Hypothesis / aims of study
Introduction
Idiopathic Overactivity Bladder (iOAB) is defined as OAB without underlying urological or neurologic diseases. iOAB is a common and distressing health problem among patients. It has major impact on patient’s psychological well-being and quality of life. According to the International Consultation on Incontinence (ICI) guidelines, it recommended behavioral therapy and pharmacotherapy as first-line treatment. Behavioral therapies are in terms of diet modification, pelvic floor muscle exercise, biofeedback and bladder training. Certain behaviors—limiting fluids, for example—can be counter¬productive but are sometimes employed by women in an attempt to prevent leaking urine or the need to void while away from home (1). Bladder training (BT) has been proven to improve urge urinary incontinence, resolution rates have been reported to range from 12% to 73%, and improvement rates from 57% to 87% (2). The aim of this study is to assess effectiveness of our Structured bladder training program for iOAB in the female urology clinic.
Study design, materials and methods
Methods
Our structured BT program consists of (1) education of normal daytime voiding frequency and amount, (2) explanation of normal physiology of storing and emptying function of bladder, (3) patient are taught to hold urine until a certain goal, and aim to increase the amount by 50 mL every 4 weeks. All patients were instructed to keep to the schedule regardless of urgency and to use strategies to control urgency if this occurs before the scheduled voiding time. Ideally, the voiding interval should be increased by 15–30 min each week according to the patient’s tolerance to the schedule, until a voiding interval of at least 3–4 hours is achieved. Also, based on the three frequency-volume charts obtained at baseline, the longest voiding interval achieved several times was deemed the initial voiding interval. (4) Refrain from voiding immediately after first sense of urge, to use distraction methods in order to decrease the desire of voiding and immediately start pelvic floor exercises during that urge episode and (5) report any problems to a urology nurse. All patients were instructed not to alter fluid intake during the study period in order to test the efficacy of the training protocols.
We retrospectively reviewed all patients who attended our Female Urology Clinic with OAB symptoms from March 2017 to December 2017. We excluded patients with previous history of genito-urinary surgery, pelvic radiation therapy and neurologic conditions such as cerebrovascular accidents, Parkinson’s disease, and spinal cord injuries. We obtained our outcomes with questionnaires UDI-6, IIQ7, OABSS and three days voiding diary before and 3 months after.
Interpretation of results
This Structured BT program is promising as it improves bladder control in a significant improvement. It is effective in improving quality of life (QoL), voiding symptoms, and is perceived to be useful in improving symptoms. This multicomponent behavioral training is a new response to urgency based on the use of pelvic floor muscle contraction as a critical component to suppress urgency, control incontinence and restore a normal voiding interval.