Overactive Bladder and the Role of the Pelvic Floor

How does pelvic floor muscle function differ in women with symptoms of overactive bladder compared to symptomatic women? A study completed by Knight and colleagues included determining if pelvic floor muscle surface electromyography (EMG) and pelvic floor muscle (PFM) performance were different among these groups. Scores regarding anxiety, life stress, and quality of life were assessed. Symptoms of overactive bladder can include urinary urgency, frequency, nocturia, and leakage of urine. Subjects in this study had "dry" overactive bladder, meaning that the patients did not experience leakage associated with the urgency.

28 women with urinary urges and frequency were age-matched to 28 asymptomatic controls. Participants completed the Beck Anxiety Inventory, Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and the Recent Life Changes Questionnaire. Surface EMG was utilized to assess pelvic floor muscle function. Results of the study included that women with urinary urgency and frequency had significantly more anxiety than women in the control group. Surface EMG measures (pathway vaginal sensor was used with self-placement) were not significantly different for ability to contract or relax the PFM. Scores on the PFIQ and the RLCQ were significantly higher for women with overactive bladder. The authors conclude that, although a causative relationship could not be made between overactive bladder and anxiety, there exists a relationship between the two conditions.

Another interesting study which compared interventions of yoga versus mindfulness for women who have symptoms of urinary urge incontinence found that mindfulness-based stress reduction was effective for reducing urinary incontinence episodes whereas yoga was not. This study followed a pilot directed by the same primary investigator which showed similar positives results of mindfulness training on urinary urge incontinence.

What are the clinical questions we may draw from these research reports? Does anxiety cause urinary urgency and frequency, or does urinary urgency and frequency cause anxiety? We all have felt the intense stress of having to empty our bladders and not knowing where the nearest restroom (or freeway exit) is. We also know how the bladder and bowels are affected by stress- how many times did you visit the port-a-potty before that last 5K run? As is the case with many conditions with which our patients present, we may not know if one started the other, and most likely, the combination of issues resulted in dysfunction. Regardless, in our pelvic rehabilitation practices we have the tools to help patients learn about their anatomy, physiology, power in healing, and skills to affect urinary urgency and frequency.