A Randomized Controlled Trial of Device Guided, Slow-Paced Respiration in Women with Overactive Bladder Syndrome

J Urol. 2019 Oct;202(4):787-794. doi: 10.1097/JU.0000000000000328. Epub 2019 Sep 6.


Purpose: We evaluated the effects of device guided, slow-paced respiration on urgency associated urinary symptoms, perceived stress and anxiety, and autonomic function in women with overactive bladder syndrome.

Materials and methods: We performed a randomized, parallel group trial of slow-paced respiration to improve perceived stress and autonomic dysfunction as potential contributors to overactive bladder. Ambulatory women who reported at least 3 voiding or incontinence episodes per day associated with moderate to severe urgency were randomized to use a portable biofeedback device to practice daily, slow, guided breathing exercises or a control device which appeared identical and was reprogrammed to play music without guiding breathing. During 12 weeks we evaluated changes in urinary symptoms by voiding diaries, perceived stress and anxiety by validated questionnaires, and autonomic function by heart rate variability and impedance cardiography.

Results: In the 161 randomized participants, including 79 randomized to paced respiration and 82 randomized to the control group, the average ± SD baseline frequency of voiding or incontinence associated with moderate to severe urgency was 6.9 ± 3.4 episodes per day. Compared to controls the participants randomized to paced respiration demonstrated greater improvement in perceived stress (average Perceived Stress Scale score decrease 2.8 vs 1.1, p=0.03) but not in autonomic function markers. During 12 weeks the average frequency of voiding or incontinence associated with moderate to severe urgency, which was the study primary outcome, decreased by a mean of 0.9 ± 3.2 episodes per day but no significant between group difference was detected.

Conclusions: Among women with overactive bladder slow-paced respiration was associated with a modest improvement in perceived stress during 12 weeks. However, it was not superior to a music listening control for reducing urinary symptoms or changing autonomic function.

Keywords: autonomic nervous system; breathing exercises; overactive; psychological; relaxation therapy; stress; urinary bladder.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Breathing Exercises / instrumentation*
  • Breathing Exercises / methods
  • Female
  • Humans
  • Middle Aged
  • Relaxation / physiology
  • Respiratory Rate / physiology
  • Stress, Psychological / complications
  • Stress, Psychological / psychology
  • Stress, Psychological / therapy*
  • Treatment Outcome
  • Urinary Bladder, Overactive / etiology
  • Urinary Bladder, Overactive / psychology
  • Urinary Bladder, Overactive / therapy*
  • Urination / physiology