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How effective and safe is bladder training for treating adults with overactive bladder (OAB) compared with no treatment, anticholinergics, beta-3 adrenergic receptor agonists or pelvic floor muscle training (PFMT), alone or in combination?
Bladder training may cure or improve OAB compared with no treatment. Moreover, bladder training may be more effective for curing or improving OAB than anticholinergics, and there may be fewer adverse events. There may be no difference in efficacy or safety between bladder training and PFMT.
When compared with anticholinergics alone, combination therapy with bladder training and anticholinergics made little or no difference to cure or improvement, symptom-related quality of life or adverse events.
Participants in these trials were predominantly women (89.3%). The majority of outcomes were informed by low or very-low-quality evidence as the overall trial numbers were small, did not treat missing data appropriately, and most had an open label design which may have caused bias. The evidence to date is insufficient to show the effectiveness of bladder training for treating OAB, and more well-designed studies are needed to reach a firm conclusion.
OAB is a common chronic condition involving daytime frequent urination, urination during sleep, and sudden urge to urinate with or without urinary incontinence (unintentional passing of urine). The disorder reduces quality of life and results in a significant economic burden on society.
Bladder training is a behavioural therapy that establishes treatment goals and uses techniques to modify inappropriate responses to urinary urgency. It is sometimes combined with other therapies, such as PFMT and pharmacotherapy, for an additive effect.
Funada S, et al. Bladder training for treating overactive bladder in adults. Cochrane Database Syst Rev 2023;10:CD013571. This review contains 15 trials with a total of 2007 participants.
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