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Acupuncture for Urinary Incontinence

Efficacy of Acupuncture in Treating Urinary Incontinence

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00297427
Enrollment
127
Registered
2006-02-28
Start date
2005-10-31
Completion date
2011-07-31
Last updated
2016-10-24

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Urinary Incontinence

Keywords

urinary incontinence

Brief summary

This research study will evaluate the effectiveness of acupuncture in decreasing urinary incontinence (involuntary urine loss) in women. The study will involve 12 acupuncture sessions over 6 weeks. We will compare the effectiveness of acupuncture and sham (placebo) acupuncture (a procedure in which the needle feels like it penetrates the skin, but is not actually inserted into the body) on the frequency and volume of involuntary (accidental) urine loss after completing the intervention, and again one month later. Individuals participating in this study will be randomly assigned to receive either the actual or sham acupuncture. Randomization means being assigned by chance, similar to flipping a coin. Study participants will not know which group (actual or sham acupuncture) they were assigned to until one month after completing the 6-weeks of treatment. The sham acupuncture needles look similar to the real acupuncture needles and feel like they penetrate the skin, but do not actually do so. If individuals are assigned to the sham acupuncture group, they will be eligible to receive the actual acupuncture one month after completing the sham acupuncture if they wanted to. All individuals will be followed for 6 months after completing the acupuncture treatments.

Detailed description

See Brief Summary

Interventions

PROCEDUREAcupuncture

Acupuncture twice weekly for 6 weeks.

OTHERSham acupuncture

Twice a week for 6 weeks

Sponsors

National Center for Complementary and Integrative Health (NCCIH)
CollaboratorNIH
University of Pittsburgh
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
FEMALE
Age
25 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Urge or stress urinary incontinence at least twice a week on average for at least 3 months

Exclusion criteria

* History of previous acupuncture * History of a neurologic problem such as Parkinson's disease or multiple sclerosis that could affect bladder function * Current treatment with overactive bladder medications or medications that relax the bladder * Urinary catheter * Pregnancy * Inability to empty the bladder effectively * Inability to toilet independently * Current treatment with steroid * Interstitial cystitis * Chronic pelvic pain * Current treatment with warfarin

Design outcomes

Primary

MeasureTime frameDescription
Percent Change in Incontinent EpisodesBaseline to 1 Week post-interventionPercent change in incontinent episodes (measured by self-report electronic bladder diary) at 1 week post-intervention (true or sham acupuncture) relative to baseline.
Physical Health-Related Quality of Live1 Week post-interventionPercent change in physical health related quality of life measured at 1 week post-intervention (true or sham acupuncture) relative to baseline; measured by the Medical Outcomes Study Short Form-36 (SF-36) Physical Component score. Higher SF-36 Physical Component scores are considered a better outcome.
Physical Health-Related Quality of Life4-weeks post-interventionPercent change in physical health related quality of life measured at 4 weeks post intervention (true or sham acupuncture) relative to baseline; measured by the Medical Outcomes Study Short Form-36 (SF-36) Physical Component score. Positive change indicates an increase in physical health-related quality of life.
Mental Health Related Quality of Life1 week post-interventionPercent change in mental health related quality of life measured at 1 week1 post intervention (true or sham acupuncture) relative to baseline; measured by the Medical Outcomes Study Short Form-36 (SF-36) Mental Health Component score. Higher Mental Health Component scores are considered a better outcome.
Incontinence-Specific Quality of Life1 Week post-interventionPercent change in incontinence specific quality of life at 1 week post intervention (true or sham acupuncture) as measured by the Incontinence Impact Questionnaire. Positive values indicate improvement in incontinence-specific quality of life.
Duration of Any Beneficial Effectsmonthly during follow-up up to 6 monthsTime to relapse in months of participants who completed true acupuncture initially or who crossed-over following sham (offered to all sham participants)

Secondary

MeasureTime frameDescription
Burden Associated With the Acupuncture Treatment Protocol1 week post-treatmentSubjects' report of burden (difficulty) associated with the frequency, number and duration of treatment) and the position they had to remain in during the true and sham treatments. Subjects rate the difficulty associated with each of the four aspects of treatment on a 10-point scale ranging from 1 (not at all difficult) to 10 (extremely difficult). The burden score was calculated as the average of the scores on the 4 items with a possible range of 1 to 10 with higher scores indicating greater burden.
Need for Booster Acupuncture During Follow-upMonthly during the 6 month follow-up periodThe number of participants who were received true acupuncture (as their initial intervention or after initially receiving sham acupuncture) and were eligible to receive a booster (had a 50% or greater reduction in incontinent episodes following true acupuncture) and completed at least one month of follow-up and experienced a 30% or greater increase in incontinent episodes during follow up.
Change in Bladder CapacityChange from baseline to 4 weeks post-interventionMeasured by filling the bladder with sterile fluid until until the subject reported a strong urge to urinate.
Pelvic Floor Muscle StrengthBaseline and 1 week post true or sham acupunctureChange in average duration of pelvic floor muscle contraction measured by electromyography. Subjects were instructed to tighten their pelvic floor muscles when prompted and hold the contraction until told to relax (up to 10 seconds). This was repeated three times and the duration of the contraction time was averaged.
Response to Booster Acupuncture if NeededAfter the booster sessionsChange in the number of incontinent episodes per day following booster acupuncture
Urodynamic Diagnostic Impression of Stress Urinary IncontinenceBaseline and 4 weeks post-treatmentDocumentation of a diagnostic impression of stress urinary incontinence following urodynamics
Urodynamic Impression of Urge Urinary IncontinenceBaseline and 4 weeks post true or sham acupunctureDocumentation of a diagnostic impression of urge urinary incontinence following urodynamics
Characteristics of Responders Based on Glasses/Cups Per Day of Non-caffeinated Fluids (Including Water)BaselineGlasses/cups per day of non-caffeinated fluids (including water) at baseline
Characteristics of Responders: Duration of Urinary Incontinence (UI) in YearsBaselineDuration of urinary incontinence in years
Adherence to Treatment Protocol6 weeksPercentage of acupuncture (true or sham) visits completed as scheduled

Countries

United States

Participant flow

Participants by arm

ArmCount
Acupuncture
Acupuncture: Acupuncture twice weekly for 6 weeks.
64
Sham Acupuncture
Sham acupuncture: Twice a week for 6 weeks
63
Total127

Withdrawals & dropouts

PeriodReasonFG000FG001
Phase 1: Initial InterventionDeath01
Phase 1: Initial InterventionLost to Follow-up03
Phase 1: Initial InterventionWithdrawal by Subject85
Phase 2: Optional Crossover for ShamLost to Follow-up10
Phase 2: Optional Crossover for ShamWithdrawal by Subject150
Phase 3: Follow-up Post-True AcupunctureCould not complete outcome diary20
Phase 3: Follow-up Post-True AcupunctureLost to Follow-up30
Phase 3: Follow-up Post-True AcupunctureWithdrawal by Subject290

Baseline characteristics

CharacteristicAcupunctureSham AcupunctureTotal
Age, Continuous56.31 years
STANDARD_DEVIATION 11.93
57.41 years
STANDARD_DEVIATION 11.86
56.86 years
STANDARD_DEVIATION 11.86
BMI29.47 Kg/m^2
STANDARD_DEVIATION 6.68
29.54 Kg/m^2
STANDARD_DEVIATION 6.65
29.50 Kg/m^2
STANDARD_DEVIATION 6.64
Co-morbidities2.92 co-morbid health problems
STANDARD_DEVIATION 2.37
2.82 co-morbid health problems
STANDARD_DEVIATION 2.09
2.87 co-morbid health problems
STANDARD_DEVIATION 2.23
Duration of urinary incontinence9.81 Years
STANDARD_DEVIATION 9.08
8.61 Years
STANDARD_DEVIATION 9.98
9.22 Years
STANDARD_DEVIATION 9.52
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants0 Participants0 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
62 Participants63 Participants125 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
2 Participants0 Participants2 Participants
Hormone replacement therapy
No
34 participants36 participants70 participants
Hormone replacement therapy
No applicable (premenopausal)
23 participants20 participants43 participants
Hormone replacement therapy
Yes
7 participants7 participants14 participants
Incontinence-Specific Quality of Life55.95 units on a scale61.43 units on a scale57.78 units on a scale
Incontinent episodes/day2.19 episodes/day
STANDARD_DEVIATION 1.57
2.59 episodes/day
STANDARD_DEVIATION 2.12
2.39 episodes/day
STANDARD_DEVIATION 1.87
Limited mobility
No
56 participants54 participants110 participants
Limited mobility
Yes
8 participants9 participants17 participants
Menopausal Status
Postmenopausal
41 participants43 participants84 participants
Menopausal Status
Premenopausal
23 participants20 participants43 participants
Mental Health-Related Quality of Life55.49 units on a scale55.90 units on a scale55.67 units on a scale
Number of prescription medications2.20 Prescription medications
STANDARD_DEVIATION 2.2
2.22 Prescription medications
STANDARD_DEVIATION 2.33
2.21 Prescription medications
STANDARD_DEVIATION 2.26
Physical Health-Related Quality of Life54.32 units on a scale53.83 units on a scale54.17 units on a scale
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
9 Participants5 Participants14 Participants
Race (NIH/OMB)
More than one race
3 Participants1 Participants4 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
2 Participants0 Participants2 Participants
Race (NIH/OMB)
White
50 Participants57 Participants107 Participants
Sex: Female, Male
Female
64 Participants63 Participants127 Participants
Sex: Female, Male
Male
0 Participants0 Participants0 Participants
Vaginal deliveries1.59 Vaginal deliveries
STANDARD_DEVIATION 1.51
1.43 Vaginal deliveries
STANDARD_DEVIATION 1.24
1.51 Vaginal deliveries
STANDARD_DEVIATION 1.38

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
56 / 6348 / 63
serious
Total, serious adverse events
0 / 630 / 63

Outcome results

Primary

Duration of Any Beneficial Effects

Time to relapse in months of participants who completed true acupuncture initially or who crossed-over following sham (offered to all sham participants)

Time frame: monthly during follow-up up to 6 months

Population: Subjects who received true acupuncture and completed at least a 1-month follow-visit post acupuncture

ArmMeasureValue (MEAN)Dispersion
AcupunctureDuration of Any Beneficial Effects2.17 MonthsStandard Error 0.25
Primary

Incontinence-Specific Quality of Life

Percent change in incontinence specific quality of life at 1 week post intervention (true or sham acupuncture) as measured by the Incontinence Impact Questionnaire. Positive values indicate improvement in incontinence-specific quality of life.

Time frame: 1 Week post-intervention

Population: Intention-to-treat analysis

ArmMeasureValue (MEDIAN)
AcupunctureIncontinence-Specific Quality of Life26.02 percentage change relative to baseline
Sham AcupunctureIncontinence-Specific Quality of Life17.36 percentage change relative to baseline
p-value: 0.38Wilcoxon (Mann-Whitney)
Primary

Incontinence-Specific Quality of Life

Percent change in incontinence-specific quality of life a 4 weeks post-intervention (true or sham acupuncture) measured by the Incontinence Impact Questionnaire. Positive changes indicate improvement in incontinence-specific quality of life.

Time frame: 4-weeks post-intervention

Population: Intention-to-treat

ArmMeasureValue (MEAN)
AcupunctureIncontinence-Specific Quality of Life48.01 percentage change relative to baseline
Sham AcupunctureIncontinence-Specific Quality of Life32.04 percentage change relative to baseline
p-value: 0.43Wilcoxon (Mann-Whitney)
Primary

Mental Health Related Quality of Life

Percent change in mental health related quality of life measured at 1 week1 post intervention (true or sham acupuncture) relative to baseline; measured by the Medical Outcomes Study Short Form-36 (SF-36) Mental Health Component score. Higher Mental Health Component scores are considered a better outcome.

Time frame: 1 week post-intervention

Population: Intention to treat analysis

ArmMeasureValue (MEDIAN)
AcupunctureMental Health Related Quality of Life0 percentage change relative to baseline
Sham AcupunctureMental Health Related Quality of Life2.66 percentage change relative to baseline
Primary

Mental Health Related Quality of Life

Percent change in mental health related quality of life measured at 4 weeks post intervention (true or sham acupuncture) relative to baseline; measured by the Medical Outcomes Study Short Form-36 (SF-36) Mental Health Component score.

Time frame: 4 weeks post true or sham acupuncture

Population: Intention-to-treat

ArmMeasureValue (MEDIAN)
AcupunctureMental Health Related Quality of Life0 percentage change relative to baseline
Sham AcupunctureMental Health Related Quality of Life1.81 percentage change relative to baseline
p-value: 0.04Wilcoxon (Mann-Whitney)
Primary

Percent Change in Incontinent Episodes

Percent change in incontinent episodes (measured by self-report electronic bladder diary) at 1 week post-intervention (true or sham acupuncture) relative to baseline.

Time frame: Baseline to 1 Week post-intervention

Population: Intention-to-treat

ArmMeasureValue (MEAN)Dispersion
AcupuncturePercent Change in Incontinent Episodes-38.26 percent change in incontinent episodesStandard Deviation 42.63
Sham AcupuncturePercent Change in Incontinent Episodes-15.29 percent change in incontinent episodesStandard Deviation 65.41
p-value: 0.02t-test, 2 sided
Primary

Percent Change in Incontinent Episodes

Percent change in incontinent episodes (measured by self-report electronic bladder diary) 4 weeks post true or sham acupuncture

Time frame: 4 weeks post true or sham acupuncture

Population: Intention-to-treat analysis

ArmMeasureValue (MEAN)Dispersion
AcupuncturePercent Change in Incontinent Episodes-42.49 percent change in incontinent episodesStandard Deviation 40.24
Sham AcupuncturePercent Change in Incontinent Episodes-34.47 percent change in incontinent episodesStandard Deviation 49.98
p-value: 0.32t-test, 2 sided
Primary

Physical Health-Related Quality of Life

Percent change in physical health related quality of life measured at 4 weeks post intervention (true or sham acupuncture) relative to baseline; measured by the Medical Outcomes Study Short Form-36 (SF-36) Physical Component score. Positive change indicates an increase in physical health-related quality of life.

Time frame: 4-weeks post-intervention

Population: Intention-to-treat

ArmMeasureValue (MEDIAN)
AcupuncturePhysical Health-Related Quality of Life0.37 percentage change relative to baseline
Sham AcupuncturePhysical Health-Related Quality of Life0 percentage change relative to baseline
p-value: 0.18Wilcoxon (Mann-Whitney)
Primary

Physical Health-Related Quality of Live

Percent change in physical health related quality of life measured at 1 week post-intervention (true or sham acupuncture) relative to baseline; measured by the Medical Outcomes Study Short Form-36 (SF-36) Physical Component score. Higher SF-36 Physical Component scores are considered a better outcome.

Time frame: 1 Week post-intervention

Population: Intention-to-treat

ArmMeasureValue (MEDIAN)
AcupuncturePhysical Health-Related Quality of Live0 percentage change relative to baseline
Sham AcupuncturePhysical Health-Related Quality of Live0 percentage change relative to baseline
p-value: 0.16Wilcoxon (Mann-Whitney)
Secondary

Adherence to Treatment Protocol

Percentage of acupuncture (true or sham) visits completed as scheduled

Time frame: 6 weeks

Population: True and sham acupuncture subjects who completed the 6 weeks of treatment; participants who dropped out of the study during treatment were not included in this analysis

ArmMeasureValue (MEAN)Dispersion
AcupunctureAdherence to Treatment Protocol91.88 percent of visitsStandard Deviation 9.39
Sham AcupunctureAdherence to Treatment Protocol91.05 percent of visitsStandard Deviation 9.28
p-value: 0.64t-test, 2 sided
Secondary

Burden Associated With the Acupuncture Treatment Protocol

Subjects' report of burden (difficulty) associated with the frequency, number and duration of treatment) and the position they had to remain in during the true and sham treatments. Subjects rate the difficulty associated with each of the four aspects of treatment on a 10-point scale ranging from 1 (not at all difficult) to 10 (extremely difficult). The burden score was calculated as the average of the scores on the 4 items with a possible range of 1 to 10 with higher scores indicating greater burden.

Time frame: 1 week post-treatment

Population: The number of participants analyzed for this outcome was only those who completed the treatment protocol and the 1-week post-treatment visit. For this reason, the number is smaller than the number for the primary outcomes

ArmMeasureValue (MEDIAN)
AcupunctureBurden Associated With the Acupuncture Treatment Protocol2.25 units on a scale
Sham AcupunctureBurden Associated With the Acupuncture Treatment Protocol2.25 units on a scale
p-value: 0.78Wilcoxon (Mann-Whitney)
Secondary

Change in Bladder Capacity

Measured by filling the bladder with sterile fluid until until the subject reported a strong urge to urinate.

Time frame: Change from baseline to 4 weeks post-intervention

Population: Subjects who agreed to have a cystometrogram at baseline and 4 weeks after completing acupuncture or sham acupuncture.

ArmMeasureValue (MEAN)Dispersion
AcupunctureChange in Bladder Capacity60.45 millilitersStandard Deviation 114.91
Sham AcupunctureChange in Bladder Capacity-17.89 millilitersStandard Deviation 121.68
p-value: 0.04Repeated measures using GEE
Secondary

Characteristics of Responders Based on Glasses/Cups Per Day of Non-caffeinated Fluids (Including Water)

Glasses/cups per day of non-caffeinated fluids (including water) at baseline

Time frame: Baseline

Population: Responders were subjects who achieved a 50% reduction in urinary incontinent episodes by 4 weeks post true acupuncture (as their initial or relayed intervention)

ArmMeasureValue (MEAN)Dispersion
AcupunctureCharacteristics of Responders Based on Glasses/Cups Per Day of Non-caffeinated Fluids (Including Water)6.88 Glasses/cups per dayStandard Deviation 3.054
Sham AcupunctureCharacteristics of Responders Based on Glasses/Cups Per Day of Non-caffeinated Fluids (Including Water)5.45 Glasses/cups per dayStandard Deviation 2.663
p-value: 0.04t-test, 2 sided
p-value: 0.01495% CI: [1.039, 1.405]Regression, Logistic
Secondary

Characteristics of Responders: Duration of Urinary Incontinence (UI) in Years

Duration of urinary incontinence in years

Time frame: Baseline

Population: Responders were subjects who achieved a 50% reduction in urinary incontinent episodes by 4 weeks post true acupuncture (as their initial or relayed intervention)

ArmMeasureValue (MEAN)Dispersion
AcupunctureCharacteristics of Responders: Duration of Urinary Incontinence (UI) in Years6.93 yearsStandard Deviation 6.69
Sham AcupunctureCharacteristics of Responders: Duration of Urinary Incontinence (UI) in Years10.66 yearsStandard Deviation 9.42
p-value: 0.023t-test, 2 sided
p-value: 0.0395% CI: [0.881, 0.994]Regression, Logistic
Secondary

Need for Booster Acupuncture During Follow-up

The number of participants who were received true acupuncture (as their initial intervention or after initially receiving sham acupuncture) and were eligible to receive a booster (had a 50% or greater reduction in incontinent episodes following true acupuncture) and completed at least one month of follow-up and experienced a 30% or greater increase in incontinent episodes during follow up.

Time frame: Monthly during the 6 month follow-up period

Population: Participants who completed true acupuncture (as either their initial treatment or following sham acupuncture), had a 50% or greater reduction in incontinent episodes at 1 or 4 weeks post-true acupuncture, and completed at least one month of follow-up.

ArmMeasureValue (NUMBER)
AcupunctureNeed for Booster Acupuncture During Follow-up43 participants
Secondary

Pelvic Floor Muscle Strength

Change in average duration of pelvic floor muscle contraction measured by electromyography. Subjects were instructed to tighten their pelvic floor muscles when prompted and hold the contraction until told to relax (up to 10 seconds). This was repeated three times and the duration of the contraction time was averaged.

Time frame: Baseline and 4 weeks post true or sham acupuncture

ArmMeasureValue (MEAN)Dispersion
AcupuncturePelvic Floor Muscle Strength0.71 secondsStandard Deviation 4.98
Sham AcupuncturePelvic Floor Muscle Strength0.53 secondsStandard Deviation 4.01
p-value: 0.86t-test, 2 sided
Secondary

Pelvic Floor Muscle Strength

Change in average duration of pelvic floor muscle contraction measured by electromyography. Subjects were instructed to tighten their pelvic floor muscles when prompted and hold the contraction until told to relax (up to 10 seconds). This was repeated three times and the duration of the contraction time was averaged.

Time frame: Baseline and 1 week post true or sham acupuncture

ArmMeasureValue (MEAN)Dispersion
AcupuncturePelvic Floor Muscle Strength0.78 secondsStandard Deviation 4.66
Sham AcupuncturePelvic Floor Muscle Strength0.04 secondsStandard Deviation 5.02
p-value: 0.48t-test, 2 sided
Secondary

Response to Booster Acupuncture if Needed

Change in the number of incontinent episodes per day following booster acupuncture

Time frame: After the booster sessions

Population: Participants who received booster acupuncture treatments during follow-up

ArmMeasureGroupValue (MEAN)Dispersion
AcupunctureResponse to Booster Acupuncture if NeededPrior to booster acupuncture1.37 incontinent episodes/dayStandard Deviation 0.97
AcupunctureResponse to Booster Acupuncture if NeededFollowing booster acupuncture0.77 incontinent episodes/dayStandard Deviation 0.69
p-value: <0.001t-test, 1 sided
Secondary

Urodynamic Diagnostic Impression of Stress Urinary Incontinence

Documentation of a diagnostic impression of stress urinary incontinence following urodynamics

Time frame: Baseline and 4 weeks post-treatment

ArmMeasureGroupValue (NUMBER)
AcupunctureUrodynamic Diagnostic Impression of Stress Urinary IncontinenceBaseline16 participants
AcupunctureUrodynamic Diagnostic Impression of Stress Urinary Incontinence4 weeks post-intervention4 participants
Sham AcupunctureUrodynamic Diagnostic Impression of Stress Urinary IncontinenceBaseline6 participants
Sham AcupunctureUrodynamic Diagnostic Impression of Stress Urinary Incontinence4 weeks post-intervention5 participants
p-value: 0.01Repeated measures using GEE
Secondary

Urodynamic Impression of Urge Urinary Incontinence

Documentation of a diagnostic impression of urge urinary incontinence following urodynamics

Time frame: Baseline and 4 weeks post true or sham acupuncture

ArmMeasureGroupValue (NUMBER)
AcupunctureUrodynamic Impression of Urge Urinary IncontinenceBaseline13 participants
AcupunctureUrodynamic Impression of Urge Urinary Incontinence4-weeks post intervention13 participants
Sham AcupunctureUrodynamic Impression of Urge Urinary IncontinenceBaseline13 participants
Sham AcupunctureUrodynamic Impression of Urge Urinary Incontinence4-weeks post intervention10 participants
p-value: 0.41Repeated measures using GEE

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026