Clinical Spotlight: Vaginal Weights vs. Tolterodine for Overactive Bladder

A 2016 randomized clinical trial published in the European Journal of Obstetrics & Gynecology and Reproductive Biology explored the effectiveness of pelvic floor muscle training (PFMT) using vaginal weights versus Tolterodine, a commonly prescribed anticholinergic, for treating overactive bladder (OAB) in women.


Study Design

The study assessed changes in:
  • Lower urinary tract symptoms (LUTS)
  • Sexual function
  • Quality of life (QOL)
Validated tools included:
  • UDI-6
  • IIQ-7
  • OAB-V8
  • Wagoner’s Questionnaire for QOL
Urodynamic testing and 24-hour pad tests were performed before and after the intervention.

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Treatment Groups

✔️ Vaginal Weight Group:
Participants used one of four progressively heavier cones for 10 minutes, twice daily, while standing or doing light activity. Once they could maintain a weight beyond 10 minutes, they advanced to the next level.

✔️  Tolterodine Group:
Participants took 4 mg of Tolterodine daily. Both groups had check-ins at 4 and 8 weeks to monitor adherence and side effects.

Outcomes

  • Both groups showed a ~68% reduction in pad weight at 8 weeks.
  • The vaginal weight group had a significant increase in pelvic floor strength and improvements across all outcome measures—including QOL.
  • The medication group improved in all areas except the Wagoner QOL score.
  • Detrusor overactivity resolved in 8 patients using vaginal weights vs. just 2 in the medication group.
No adverse effects were reported in either group.


Clinical Implication

This study supports vaginal weights as a safe, effective, and conservative treatment for OAB—particularly for symptoms like urgency and frequency. The 10-minute, twice-daily protocol, though more intensive than typical recommendations, was well tolerated and highly effective.


1. Yucay T., Dokmeci F, Cetinkaya S. A prospective randomized trial comparing the use of tolterodine or weighted vaginal cones in women with overactive bladder syndrome. European Journal of Obstetrics & Gynecology and Reproductive Biology. (2016)197: 91-97. 

2. O’Sullivan R, Karantanis E, Stevermuer TL, Allen W, Moore KH. Definition of mild, moderate and severe incontinence on the 24-hour pad test. BJOG
2004;111(8):859–62.

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You now have a true advocate. Dr. Amanda Olson's commitment to pelvic health developed from her own emotional and challenging experience first as a patient. In 2008, while on a family campaign trip, Dr. Olson fell over 40 feet into a river. She sustained a dislocation to her coccyx and significant damage to the muscles, tendons, and pelvic floor ligaments. Fortunately, Amanda saw a pelvic physical therapist who used a comprehensive evaluation, manual techniques, and exercises that allowed her to heal. That next year, she shifted her focus from pediatrics to pelvic physical therapy which eventually led her to Intimate Rose!