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Kafri R.1, Azuri J.2,3, Ziv-Baran T.3, Stav K.3,4, Deutscher D.5
1Maccabi Healthcare Services, Physical Therapy, Rishon Lezion, Israel, 2Maccabi Healthcare Services, Head of Clinical Studies Unit, Tel Aviv, Israel, 3Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel, 4Assaf Harofeh Medical Center, Urology Department, Zerifin, Israel, 5Maccabi Healthcare Services, Physical Therapy, Tel Aviv, Israel
Background: Conservative treatments for Overactive Bladder (OAB) include fluid management, bladder training (BT), bladder control strategies, and pelvic floor muscle training (PFMT). First-line treatment with behavioral therapy presents essentially no risks to patients and should be offered to all patients. Second-line treatment with anticholinergic drugs, though not invasive, presents the risk of side effects that primarily compromise quality of life. Data on the long-term effect of these treatments are sparse.
Purpose: We investigated the 4-year outcomes of three different protocols of pelvic floor physical therapy and anticholinergic drug in women with wet-OAB.
Methods: One hundred and sixty-four women aged 4575 who experienced at least three episodes of wet-OAB per week were recruited for the original randomized controlled study. Patients were randomly allocated to one of the four study groups: Drug therapy (DT)-Tolterodine SR 4 mg, BT, PFMT, and combined pelvic floor rehabilitation (CPFR) that included BT, PFMT, and behavioral advice, including bowel education to avoid constipation, modification of fluid intake and increasing daily activity. Patients from the BT, PFMT, and CPFR groups participated in four sessions, once every 3 weeks, given by 1 of 20 female physical therapists who specialize in pelvic floor rehabilitation. The examiner was blinded to the participants allocation. Outcome measures were: number of voids per 24hr, self-recording of wet-OAB episodes during the previous week, and the Incontinence Quality of Life questionnaire (I-QOL) score. Outcomes were recorded at baseline, 3 months after active treatment, and at a 12-month follow-up. The same questionnaires were posted 4 years after the end of the active treatment to 132 women who completed the 12-month follow-up.
Results: After 4 years of follow-up, all outcome measures improved significantly compared to the baseline with no significant differences between the four groups.
During the follow-up period, 14 patients (11.6%) had used anti-cholinergic drugs: 7, 6, 1 and none of the patients in the DT, BT, CPFR, and PFMT groups, respectively. Thirteen women (10.8%) had practiced pelvic floor physical therapy during the follow-up period: 4, 3, 4 and three patients in the DT, BT, CPFR, and PFMT groups, respectively. Only one patient who continued with anti-cholinergic drugs was completely dry (7%), compared to five patients who continued practicing pelvic floor physical therapy (38.5%, P=0.032).
Interestingly, 54% of the study population (n=65) suffered from musculoskeletal pain such as low back pain and extremities pain. The presence of pain was significantly associated with the number of wet-OAB/week but not with age, number of voids/24 hr, body mass index or I-QOL score.
Conclusion(s): It was described earlier that wet-OAB symptoms are associated with reduced QOL, depression and falls. The association between orthopedic pain and the number of wet-OAB episodes may represent the horrendous functional status of these women, and it certainly should be investigated and addressed in future studies.
Implications: PFMT, BT and behavioral advice provided by pelvic-floor physical therapists in four sessions over 3 months should be considered as the first line of treatment in women with wet-OAB.
Funding acknowledgements: We thank the physical therapists of Maccabi specializing in pelvic floor rehabilitation and their clinic managers for their cooperation.
Topic: Women's & mens pelvic health
Ethics approval: All subjects provided informed consent in accordance with procedures approved by the Institutional Review Board of Maccabi Healthcare Services
All authors, affiliations and abstracts have been published as submitted.
