AHN Study: Pelvic Floor Physical Therapy Adherence Higher for Overactive Bladder Patients Without Concurrent Prescription Medication

PITTSBURGH - A new retrospective study published in the International Urogynecology Journal (DOI: 10.1007/s00192-025-06209-8) by researchers at Allegheny Health Network's (AHN) Women's Institute found that patients diagnosed with overactive bladder conditions show better adherence to pelvic floor physical therapy (PFPT) when its prescribed by itself, compared to patients who were given a dual regimen of PFPT and prescription medication.

The study evaluated 346 patients who were diagnosed with some form of overactive bladder (OAB) conditions, which are characterized by the urge or need to frequently urinate, as well as constant night wakings with or without urinary incontinence.

Of the 346 patients, 196 were prescribed only pelvic floor physical therapy, and the remainder (150) prescribed a dual regimen of both PFPT and medical therapy. Pharmacotherapy options typically include either anticholinergic medication or beta-3 agonists.

OAB is estimated to affect up to 43% of U.S. women and can have detrimental effects on quality of life, including interference with daily activities, sleep disturbances, and depression. Patients with OAB also have increased health care costs, with direct health care costs in the U.S. totaling more than $24 billion each year.

Overall adherence for the entire study was low, which is typical for pelvic floor therapy, with only 83 patients (about 24%) completing more than half of recommended PFPT sessions. But the adherence rate - those who met the physical therapy threshold - was twice as high (30.6%) in the PFPT-only group, compared to just 15.3% in the PFPT + medicine group.

Additionally, patients in the PFPT only group were more likely to be proactive in scheduling the therapy sessions compared to their '+ medicine' counterparts.

"We think a primary driver of low adherence rates in the dual group was that patients were ultimately feeling better and therefore decided they did not need to go through physical therapy sessions, in addition to taking their medication," said Jessica Sassini, MD, AHN urogynecologist and lead author of the study. "The primary learning from this study is that patients may likely benefit from being offered a variety of therapies to overactive bladder conditions, instead of just solely medication or behavioral therapies alone - it's impactful to have several options available for these persistent, often life-disrupting problems from the onset of treatment."

Treatment guidelines for OAB previously supported a tiered approach beginning with therapies based in behavioral-based methods, but are now encouraging multimodal treatment options with full patient-centered discussion of goals and preferences. Examples of behavioral-based methods include bladder training, scheduled voiding, fluid intake management and pelvic floor exercises.

"AHN has an extremely skilled team of urogynecologists who are deeply committed to advancing medicine and improving the lives of women across western Pennsylvania and beyond," said Marcia Klein-Patel, MD, PhD, Chair of AHN Women's Institute. "This study is among the first to evaluate pelvic floor therapy adherence among these types of variables, and we're confident these findings will further establish the groundwork necessary to better understand factors that affect pelvic floor therapy adherence in overactive bladder patients."

The study was comprised of female OAB patients with a PFTP referral to the AHN Division of Urogynecology between 2017 and 2024 with either a diagnosis of urinary incontinence, urinary urgency, urinary frequency, or urge-predominant mixed urinary incontinence.

To make an appointment with AHN Women's Institute, visit ahn.org.

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