Overactive bladder (OAB) is strongly associated with increased psychological burden, including elevated stress levels, anxiety, and reduced quality of life. The interaction between emotional state and bladder function suggests that targeting psychosocial factors may improve clinical outcomes [1]. Pelvic floor muscle training (PFMT) can meaningfully reduce the severity of OAB symptoms, particularly urgency, urgency‑incontinence, frequency, and nocturia, especially in women. It is generally recommended as a first‑line or adjunctive therapy, especially when combined with bladder training. Sometimes, however, it turns out to be insufficient. Virtual reality (VR) has been increasingly used as a tool for relaxation and stress reduction [1]. Unlike conventional rehabilitation approaches, VR-based interventions may influence bladder symptoms indirectly through modulation of psychological and behavioral responses [3]. The aim of this study was to evaluate the effect of VR-based relaxation therapy on quality of life, perceived stress, and symptom severity in women with urinary incontinence, compared to conventional pelvic floor electrostimulation with biofeedback.

A randomized controlled trial included 40 women with urinary incontinence (mean age 63.0 ± 12.7 years), randomly assigned to: (1) VR group (VR-based relaxation therapy combined with electrostimulation and EMG biofeedback) and (2) control group (electrostimulation with EMG biofeedback only). The VR intervention consisted of immersive therapeutic sessions using a virtual environment designed to induce relaxation and reduce cognitive focus on symptoms. Patients engaged in tasks (e.g., mandala coloring) within a symbolic, nature-based environment, promoting distraction, emotional regulation, and stress reduction.
Both groups completed 8 sessions over 2 weeks. Outcomes were assessed at baseline (T0), post-intervention (T1), and 2-week follow-up (T2). Assessment was performed using validated tools: the Incontinence Quality of Life Questionnaire (I-QOL) to measure quality of life, the Rosenberg Self-Esteem Scale (SES) to evaluate psychological status and perceived stress, and a voiding diary to assess the severity of urinary symptoms, including frequency and urgency-related episodes.

Both groups demonstrated improvement in quality of life; however, greater improvements were observed in the VR group, particularly in psychosocial domains of the I-QOL questionnaire. Perceived stress levels decreased in both groups, with a more pronounced reduction in the VR group, suggesting a beneficial effect of VR-based relaxation on psychological well-being. Bladder diary analysis showed a reduction in urinary symptoms, including decreased urgency episodes and improved bladder control, with a trend toward greater improvement in the VR group. Improvements were maintained at short-term follow-up, indicating early persistence of therapeutic effects.

The findings suggest that VR-based relaxation may improve bladder symptoms indirectly by reducing psychological stress and altering patients’ perception of urgency. The immersive environment and task-oriented distraction (e.g., mandala activities) likely reduce hypervigilance toward bladder sensations and interrupt maladaptive cognitive patterns associated with OAB. These results support the concept of a bidirectional relationship between emotional regulation and bladder function and highlight the importance of incorporating psychological interventions into urogynecological care.

VR-based relaxation appears to be a promising adjunct to conventional therapy in women with urinary incontinence, leading to improvements in quality of life, reduction of perceived stress, and potential alleviation of OAB symptoms. This approach emphasizes the role of the brain–bladder axis and supports the integration of non-invasive, psychologically oriented interventions in modern urogynecological rehabilitation.

Gleicher S, Sebesta EM, Dmochowski RR,. The psychosocial impact of urinary dysfunction. Urol Res Pract. 2024;50(3):167-172.
Freeman D, Freeman J, Rovira A, et al. Randomised controlled trial of automated VR therapy to improve positive self-beliefs and psychological well-being in young people diagnosed with psychosis, a study protocol for the Phoenix VR self-confidence therapy trial. BMJ Open 2023;13:e076559. doi:10.1136/ bmjopen-2023-076559
Hagar E. Lialy, Hamid Ali Abdalrahman, Mai Elsebaie et al. Virtual reality gaming for rehabilitation of patients with urinary incontinence: A systematic review and meta-analysis, Physiotherapy Research International, Volume29, Issue 4 October 2024, e2112

Continence 19S (2026) 102804
DOI: 10.1016/j.cont.2026.102804