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.
About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.
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).
More information is available here
Prostatitis related bladder symptoms:
In a review of the literature, acupuncture has been found to be beneficial in reducing the symptoms of prostatitis, including urinary symptoms (Franco et al, 2019).
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 were 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.
Acupuncture may be most useful in combination with other approaches in this area, including exercise and pelvic floor physiotherapy for issues of incontinence.
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).
Acupuncture’s observed benefit on urinary incontinence symptoms may be because physiological/animal studies have shown it decreases 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 influence nitrergic neurotransmitters, which raises nitric oxide levels in bladder tissue and causes smooth muscle relaxation, leading to increased bladder capacity (Chen 2006).
The British Acupuncture Council has produced an evidence based factsheet about Bladder Issues including specific research, trials and mechanisms of action for acupuncture in this condition.
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.
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.
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
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).