Suction is widely used by animals for strong controllable underwater adhesion but is less well understood than adhesion of terrestrial climbing animals. Here we investigate the attachment of aquatic insect larvae (Blephariceridae), which cling to rocks in torrential streams using the only known muscle-actuated suction organs in insects. We measured their attachment forces on well-defined rough substrates and found that their adhesion was less reduced by micro-roughness than that of terrestrial climbing insects. In vivo visualisation of the suction organs in contact with microstructured substrates revealed that they can mould around large asperities to form a seal. We have shown that the ventral surface of the suction disc is covered by dense arrays of microtrichia, which are stiff spine-like cuticular structures that only make tip contact. Our results demonstrate the impressive performance and versatility of blepharicerid suction organs and highlight their potential as a study system to explore biological suction mechanisms.