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Physiotherapy and behavior therapy for the treatment of overactive bladder syndrome: a prospective cohort study

Abstract

Purpose

To determine the efficacy of physiotherapy and behavior therapy and to find specific subgroups of women with overactive bladder syndrome that might gain increased benefit from this therapy.

Methods

Women with ≥10 micturitions per 24-h period were included. Six to nine therapy sessions were held within a 14-day interval. Efficacy end point was a reduction in micturitions and in episodes of nocturia. Secondary outcomes included ICIQ-OAB, ICIQ-OABqol and visual analog scales. Follow-up was 6 months. Levene test, Student’s t test, Pearson´s and Spearman’s correlations were utilized as well as the Friedman test and a multivariable-multilevel model.

Results

32 women were included. Mean age was 51 ± 15.9 (years ± standard deviation, sd). Mean body mass index (BMI) was 24.4 ± 4.8 (kg/m2 ± sd). There was a 22.9% reduction in the number of micturitions per 24 h (11.7 ± 1.6 vs. 9.0 ± 1.3 p < 0.001), a 21.3% reduction during the day (10.3 ± 1.4 vs. 8.1 ± 1.1 p < 0.001) and a 34.7% reduction in episodes of nocturia (1.5 ± 1.0 vs. 1.0 ± 0.8 p = 0.026). Both ICIQ-OAB (8.7 ± 2.3 vs. 5.8 ± 2.7 vs. 6.3 ± 3.3 p < 0.001) and ICIQ-OABqol (73.4 ± 25.9 vs. 47.5 ± 14.5 vs. 47.7 ± 18.6 p < 0.001) questionnaires as well as VAS (7.5 ± 1.4 vs. 4.1 ± 2.4 vs. 4.2 ± 2.7 p < 0.001) showed significant improvement persisting in the 6-month follow-up. In addition, in a multivariable model controlling for age, women who were overactive bladder syndrome therapy naïve responded significantly better than those who had already been under therapy (p < 0.001).

Conclusions

This study shows the efficacy of physiotherapy and behavior therapy in women with overactive bladder syndrome with a post-therapy effect especially for women with no prior treatment.

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Abbreviations

BT:

Behavior therapy

BMI:

Body mass index

ICIQ:

International Consultation on Incontinence Modular Questionnaire

OAB:

Overactive bladder

PFMT:

Pelvic floor muscle training

PT:

Physiotherapy

Qol:

Quality of life

Sd:

Standard deviation

VAS:

Visual analog scale

vs.:

Versus

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Acknowledgements

The authors acknowledge the contribution in recruitment. Thank you to the team of the urogynecology division of the University Hospital Tuebingen, Germany: Tanja Litzenburger, MD, Verena Henninger, MD and Ella Rezlaw, MD.

Author contributions

MW-B: protocol/project development, manuscript writing/editing, data analysis, data collection or management. CR: protocol/project development, data analysis, manuscript writing/editing. GEK: manuscript writing/editing, data analysis, statistical analysis. SH: data analysis, manuscript writing/editing. SYB: data analysis, manuscript writing/editing. MH: protocol/project development, manuscript writing/editing, data collection or management, data analysis, statistical analysis.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Markus Huebner.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

Christl Reisenauer received speaker‘s honoraria from Astellas Pharma GmbH, Medtronic GmbH, Pharm-Allergan GmbH. The other authors report no conflicts of interest. There was no financial support for the research.

Funding

There was no funding or compensation.

Appendix 1

Appendix 1

Aspects of physiotherapy and behavior therapy used in each visit:

Assessment of an individualized urge profile

All women received an unvalidated questionnaire to analyze certain patterns of behavior regarding symptoms of urgency. Women were asked to look into their typical urgency-related behavior patterns. Nutrition-related habits as well as day to day and business-related characteristics were analyzed.

Voiding diary

The voiding diary, which was mandatory to all participating women had to be used for at least 14 consecutive days. Women received detailed information about how to complete the voiding diary. A self-assessment of urgency symptoms is known to be crucial for a successful therapy.

Insights into physiological aspects of bladder function and onset of urgency

Detailed and subject-adapted information was given to all women participating to determine all causes and effects of urgency. What does an increase of abdominal pressure do? What does the detrusor actually do? Valsalva during micturition should be avoided, regardless of whether this is voluntary or accidental. Women received information about urgency-inducing food and drinks as well.

Urgency-control techniques and management in situations of urgency

Another strategy was the use of urgency-control techniques or delay strategies. One idea is to deactivate a so-called “last-minute-symptom” to reach the toilet dry. Another aim is to achieve an increased volume of bladder capacity. An individualized training was performed with each participating woman.

Change of behavior and abolish malconditioning

Aim of this issue was to stop certain behavior patterns which can be described as malconditioning. “Whenever I arrive at home, the first I do is go to the toilet.” To retrieve bladder control was the major task of this part of the therapy.

Physiotherapy and pelvic floor training

Awareness of pelvic floor muscles and sphincters is crucial for successful training. Improvement of perception was one of the key points. Breathing techniques, bearing and ways to deal with intra-abdominal pressure were taught. All women who agreed underwent vaginal examination by the physiotherapist to assess pelvic floor muscle status.

Acquisition of pressure-decreasing and physiological daily routine

Another part of the physiotherapy visits involved learning to decrease intra-abdominal pressure in daily routine, trying to decrease nocturia episodes, learning how to get up at night with avoiding “last-minute-symptoms”.

Physical procedures such as warmth, reflexology, specific clothing

This takes into account the fact that a lot of OAB-women report an increase of symptoms during cold rainy weather.

Relaxation and body perception

This contains specific pelvic floor training and awareness.

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Wolz-Beck, M., Reisenauer, C., Kolenic, G.E. et al. Physiotherapy and behavior therapy for the treatment of overactive bladder syndrome: a prospective cohort study. Arch Gynecol Obstet 295, 1211–1217 (2017). https://doi.org/10.1007/s00404-017-4357-1

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  • DOI: https://doi.org/10.1007/s00404-017-4357-1

Keywords

  • Alternative therapy
  • Behavior therapy
  • Overactive bladder syndrome
  • Physiotherapy
  • Quality of life