Acupuncture plus pelvic floor training may improve postpartum urinary incontinence outcomes versus training alone

Postpartum urinary incontinence (PPUI) significantly impacts women’s quality of life. While pelvic floor muscle training (PFMT) is the standard care, its efficacy can be limited by poor adherence. Acupuncture is increasingly used as an adjunct therapy, but its added value remains controversial due to variability in clinical practice. This systematic review aimed to evaluate the efficacy and safety of acupuncture combined with PFMT for the treatment of PPUI. We searched eight databases, including PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Database (CBM), the Chinese Scientific Journals Database (VIP), and Wanfang, from inception to 30 October 2024, for randomized controlled trials (RCTs) comparing acupuncture plus PFMT with PFMT alone. The outcome measures included validated metrics (the 1-h pad test and the International Consultation on Incontinence Questionnaire-Short Form (ICI-Q-SF) score), and the total effective rate. Risk of bias was assessed using the Cochrane risk-of-bias tool, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Nine RCTs involving 865 patients were included. For validated metrics, a narrative synthesis of the 1-h pad test and ICI-Q-SF scores showed a trend toward greater improvement in the acupuncture plus PFMT group compared with PFMT alone, although high clinical and statistical heterogeneity (I2 > 90%) precluded a reliable meta-analysis for these outcomes. Regarding the total effective rate, the pooled analysis showed a significant benefit for the combined therapy (RR = 1.20, 95% CI [1.13, 1.27], p  Low- to very-low-certainty evidence suggests that acupuncture as an adjunct to PFMT may offer additional benefits in improving clinical symptoms and quality of life for women with PPUI. However, the high heterogeneity and methodological limitations of the current evidence preclude precise estimation of the effect size for objective outcomes. More rigorous, high-quality RCTs with standardized protocols are required to confirm these findings. https://www.crd.york.ac.uk/PROSPERO/view/CRD42020169815.