International continence society (ICS) defines urinary incontinence (UI) as the involuntary loss of urine from the urethra, usually among women [1,2]. The common types of UI include stress urinary incontinence (SUI), urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI) [3,4]. Epidemiological studies show that the prevalence of UI among women ranges between 25% to 45% and is increasing worldwide [5]. Besides the complications such as urinary tract infection and dermatitis, UI also brings a series of negative psychological impact to patients, e.g. anxiety, depression and stigma due to the constrained physical activities, unpleasant body smell, etc. induced by urine leakage. It seriously undermines patients’ quality of life (QoL). The non-surgical treatments of Western medicine generally include pelvic floor muscle training (PFMT), medication, electric stimulation, etc.. Of these therapies, PFMT is applicable for SUI, UUI and MUI, but with poor patients’ compliance [6], [7], [8]. For medication treatment, adverse effects are frequently reported, leading to problematic compliance as well. For example, anticholinergic drugs and β 3 adrenoceptor agonists cause dry mouth, blurred vision and high systolic blood pressure; and duloxetine used for SUI induces nausea and vomiting [8]. Therefore, it is necessary to explore an effective, safe and easy accessible treatment for UI.

In TCM, SUI, UUI and MUI are in the category of “enuresis” or “incontinence of urine” and result from impairment of qi movement of the bladder in pathogenesis [9]. Being one of the featured treatments of TCM, moxibustion has several merits including safety, low cost and simple operation. It works on acupoints and meridians by its actions as warming, replenishing and unblocking, in order to consolidates kidney qi and promote qi movement of the bladder [10]. Preliminary research found that acupuncture-moxibustion practitioners at home and abroad paid high attention to the effect of moxibustion for this disease [11,12]. Modern studies found that moxibustion could increase the local vascular blood flow, repair the damaged histocytes, and then improve the pelvic floor muscle strength and the urine control ability of the urethral sphincter [13,14]. Moxibustion can also reduce the expression of M2 and M3 receptor protein and inhibit the excessive contraction of bladder detrusor muscle, thus improving the bladder compliance [15]. The systematic review [16] suggested that moxibustion could be effective for women with SUI on reduction of urine leakage and improvement of QoL. However, in this review the included studies were not grouped according to intervention types in control group (i.e. acupuncture and PFMT in control group were synthesized together), thus, its conclusion needs to be further proved. Therefore, this study aims to systematically review the effect and safety of moxibustion for women with UI (including SUI, UUI and MUI) and present the status-quo of current evidences, through comprehensive literature search of clinical evidences and application of internationally recognized outcomes and GRADE approach.