Effects of bladder training andbehavioural intervention in Female patients with overactive bladdersyndrome:A randomized controlled trial at AKU
R. M. RIZVI1, N. G.CHUGHTAI 2, N. N. KAPADIA 3;
1OfObstetrics anf Gynecology, AKUH, karachi, Pakistan, 2AKUH,karachi, Pakistan, 3physiotherapy, AKUH, karachi,Pakistan.
Introduction: Overactive bladderis defined as urinary urgency, usually accompanied by frequency andnocturia, with or without urgency urinary incontinence, in theabsence of urinary tract infection or other obvious pathology1.OAB is usually treated with anticholinergics which inhibit detrusorcontractions but they have several side-effects, such as nausea,headache, dry eyes and mouth as well as constipation. Suchside-effects negatively affect patients’ compliance.Behaviouraltreatments have proven effective by changing voiding habits orteaching new continence skills. Use of electrical stimulation andPelvic Floor MuscleTraining (PFMT) also reduces detrusor activity andimproves Quality of Life (QoL)in OAB patients. Although Cochrane hasreviewed the bladder training for urinary incontinence in adults2but there is only one trial which compared bladder trainingwith behavioural treatment3 and another trial4which compared the PFMT using biofeedback with placebo drugtreatment, reported in recent Cochrane review5. . Thepurpose of study was to define first line of treatment for OAB bycomparing efficacy in terms of symptom reduction and quality of life(QoL) improvement by three different treatment modalities.
Objective:Objective of the study was to compare the efficacy of three differentmodes of treatment for Overactive Bladder in terms of symptomsreduction and quality of life (QoL) improvement .
Methods:After approval by Ethical Research Committee we conducted a singleblinded randomized(computer randomization into 3 groups) controlledtrial of women aged 22-65 years with clinical diagnosis of OAB for aminimum of 3 months.We recruited 50 women in each group (150 totals). Initial assessment of all women with OAB was done using validatedurogenital distress inventory(UDI-SF6)and IIQ (incontinence impactquestionnaireSF7,followed by physical assessment, urine culture, andbladder diary . Arm A received Behavioral intervention which includedgood bladder habits and Bladder training techniques. Arm B receivedPFMT AND Arm C received PFMT using biofeedback .The patients werefollowed up every two weeks for 12 weeks and progressive changes insymptoms of patients were assessed by at least seven days record ofurinary diary including one before treatment . Data was computed andanalyzed by using frequency and proportions for categoricalvariables, mean and standard deviation for quantitative continuousvariables. Overall comparison among three groups was made using theIndependent Sample T test.
Results: All 3 groups weresimilar in terms of age,parity and BMI.Dry OAB was seen in 64% ofwomen in arm A while wet OAB was seen in 58% of women in arm B and51.3% in arm C respectively .The mean difference in UDI SF-6 scoresin arm A ,B and C was reduced from an initial value of 8.38 to 4.7,9.10 to 5.44 and 7.16 to 4.46 respectively with( p < 0.05) in all3 arms. Similarly QoL scores on IIQ-SF7 were reduced from 8.3 to 5.34in arm A, 8.92 to 6.34 in arm B and 9.2 to 4.5 in arm Cwith(p<0.05).
Conclusions: All three arms of studyshowed statistically significant reduction in UDI and IIQ scoreshowever the comparative efficacy of three arms of study was notstatistically significant and hence we cannot define the first lineof treatment for OAB but we conclude that a combination of goodbladder habits along with PFMT using biofeedback can be quiteeffective in symptoms reduction and improving QoL in women withOAB.
References: Bernard T. Haylen, Robert M. Freeman etal: An International Urogynecological Association(IUGA)/InternationalContinence Society (ICS) joint report on the terminology for femalepelvic floor dysfunction. Int Urogynecol J (2010) 21:5-26 2. WallaceSA, Roe B, Williams K, Palmer M. Bladder training for urinaryincontinence in a 8. Dumoulin C, Hay-Smith J. Pelvic floor muscletraining versus no treatment, or inactive control treatments,forurinary incontinence in women. 3. Cochrane Database of SystematicReviews 2010, Issue 1dults. Cochrane Database of Systematic Reviews2004, Issue 1.