Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
Incontinence and bladder issues may be caused by structural issues, pregnancy and post-partum, overactive bladder in women, and in men there may be issues caused by prostatitis or oncology treatment following prostate cancer impacting upon the bladder function. Bladder function can also be affected after someone has had a stroke, or related to chronic health conditions.
Research and Resources on Bladder (Urinary System) Issues and Acupuncture:
A scholarly search of the available research studies on “acupuncture” + “urinary”* reveals over 32,000 papers from journals, and narrowing this to “RCT” leads to over 3,400 hits, of which 39% have been carried out since 2017. From this we can deduce that acupuncture is being used, traditionally and currently in this area; scientific research is being conducted in this area at an increasing pace -indicating an area worthy of scientific appraisal and consideration. (*We did not use the search term “bladder” as this is an acupuncture meridian and point location name and would otherwise bring up articles that mention these acupoints, as well as those to do with bladder conditions).
Up to 6% of adult women experience up to 3 episodes of acute lower urinary tract infections (UTIs) annually (Alreak & al, 2002). A common issue, millions of women in the receive antibiotic treatment every year, and with raising concerns of antibiotic resistance in pathogens, alternate ways to look at this issue are warranted
Interpreting the research:
When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms. The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment). In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.
The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control). Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.
The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.
Stress Incontinence and overactive bladder:
A large, multicentre RCT (China: 12 hospitals; n=504) for women with stress incontinence showed that the electroacupuncture group experienced less urine leakage after 6 weeks of treatment, than did the sham electroacupuncture control group (Liu et al, 2017). A further systematic review (Zhao 2018; 10 trials; n=794), showed acupuncture (in particular electroacupuncture) as more effective than sham in decreasing nocturia (night-time incontinence), relieving voiding symptoms, decreasing micturition and incontinence frequency, and enhancing quality of life
A small Chinese (n-71) randomised controlled trial for female stress urinary incontinence compared acupuncture plus pelvic floor muscle exercises with the exercises alone. All outcomes improved significantly in both groups, with the total effective rate being higher in the acupuncture group than in the control group, along with improves quality of life scores. A systematic review of treatment of overactive bladder, urge urinary incontinence, and related symptoms (Hartmann et al, 2009; 232 studies) acupuncture was the sole complementary treatment that showed early evidence of benefit.
Forde et al (2016), in a literature review in the International Urogynecology Journal, stated existing studies showed promise for suggesting a role for acupuncture in addressing overactive bladder issues, however there were limitations in the research design, and further well-designed studies should follow to corroborate this.
In other studies, acupuncture treatment significantly reduced the frequency of urinary incontinence compared to a control group (Kim et al, 2008; n=52); a statistically significant difference was found in favour of acupuncture compared to “western” medicine for post-apoplectic urinary issues (Liu et al, 2008); and bladder-specific acupuncture treatments resulted in significant improvements in bladder capacity, urgency, frequency, and quality-of-life scores when compared with placebo acupuncture treatments in a randomised controlled trial (Emmons et al, 2005; n=85).
For Overactive Bladder, Aydoğmuş et al, (2014; RCT; N=82) looked at Urine Nerve Growth Factor (NGF) as a biomarker regarding acupuncture’s effect on bladder function. NGF is a chemical messenger in the body and related to the smooth muscle and urothelium (lining of the urinary tract). Comparing drug treatment solifenacin with acupuncture in two groups, they concluded that “In patients with OAB in whom anticholinergic treatment is contraindicated, acupuncture may be considered another treatment option.” NGF has been shown in a number of studies, to be mediated, normalised by acupuncture.
Acupuncture on the sacral vertebrae (spinal area at the sacrum); the area where nerves suppling the bladder emerge; has been shown to suppress bladder activity, as well as to suppress activity in the areas of the brainstem related to micturition (urination), this in turn could suppress/normalise overactivity of bladder contraction (Wang et al, 2012).
Objective (scientifically measurable) improvements from acupuncture have also been seen in urodynamic studies on females with frequency, urgency and dysuria (Chang, 1988; n=52). Urodynamic studies are medical tests measuring lower urinary tract function. Per Chang in the American Urological Association Journal of Urology : “Our studies indicated that acupuncture could be used as a simple and effective method to treat female patients with frequency, urgency and dysuria”.
More information on acupuncture and the Urinary System is available on out page here
Diabetic neurogenic bladder:
A randomised controlled trial (n=70) compared acupuncture plus the drug methycobal, with the drug alone. The acupuncture plus methycobal group saw significant improvement in the rate of urgency of urination, frequency of micturition, dribbling urination, urinary incontinence and dysuria, than did the drug alone group. A combined approach was therefore advocated, with acupuncture improving the drug action (Tian et al, 2007)
Acupuncture has been tentatively shown to have positive results for urinary incontinence post-stroke in a systematic review (Thomas, 2008; n=724 from 12 trials, of which 3 were acupuncture trials), although further trials for acupuncture in this field are warranted, due to the low number and quality of the research studies available at the time of the review. A randomised controlled trial (n=58) found the moxibustion group (an acupuncture adjunct treatment) had greater improvement in urinary symptoms than the control group (Yun et al, 2007). In a large study in Taiwan, stroke patients in hospital who received acupuncture treatment experienced a lower incidence of urinary tract infections than did those who didn’t receive acupuncture (Yang et al, 2019)
Bed-wetting in children:
There was some evidence from a systematic review (Bower et al, 2005; 11 studies), that acupuncture could be useful for nocturnal enuresis (bed-wetting) in children when used in conjunction with other treatment, although further trials are warranted due to the low methodological quality of the research studies available at the time.
A randomised controlled trial (n=110) examined electroacupuncture on recovery of urinary bladder function after radical hysterectomy. The electroacupuncture group experienced faster improvement of recovery of bladder function, greater improvement of dynamic indexes, fewer days in hospital after surgery and a reduced likelihood of bladder infection than did the control group.
Urinary tract infection (cystitis):
A randomised controlled trial (Qin et al, 2020; n=341) found acupuncture appeared to be beneficial for treatment and prevention of recurrent UTIs, but also noted limitations in the current evidence. The researchers noted the increasing problem of antibiotic resistance, meant such research becomes increasingly important in the overall approach.
From the guidelines The Society of Obstetricians and Gynaecologists of Canada: “Acupuncture may be considered as an alternative in the prevention of recurrent urinary tract infections in women who are unresponsive to or intolerant of antibiotic prophylaxis.” (Epp and Larochelle, 2017).
Alraek et al (2002) concluded from their small RCT (n=100): “our results, as well as previous findings, indicate that acupuncture treatment may be effective in preventing recurrent lower UTIs in healthy adult women.” This echoed the small Norweigan study (N=67) which concluded that acupuncture seems a worthwhile alternative approach in the prevention of recurring lower UTI in women (Aune et al, 1998).
Prostatitis related bladder symptoms:
In a review of the literature, acupuncture was found to be beneficial in reducing the symptoms of prostatitis, including urinary symptoms (Franco et al, 2019).
Mechanisms of action of acupuncture in the urinary system:
Initial animal studies suggest a number of biochemical mechanisms of action involved the effect of acupuncture on suppressing overactive bladder (Forde et al, 2016). Physiological/animal studies have shown acupuncture to decrease the expression of a relevant biomarker (c-Fos) in the brain, along with associated reduction in stress urinary incontinence (Chung et al, 2008).
Acupuncture was also found in physiological studies to influence nitrergic neurotransmitters, which raises nitric oxide levels in bladder tissue and causes smooth muscle relaxation, leading to increased bladder capacity (Chen 2006).
Regarding Your Individual Condition and Symptoms:
Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response. We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation. For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.
The British Acupuncture Council evidence based factsheet about Cystitis including specific research, trials and mechanisms of action for acupuncture in this condition.
The British Acupuncture Council evidence based factsheet about Urinary Incontinence
Alraek, T., Soedal, L.I.F., Fagerheim, S.U., Digranes, A. and Baerheim, A., 2002. Acupuncture treatment in the prevention of uncomplicated recurrent lower urinary tract infections in adult women. American Journal of Public Health, 92(10), pp.1609-1611.
Aydoğmuş, Y., Sunay, M., Arslan, H., Aydın, A., Adiloğlu, A.K. and Şahin, H., 2014. Acupuncture versus solifenacin for treatment of overactive bladder and its correlation with urine nerve growth factor levels: a randomized, placebo-controlled clinical trial. Urologia Internationalis, 93(4), pp.437-443.
Aune, A., Alraek, T., Lihua, H. and Baerheim, A., 1998. Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women. Scandinavian journal of primary health care, 16(1), pp.37-39.
Bower, W.F., Diao, M., Tang, J.L. and Yeung, C.K., 2005. Acupuncture for nocturnal enuresis in children: a systematic review and exploration of rationale. Neurourology and Urodynamics: Official Journal of the International Continence Society, 24(3), pp.267-272.
Chang, P.L., 1988. Urodynamic studies in acupuncture for women with frequency, urgency and dysuria. The Journal of urology, 140(3), pp.563-566.
Chen, Y.L., Cen, J., Hou, W.G., Gao, Z.Q., Yu, X.M. and Ma, X.M., 2006. Effects of electroacupuncture treatment on nitrergic neurotransmitter in bladder neck and detrusor of rats with unstable bladder. Zhong xi yi jie he xue bao= Journal of Chinese integrative medicine, 4(1), pp.73-75.
Chung, I.M., Kim, Y.S., Sung, Y.H., Kim, S.E., Ko, I.G., Shin, M.S., Park, H.J., Ham, D.H., Lee, H.J., Kim, K.J. and Lee, S.W., 2008. Effects of acupuncture on abdominal leak point pressure and c-Fos expression in the brain of rats with stress urinary incontinence. Neuroscience letters, 439(1), pp.18-23.
Emmons SL, Otto L. Acupuncture for overactive bladder: a randomized controlled trial. Obstet Gynecol 2005; 106: 138-43.
Epp, A. and Larochelle, A., 2017. No. 250-Recurrent urinary tract infection. Journal of Obstetrics and Gynaecology Canada, 39(10), pp.e422-e431.
Franco, J.V., Turk, T., Jung, J.H., Xiao, Y.T., Iakhno, S., Garrote, V. and Vietto, V., 2019. Non‐pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review. BJU international, 124(2), pp.197-208.
Forde, J.C., Jaffe, E., Stone, B.V., Te, A.E., Espinosa, G. and Chughtai, B., 2016. The role of acupuncture in managing overactive bladder; a review of the literature. International urogynecology journal, 27(11), pp.1645-1651.
Hartmann, K.E., McPheeters, M.L., Biller, D.H., Ward, R.M., McKoy, J.N. and Jerome, R.N., 2009. Treatment of Overactive Bladder in Women. Evidence Reports/Technology Assessments No. 187.
Kim, J.H., Nam, D., Park, M.K., Lee, E.S. and Kim, S.H., 2008. Randomized control trial of hand acupuncture for female stress urinary incontinence. Acupuncture & electro-therapeutics research, 33(3-4), pp.179-192.
Liu ZS, Du Y. [Evaluation of the curative effect of electro acupuncture on post-apoplectic urinary incontinence](in Chinese). Zhen Jiu Tui Na Yi Xue 2008; 6/2: 97-8.
Liu, Z., Liu, Y., Xu, H., He, L., Chen, Y., Fu, L., Li, N., Lu, Y., Su, T., Sun, J. and Wang, J., 2017. Effect of electroacupuncture on urinary leakage among women with stress urinary incontinence: a randomized clinical trial. Jama, 317(24), pp.2493-2501.
Qin, X., Coyle, M.E., Yang, L., Liang, J., Wang, K., Guo, X., Zhang, A.L., Mao, W., Lu, C., Xue, C.C. and Liu, X., 2020. Acupuncture for recurrent urinary tract infection in women: a systematic review and meta‐analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 127(12), pp.1459-1468.
Thomas, L.H., Cross, S., Barrett, J., French, B., Leathley, M., Sutton, C.J. and Watkins, C., 2008. Treatment of urinary incontinence after stroke in adults. Cochrane Database of Systematic Reviews, .
Tian FS et al. [Study on acupuncture treatment of diabetic neurogenic bladder]. Zhongguo Zhen Jiu. 2007 Jul;27(7):485-7
Wang, H., Tanaka, Y., Kawauchi, A., Miki, T., Kayama, Y. and Koyama, Y., 2012. Acupuncture of the sacral vertebrae suppresses bladder activity and bladder activity-related neurons in the brainstem micturition center. Neuroscience research, 72(1), pp.43-49.
Yang, J.L., Chen, T.L., Yeh, C.C., Hu, C.J., Liao, C.C., Lane, H.L. and Shih, C.C., 2019. Acupuncture treatment and the risk of urinary tract infection in stroke patients: a nationwide matched cohort study. Acupuncture in Medicine, 37(3), pp.175-183.
Yi, W.M., Li, J.J., Lu, X.M., Jin, L.L., Pan, A.Z. and Zou, Y.Q., 2008. Effects of electroacupuncture on urinary bladder function after radical hysterectomy. Zhongguo zhen jiu= Chinese acupuncture & moxibustion, 28(9), pp.653-655.
Yun, S.P., Jung, W.S., Park, S.U., Moon, S.K., Park, J.M., Ko, C.N., Cho, K.H., Kim, Y.S. and Bae, H.S., 2007. Effects of moxibustion on the recovery of post-stroke urinary symptoms. The American journal of Chinese medicine, 35(06), pp.947-954.
Zhao, Y., Zhou, J., Mo, Q., Wang, Y., Yu, J. and Liu, Z., 2018. Acupuncture for adults with overactive bladder: a systematic review and meta-analysis of randomized controlled trials. Medicine, 97(8).