Overactive bladder (OAB) affects 17% of American men and women and represents a burden in terms of both quality of life and finances. Alternative therapies may be sought for this condition as there is a high drop-out rate with regards to traditional antimuscarinic medications. This literature review looked at the role of acupuncture in managing overactive bladder. Several animal studies proposed a mechanism of action for acupuncture such as the stimulation of secretion of endogenous opioids. No unified mechanism of action was identified. In total eight studies, looking at the clinical effects of acupuncture, were identified. Two were case studies, the others comparative trials. All eight studies demonstrated a subjective improvement in OAB symptoms, with some also showing an objective improvement on urodynamics. Of interest some comparative trials showed a benefit of acupuncture when compared with antimuscarinics. All of the trials looked at had their limitations but the initial results certainly suggest a role for acupuncture in the management of OAB. Further studies are required to assess this.