New NICE guidance should include acupuncture, says membership body

The British Acupuncture Council has said it is ‘extremely disappointed’ that updated guidance on the treatment of urinary incontinence does not include acupuncture.

The new guidance was published on 2 April 2019 by the National Institute for Health and Care Excellence (NICE) alongside a set of decision aids to help women make informed decisions about surgical interventions. 

It also recommends a series of non-surgical treatments including losing weight, eliminating caffeine, pelvic floor exercises, bladder training through behavioural therapy and anticholinergic medicines, but it fails to include acupuncture, despite the recent publication of two landmark, high quality clinical studies showing positive results.

Head of research at the British Acupuncture Council, Mark Bovey, said: “At a time when the NHS is under so much pressure, health leaders should be exploring effective alternatives to conventional care. Acupuncture has been shown to be effective in treating urinary incontinence, it is very safe and has high levels of patient satisfaction, so it would appear to provide a sensible alternative option for the NHS.

"The British Acupuncture Council is extremely disappointed that NICE has failed to include acupuncture as a recommended treatment for urinary incontinence in its guidance, even though we alerted them to the research during the consultation period.

"Pelvic floor exercises and anticholinergic drugs are mainline recommendations by NICE for urinary incontinence, but compliance can be a problem with the former and adverse effects with the latter. Long term adherence to both can be poor."

In January 2019, a large study, carried out by Lui et al at the Chinese Academy of Medical Sciences in Beijing, showed that in women with moderate to severe mixed urinary incontinence (MUI), electroacupuncture was not inferior to standard treatment.

The randomised controlled trial (RCT) was carried out across ten hospitals in China between 1 March 2014 and 10 October 2016.

Patients were randomised to receive either electroacupuncture (36 sessions) over 12 weeks with 24 weeks of follow-up, or standard treatment of pelvic floor muscle training (PRMT) with antimuscarinic agent, solifenacin (5mg/d) for 36 weeks.

Of the 500 participants, 467 completed the trial (239 in the electroacupuncture group and 228 in the PFMT-solifenacin group). Between weeks one and 12, there was a 38% reduction from baseline in mean 72-hour urinary incontinence episode frequency (IEF) in the electroacupuncture group and a 36% reduction in the PFMT-solifenacin group. 

Another large RCT, conducted by Liu and his team, and published in 2017, showed that electroacupuncture, compared with sham electroacupuncture, resulted in less urine leakage after six weeks. This was for stress urinary incontinence (SUI), one of the three main types along with urgency urinary incontinence (UUI) and MUI.

According to research, up to 70% of women will suffer from one or more of these at some point in their life.

For UUI there is still a need for large high-quality trials. In the latest systematic review (Zhao 2018), acupuncture was shown to be more effective than sham in decreasing night-time incontinence, relieving voiding symptoms and enhancing patients’ quality of life. Ten RCTs with 794 patients were included.


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