bladder. After a stroke, retention comes from a bladder muscle that contracts too weakly or that contracts against a sphincter that fails to relax, as a 2026 review by Hong and colleagues describes it. Trials measure the post-void residual (PVR), the volume left in the bladder after passing urine, and the time to the first unaided void. Most trials of acupuncture, electroacupuncture (needles carrying a small electric current) and moxibustion (burning dried mugwort over or near the skin) for retention that the reviews below pooled were run in China, and almost none compared the treatment with a sham.

The Cochrane review

Cochrane has not reviewed acupuncture, electroacupuncture or moxibustion for urinary retention. Its one review of treatment for retention after surgery, Buckley and Lapitan’s, covers drugs only: 7 studies with 494 people, searched to February 2010. It found weak evidence for cholinergic drugs combined with a sedative and for prostaglandin given into the bladder, and no significant effect from cholinergic drugs, alpha-blockers or sedatives given alone.

Systematic reviews

The reviews below each pool trials from one setting. They mostly report a “total effective rate”, a share of patients the trial authors classed as improved, whose definition changes from trial to trial. Sham acupuncture describes the control procedures that the few blinded trials used.

Zhong and colleagues, at Guangzhou University of Chinese Medicine, drew on trials after hysterectomy (10), anorectal surgery (8), orthopaedic surgery, prostate surgery and spinal anaesthesia. Pooled against all controls, electroacupuncture was associated with lower residual volumes, larger bladder capacity and an earlier first void. Only one trial blinded its participants, with sham electroacupuncture; the reviewers rated the rest at high risk of bias. Xu and colleagues, at Guangxi University of Chinese Medicine, found a higher clinical effective rate (risk ratio 1.32), less residual urine and a shorter time with a catheter in place after surgery for cervical cancer; none of their 31 trials described how allocation was concealed. Liu and Chien, in Taipei, defined a “markedly effective” result as voiding with full relief within 30 to 60 minutes of treatment and found it more often with moxibustion than with usual care (risk ratio 2.53). Moxibustion describes the method.

Wang and colleagues, in Beijing, compared acupuncture with neostigmine, which they describe as a drug commonly used for retention after childbirth. Across 12 trials, the share of women the trial authors classed as “cured” was almost twice as high with acupuncture (risk ratio 1.91). The trials defined it differently, mostly by how soon a woman could pass urine after treatment; none described concealing allocation and none had registered a protocol. No adverse event was reported with acupuncture.

After stroke, Zhang and colleagues, at Shanghai University of Traditional Chinese Medicine, reported a lower PVR and a higher effectiveness ratio (risk ratio 1.36) with electroacupuncture than with usual treatment or manual acupuncture. Hong and colleagues, in Korea, covered post-stroke bladder dysfunction more broadly, including incontinence, and found a higher total effective rate (risk ratio 1.23) with lower residual volumes. They rated every outcome very low in certainty, because the trials lacked blinding and allocation concealment, the controls differed and all were published in China, and concluded that no definitive conclusion could be drawn.

Trials after childbirth

The 2025 Jakarta trial, by Sari and colleagues, is one of the few with a sham arm. It randomised 60 women who still had 500 to 1,000 mL in the bladder 6 hours after a vaginal delivery, with a catheter in place. One group had electroacupuncture at CV03 (Zhongji), CV04 (Guanyuan), SP06 (Sanyinjiao) on both sides, BL32 (Ciliao) and BL33 (Zhongliao), at 2 Hz for 30 minutes, twice within 24 hours. The sham group had needles taped to the skin without piercing it, connected to the stimulator with no current. The first unaided void came at a mean of 102 minutes with electroacupuncture and 192 minutes with sham, and the median residual volume afterwards was 100 mL against 185 mL.

A 2018 study by Lauterbach and colleagues in Israel offered 55 women with retention after delivery the choice of acupuncture or a catheter, so the groups were not formed at random. In the acupuncture group, 23 women (92%) passed urine within an hour of treatment.

A trial of heat rather than needles enrolled the most women. A 2022 trial in JAMA Network Open by Zhu and colleagues randomised 1,200 women at 12 hospitals in China after a vaginal delivery. Half had routine care; half also had heated packs, at about 45°C, laid for 4 hours over CV08 (Shenque) at the navel, the sacral points BL31 (Shangliao) to BL34 (Xialiao), and KD01 (Yongquan) on the soles, within 30 minutes and again at 24 and 48 hours. Retention, defined as a first void more than 6.5 hours after delivery or a catheter within 72 hours, occurred in 4.5% of the hot-compress group and 7.7% of the routine-care group (risk ratio 0.58), among the 1,085 who completed the study. The trial had no placebo compress, so the women knew their group, though the outcome assessors did not.

Trials after surgery

A 2026 trial by He and colleagues at the Jiangsu Province Hospital of Chinese Medicine in Nanjing tested wrist-ankle acupuncture, in which needles run flat under the skin at set zones above the wrist or ankle, after haemorrhoidectomy. It randomised 275 patients to conventional care, to needling at the first sign of pain, or to needling within an hour of surgery before pain began, with needles left in for 6 hours. Pain was the primary outcome. Retention, judged by bladder ultrasound within 8 hours, occurred in 29.2% of the control group, 24.7% of the group needled at first pain and 14.4% of the group needled before pain; only the last difference was significant. The acupuncturist could not be blinded, and the trial ran at one centre.

A 2023 trial by Olia and colleagues in Tehran gave 40 of 80 patients who had spinal anaesthesia for orthopaedic surgery electroacupuncture at SP06, SP09 (Yinlingquan), ST28 (Shuidao) and CV02 (Qugu) for 20 minutes in the recovery room, and the other 40 no intervention. Retention was less frequent and the first void earlier with electroacupuncture. The authors call the trial double-blind and placebo-controlled, although the control group received nothing.

After lumbar spine surgery, a 2024 retrospective study by Tran and colleagues at the National Hospital of Acupuncture in Hanoi reviewed the records of 45 patients given up to three sessions of electroacupuncture at CV02, CV03, BL54 (Zhibian), BL28 (Pangguanshu) and BL60 (Kunlun). In 42 of them (93.3%) the treatment was recorded as successful, meaning they passed urine with less than 100 mL left behind; the other three were catheterised. The study had no control group.

After stroke

A sham-controlled trial in stroke survivors was planned in Korea. Its 2016 protocol, by Shin and colleagues, set out to randomise 54 people at three hospitals to 10 sessions of electroacupuncture or a sham with non-penetrating needles and recorded stimulator sounds. The trial registration shows it was terminated in 2016 because of difficulty enrolling participants, and no results are posted. Stroke recovery covers acupuncture trials for other effects of stroke. Spinal cord injury reports the trials of retention after injury to the spinal cord.

What guidelines say

NICE’s guideline CG148 on urinary incontinence in neurological disease, which includes stroke, was published in August 2012 and last updated in October 2023. Its section on improving bladder emptying advises against alpha-blockers and does not mention acupuncture. The European Association of Urology’s guidelines on neuro-urology, in their 2026 edition, state in their text on bladder rehabilitation that electroacupuncture might improve lower urinary tract function in people with spinal cord injury or stroke, and that high-level evidence for rehabilitation techniques is very limited; they make no formal recommendation on it.

What the reviews could not settle

Nearly every pooled estimate compares acupuncture or moxibustion with usual care, a drug or no treatment, in trials where patients and staff knew the group and whose effective rates were defined by the trial authors. Of the 23 trials in Zhong’s review, one used a sham; the post-stroke reviews found none, and the one sham-controlled post-stroke trial that was registered stopped for lack of recruits. Among the studies on this page, the only sham-controlled trial after childbirth is the 2025 Jakarta trial, with 60 women. A trial protocol published in 2025 by Dou and colleagues plans to randomise 660 women at four hospitals in China to electroacupuncture or sham within two days of delivery, with the incidence of retention as its primary outcome. Urinary incontinence covers the sham-controlled electroacupuncture trials in a related bladder condition.

AcuiQ’s urinary retention, postoperative urinary retention, retention after haemorrhoidectomy, postpartum urinary retention and urinary retention after stroke pages list the protocols individual studies prescribed, each with its citation.