Overactive bladder (OAB) is a chronic condition characterized by urinary urgency, frequency, and nocturia, with or without urgency incontinence.^1,2 It is estimated to affect 10%-20% of women, with higher incidence and more severe symptoms observed among older individuals.^1,2 Behavioral therapy encompassing lifestyle modifications, bladder training, and pelvic floor muscle training is considered a first-line therapy for OAB as literature supports its superior efficacy and safety compared with drug therapy.¹ However, there is a lack of structured treatment manuals to guide the use of behavioral therapy for OAB management and clinicians may still be unfamiliar with this type of therapy or perceive it as cumbersome.¹ Researchers from the Kyoto University Graduate School of Medicine, Kyoto, Japan, thus developed a structured multicomponent intervention that integrates cognitive behavior therapy (CBT) and conducted a randomized controlled trial (RCT) to evaluate the efficacy of their program in treating women with moderate to severe OAB.¹

OAB can be detrimental to the quality of life of patients, often leading to sleep disorders, anxiety and depression, as well as affecting daily activities and social interactions.^2,3 Various pathological pathways have been proposed for OAB, which converge on detrusor overactivity, affecting the bladder’s sensory pathway and contributing to the urge to urinate at low bladder volume.³ Non-pharmacological treatments are considered first-line treatments which aim to educate patients about OAB and assist them in developing symptom management strategies.^2,3 Behavioral therapy includes advising the patient to make lifestyle changes (e.g. losing weight, reducing fluid intake and ceasing smoking), bladder retraining which involves urination at regular intervals, and pelvic floor muscle training aimed at reducing detrusor contractions through tightening of pelvic floor muscles.³ Recently, an RCT was conducted to examine the efficacy of a multicomponent intervention with cognitive components in improving health-related quality of life (HRQoL) for women with moderate to severe OAB.¹

In this multicenter, open-label RCT conducted in Japan, women aged 20-80 years who had moderate to severe OAB were recruited from 4 institutions between 2020 and 2022 through self-referral via advertisement or referral from the participating institutions.¹ In total, 79 women were randomized to the multicomponent intervention group (n=39) or the waiting list control group (n=40).¹ A multicomponent therapy program was developed for the intervention group, consisting of 4 sessions (each lasting 30 minutes) and 6 techniques, including cognitive and behavioral skills, implemented over a 4-week period.¹ The 6 techniques included (1) self-monitoring of urinary habits using frequency volume charts; (2) educational sessions on the normal urinary tract system, abnormal voiding function, OAB epidemiology and physiology, and a CBT model for OAB; (3) lifestyle modifications such as restrictions on water and coffee intake; (4) pelvic floor muscle training; (5) exposure-based bladder training using a graded exposure task to correct distorted or exaggerated beliefs about incontinence; and (6) relapse prevention, involving future planning and encouragement to continue the techniques taught.¹

The primary outcome of this study was the change in HRQoL total scores assessed by the Overactive Bladder Questionnaire (OAB-q) from baseline to week 13, with higher scores indicating improvement.¹ The change in HRQoL total score from baseline to week 13 was 23.9 points (95% CI: 18.4-29.5) in the intervention group and 11.3 points (95% CI: 6.2-16.4) in the waiting list group, translating to a significant between-group difference of 12.6 points (95% CI: 6.6-18.6, p<0.001).¹ Results from subgroup analysis suggested that the intervention may be less effective in certain subgroups, including participants with higher age, anxiety or without any prior treatment.¹ The intervention was similarly superior for frequency of micturition and urgency but not for total OAB symptom score (OABSS), thus it was important to note that improvements in HRQoL do not always correspond to changes in the total OABSS.¹ Patient-reported improvement and satisfaction were also reported to be better in the intervention group than in the control group.¹

In summary, the findings of the study demonstrated the notable efficacy of the multicomponent intervention with cognitive components for women with moderate to severe OAB, where significant improvements in disease-specific HRQoL over time with a significant effect size, high feasibility, and minimal side effects were observed, suggesting that the cognitive component may be an effective treatment option for women with OAB.