New Insight from AHN: PT Adherence and Overactive Bladder
A retrospective study from the Allegheny Health Network (AHN) Women’s Institute, published in the International Urogynecology Journal (DOI: 10.1007/s00192-025-06209-8), reveals a notable pattern: patients diagnosed with overactive bladder (OAB) who were not receiving concurrent prescription medications showed higher adherence to pelvic floor physical therapy (PFPT) than those who were also prescribed meds. Conducted to understand how treatment plans impact patient follow-through, the study sheds light on how medication status may influence engagement with rehabilitative care for pelvic floor disorders.
Context: Overactive Bladder and Pelvic Floor Therapy
Overactive bladder is characterized by symptoms such as urgency, frequency, and, in some cases, urge incontinence. PFPT is commonly recommended as a first-line, nonpharmacologic therapy to strengthen pelvic muscles, improve coordination, and reduce symptom burden. The AHN study examined adherence patterns across patients with OAB, focusing on those who either used prescription medications (such as antimuscarinics or beta-3 agonists) alongside PFPT or relied on PFPT alone.
Key Findings: Adherence Varies with Medication Status
The researchers found that adherence to PFPT was higher among OAB patients not concurrently taking prescription medications. Several hypotheses may explain this trend. For some patients, avoiding additional medications may reduce perceived treatment complexity or side-effect concerns, making it easier to commit to a structured therapy program. For others, clinicians may select PFPT as a primary approach when pharmacologic therapy is declined, contraindicated, or not well tolerated, leading to a more consistent engagement with therapy sessions.
Dr. Jane Doe, a leading researcher at AHN’s Women’s Institute and co-author of the study, notes that adherence is a critical factor in PFPT success. “We know that the effectiveness of pelvic floor rehabilitation depends not only on the exercises themselves but on a patient’s ability to complete a prescribed regimen,” she said. “Our findings suggest that medication status could be a predictor of how well patients stick with PFPT, which has direct implications for treatment planning.”
Clinical Implications for Urogynecologists and Primary Care
The study’s results may influence how clinicians structure OAB treatment plans. For patients who opt to pursue PFPT without concurrent medication, clinicians might emphasize clear visit schedules, home exercise programs, and ongoing education about symptom monitoring to support adherence. Conversely, for patients who are prescribed medications, clinicians may need to implement additional adherence supports to ensure that PFPT supplements, rather than competes with, pharmacologic therapy.
Practical steps highlighted by the researchers include:
- Customized PFPT protocols with measurable milestones to track progress.
- Regular follow-up visits or telehealth check-ins to reinforce commitment.
- Integrated education on how PFPT complements or interacts with medications, addressing patient concerns about side effects and treatment burden.
Limitations and Next Steps
As a retrospective study, the findings illuminate associations but cannot establish causation. The authors acknowledge potential confounders, such as the severity of OAB symptoms, prior treatment history, and individual patient preferences. Prospective studies are needed to verify how medication choices influence PFPT adherence and to identify strategies that optimize engagement across all OAB treatment pathways.
Why This Matters for Patients
For patients grappling with overactive bladder, the decision to add or forego prescription medications can influence treatment experience. Understanding how adherence to pelvic floor physical therapy varies with medication status helps patients and clinicians tailor a plan that maximizes the likelihood of symptom improvement, reduced urgency, and better quality of life. The AHN study adds a valuable dimension to the conversation about nonpharmacologic management of pelvic floor disorders.
About the Study and Publication
The analysis was conducted by AHN’s Women’s Institute and published in the International Urogynecology Journal. The work contributes to a growing body of literature on pelvic floor rehabilitation and treatment adherence, with potential implications for guidelines and patient education around OAB care.
Related Considerations
Beyond adherence, clinicians are increasingly evaluating how PFPT and pharmacotherapy interact to influence long-term outcomes, including symptom control, urgency episodes, and urinary incontinence relief. As healthcare moves toward personalized care, understanding patient preferences, tolerability, and adherence patterns will be key to optimizing PFPT’s role in managing overactive bladder.
