Objective To investigate the improvement effect of intermittent wave alternating long needle stimulation at“ Four Abdominal Points” and“ Four Sacral Points” combined with anal constriction exercise for elderly female patients with stress urinary incontinence (SUI). Methods Prospectively, 100 elderly female patients with SUI who visited Zhangye Traditional Chinese Medicine Hospital from February 2024 to February 2025 were selected as the research subjects. They were randomly divided into the observation group and the control group, with 50 cases in each group. The control group received conventional acupuncture combined with anal constriction exercises. The observation group was treated with elongated needles applied with intermittent wave alternating stimulation at the“ Four Abdominal Points” and“ Four Sacral Points” also combined with anal constriction exercises. Before and after the treatment, the severity of urinary incontinence was evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and the urine leakage was measured using the 1-hour urine pad test. The differences in clinical efficacy between the two groups were compared, and the occurrence of adverse events (local hematoma, pain, infection, etc.) in both groups during the treatment period were simultaneously recorded. Results After treatment, the ICIQ-SF score and the urine leakage in 1-hour urine pad test of both groups were significantly lower than those before treatment (all P＜0.05), and the reduction in the observation group were both greater than that in the control group (all P＜0.001). The ICIQ-SF score and the urine leakage in 1-hour urine pad test in the observation group after treatment were significantly lower than those in the control group (all P＜0.001). The total effective rate of treatment in the observation group was significantly higher than that in the control group (P＜0.05). No serious adverse events occurred in either group. In the observation group, 2 cases (4.00%) of local minor hematoma occurred, while in the control group, 1 case (2.00%) of local pain occurred, both of which relieved spontaneously and did not affect the subsequent treatment. Conclusion The combined therapy of intermittent wave alternating long needle stimulation at the“ Four Abdominal Points” and“ Four Sacral Points” with anal constriction exercises can effectively alleviate urinary leakage symptoms in elderly female patients with SUI, improve their the quality of life , demonstrating a favorable safety profile. Its therapeutic effect is superior to that of conventional acupuncture combined with anal constriction exercises.