Overactive bladder (OAB), a condition defined by the International Continence Society as the manifestation of “urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology”, detrimentally affects the psychological and sexual health of women and negatively affects quality of life. Although some theories including myogenic, urotheliogenic, urethrogenic and supraspinal hypotheses are mentioned in the pathophysiology of OAB, it is still not completely understood. Several other pathophysiological factors such as affective disorders, sex hormone deficiency and autonomic nervous system dysfunctions have also been implicated (1).

According to the European Association of Urology, primary treatment for OAB includes behavioral interventions and physiotherapy approaches such as pelvic floor muscle training (PFMT) and electric stimulation, being the most commonly used interventions (2). Connective tissue massage (CTM), one of the physiotherapy approaches, is recommended to improve internal organ functions, balance autonomic nervous system dysfunction, and increase psychological well-being (3).

According to our knowledge, there is no study done with PFMT plus CTM in management of OAB. Therefore, the aim of this study is to investigate the effect of PFMT combined with CTM on anxiety level and sexual functions in women with OAB.

The pilot study included 18 women (age: 47.17±8.66 years; body mass index: 34.00±5.19 kg/m2) with OAB. Demographic and physical characteristics were recorded. Pelvic floor muscle strength (PFMS) with perineometer, OAB symptoms with bladder diary and the Overactive Bladder Questionnaire (OAB-V8); sexual functions with Female Sexual Functıon Index (FSFI) (desire, arousal, lubrication, orgasm, satisfaction, pain, FSFI total score) and anxiety level with the Spielberger State Trait Anxiety Inventory (STAI) were evaluated. All assessments were performed before the treatment (BF) and after the treatment (AT, 6th week). The PFMT was performed every day of the week for 6 weeks. It was conducted with a physiotherapist as a progressive home-based exercise program to increase muscle strength and endurance. Women kept an exercise diary. The physiotherapist regularly checked the diary one day per week. The CTM was applied 3 days a week for 6 weeks. The CTM started in the lumbosacral area, and progressed to the lower thoracic area, the abdominal area, and the anterior pelvic area according to the vascular response of the cutaneous tissue. For creating traction between the cutaneous tissues, the middle fingers of both hands were used during the CTM.

Demographic and physical characteristics of women with OAB were shown in Table 1. No patient reported any adverse effects during the applications. AT, the PFMS (p<0.001), average urination volume (p<0.001), desire (p=0.001), arousal (p=0.001), lubrication (p=0.011), satisfaction (p<0.001), pain (p=0.002) and FSFI-total scores (p<0.001) increased, while average number of voids/day (p<0.001), average nocturia (p<0.001), average number of incontinence episodes (p<0.001), OAB-V8 (p<0.001), state anxiety (p<0.001) scores decreased (Table 2). Trait anxiety level and orgasm scores did not change in women with OAB (p>0.05) (Table 2).

In this study, it was seen that PFMS increased, OAB symptoms decreased, sexual functions (except orgasm) improved, and state anxiety level decreased when PFMT and CTM were applied to women with OAB. The PFMT in addition to CTM may be beneficial in improving the anxiety level and sexual function of women with OAB.

In the clinics, the PFMT in addition to CTM could be a complementary and beneficial application for improving the anxiety level and the sexual function in the OAB. Randomized controlled studies on this subject should be conducted in the future.

Peyronnet B, Mironska E, Chapple C, Cardozo L, Oelke M, Dmochowski R, et al. A comprehensive review of overactive bladder pathophysiology: on the way to tailored treatment. Eur Urol. 2019;75(6): 988-1000.
Burkhard FC, Bosch JLHR, Cruz F, Lemack GE, Nambiar N, Thiruchelvam N, et al. EAU Guidelines. Available at: http://uroweb.org/guidelines/compilations-of-allguidelines/. Accessed April 30, 2021.
Holey LA, Dixon J. Connective tissue manipulation: a review of theory and clinical evidence. J Bodyw Mov Ther. 2014;18(1):112-8.