Research supports the use of pelvic floor muscle training (PFMT) for the conservative management of people with overactive bladder (OAB) (1).  The training approach includes the amelioration of the contraction of the pelvic floor muscles for urethral stability and the (reflex) inhibition of undesirable contractions of the detrusor muscle of the bladder.  The pelvic floor musculature is trained with the goal of improving urethral closure in response to bladder filling and for use as an urge-suppression strategy.  This goal differs from the PFMT goals used for people with stress urinary incontinence, which are improved urethral closure and improved bladder neck support in response to increases in intra-abdominal pressure.  It can be considered that the specific type of muscle training required for detrusor control and urge suppression would differ from that required in response to or in anticipation of increases in intra-abdominal pressure.  The aim of this study is to explore the exercise prescription components (EPC) being used in PFMT for people with OAB and to determine whether specific EPCs have been proposed to be effective for this population.

This study is a scoping review of the literature on the PFMT exercise prescription components for adults with overactive bladder.   Relevant articles were obtained from a systematic search of four electronic databases (MEDLINE/PubMed, EMBASE, CINAHL, and Web of Science), and selected based on defined inclusion and exclusion criteria.  Articles published in English or French describing the use of active pelvic floor contractions for overactive bladder and reporting at least one of the following parameters were included: contraction intensity, contraction duration, rest duration.  Articles including study populations with neurogenic OAB were excluded.

The title and abstract of each article were independently reviewed by two researchers who categorized them as ‘included’, ‘excluded’, or ‘maybe’, after which three researchers met to reach a consensus on articles categorized under ‘maybe’.  Any discrepancies were discussed amongst the reviewers until a final decision was reached. 

A data extraction form was created in Covidence to organize relevant article information. Two researchers independently reviewed each article and compared their extracted data to ensure consistent data charting.  Key findings were entered into a data extraction table for analysis using a numeric descriptive approach (measures of frequency, central tendency, and dispersion or variation).

Of the 4632 studies identified from the databases/registers, after removal of duplicates, screening, and assessment for eligibility, 78 studies were included for analysis in this scoping review.  Although this review focuses on PFM contractions for inhibition of urge in individuals with urge urinary incontinence (UUI) or OAB, articles were also included in the review if they studied mixed urinary incontinence or if they studied other types of incontinence in addition to UUI.  

Physiotherapists most commonly oversaw interventions in the included studies (32 of 78, 41%), and other healthcare professionals involved were nurses, doctors, continence advisors, and coaches/exercise instructors. PFM contractions were often compared to or accompanied by other interventions.

The reporting of exercise prescription parameters was incomplete and inconsistent.  34 studies looked specifically at exercise programs for UUI/OAB.  For those studies that did report exercise prescription components such as patient position, contraction intensity, contraction duration, rest duration, number of repetitions, number of sets, exercise frequency and intervention duration, a wide variation of and among these components was reported.  

Patient position was not reported by 15 of the 34 studies. Positions reported included supine, prone, sitting, standing, lithotomy, semi-squat, and performing PFM contractions during daily activities. 

Contraction intensity was inconsistently reported and ranged from submaximal to maximal.

Contraction duration was either not reported or varied considerably between studies. The majority of articles described contractions as “sustained” or “held”.  

Rest duration was reported in 24 studies, and ranged from 2-20 seconds.

The number of repetitions of PFM exercises was not reported by 6 studies. Among studies that reported it, values ranged from 6-80 reps. 

The number of sets of PFM exercises was not reported by 14 studies. This value ranged between a single set and 5 sets. Certain studies defined sets as the number of times a given number of repetitions of the exercise was repeated throughout the day, while others referred to sets within a single exercise bout.

18 of the 34 studies did not report the frequency of their exercise interventions. However, among the studies reporting this exercise parameter, the frequency ranged between 2-7 days per week, with the most reported exercise frequency being 7 days per week or daily (7/16, 44%).

Intervention duration was not reported by 7 of the 34 studies and ranged between 6 weeks and 24 months in studies that reported this parameter.

This review underlines a lack of detail, consistency and standardization in the reporting of specific exercise components of PFMT programs,  as well as a wide variability in the programs currently used in the management of OAB.

For people with OAB, urge suppression techniques that involve the active use of pelvic floor contractions to control symptoms of urgency and urge incontinence are recommended.   The purpose of urge suppression techniques is to inhibit detrusor activity through the voluntary urinary inhibition reflex, also known as the perineodetrusor inhibitory reflex. This reflex is activated during a pelvic floor contraction and causes the detrusor to relax through inhibition at the sacral micturition reflex center. As such, the sense of urgency is decreased and the bladder continues to expand as it fills (2).

While it is generally accepted that PFMT for stress urinary incontinence should involve the practice of maximal contractions to increase strength and trophicity, important to prevent leakage during increases in intra-abdominal pressure, the optimal exercise prescription for bladder inhibition has not been established.  

While the PFMT training goals are different for people with overactive bladder in comparison to people with stress urinary incontinence, a specific training regime does not seem to exist for PFMT for people with overactive bladder.

Pelvic floor muscle training for people with overactive bladder targets an improved pelvic floor contraction for increased urethral stability and better closure for reflex detrusor inhibition, as well as the use of the pelvic floor contraction as an urge suppression strategy.  Although this should require specificity in the PFMT training regime, this scoping review has shown that specific exercise prescription parameters have not been consistently reported in the scientific literature.

Studies involving PFMT programs should include standardized and detailed exercise prescription components.

Research is required to determine ideal and specific exercise prescription parameters that promote optimal detrusor inhibition, to improve and standardize training programs for people with overactive bladder.

Corcos, J., Przydacz, M., Campeau, L., Witten, J., Hickling, D., Honeine, C., Radomski, S. B., Stothers, L., & Wagg, A. (2017). CUA guideline on adult overactive bladder. Canadian Urological Association Journal, 11(5), E142–73. https://doi.org/10.5489/cuaj.4586
Shafik, A. ,  Shafik, I.A.   Overactive bladder inhibition in response to pelvic floor muscle exercises.  World Journal of Urology , 20(6), pp. 374–377 2003