Bladder and bowel dysfunction (BBD) is a common condition that includes problems such as urinary urgency, daytime urinary incontinence, bedwetting, constipation, or difficulties emptying the bladder or bowel. These symptoms can negatively affect quality of life, emotional well-being, school participation, and social relationships.
Adolescents with obesity may be at a higher risk of developing BBD, but few studies have evaluated effective treatments specifically for this population.
The OBE-BBD trial is a randomized controlled study designed to evaluate whether two different non-drug interventions can improve bladder and bowel symptoms in adolescents with obesity when added to standard obesity care.
Adolescents aged 13 to 18 years receiving treatment for obesity at the Pediatric Outpatient Clinic of Hospital de Santa Maria (Lisbon, Portugal) will be randomly assigned to one of three groups: (i)Target physiotherapy, consisting of individualized urotherapy and bowel-management education combined with pelvic floor muscle training, breathing exercises, lumbopelvic mobility exercises, stretching, strengthening exercises, and a structured home exercise program; (ii) Exercise support intervention, consisting of supervised physical exercise sessions and a standardized home-based high-intensity interval training (HIIT) program designed for adolescents with obesity; or (iii) Usual care, consisting of the standard multidisciplinary obesity treatment provided at the clinic.
Both intervention programs will last 12 weeks. Participants will be assessed before the intervention, immediately after the 12-week intervention period, and again 3 months later.
The main objective is to determine whether either intervention reduces the severity of bladder and bowel dysfunction symptoms compared with usual care. The study will also examine whether the interventions improve urinary symptoms, constipation, urinary tract infections, quality of life, psychological well-being, physical activity, sedentary behavior, sleep, dietary habits, and obesity-related outcomes. In addition, the study will investigate whether changes in lifestyle behaviors and obesity-related measures help explain improvements in bladder and bowel symptoms.
The results of this study are expected to provide new evidence on effective, non-pharmacological treatment strategies for adolescents with obesity and bladder-bowel dysfunction and may support more comprehensive, multidisciplinary care for this population.
Male or female adolescents aged 13 to 18 years.
Obesity defined as BMI z-score ≥2, according to the WHO growth reference for school-aged children and adolescents.
Currently receiving obesity treatment at the Pediatric Outpatient Clinic, Department of Pediatrics, Hospital de Santa Maria, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal.
Able to understand the study procedures and comply with study requirements.
Known neurological disorder affecting bladder or bowel function.
Structural urinary tract or gastrointestinal malformation.
Previous pelvic surgery affecting urinary or bowel continence.
Diabetes mellitus or uncontrolled endocrine or monogenic disorders affecting obesity or bladder/bowel function.
Parallel
Target physiotherapy
BehavioralParticipants will receive a 12-week physiotherapy program integrating urotherapy and bowel management. The intervention includes one individual 60-minute session followed by five group sessions delivered every two weeks. The program provides education on bladder and bowel habits, hydration, toileting posture, pelvic floor muscle relaxation and training, diaphragmatic breathing, lumbo-pelvic mobility exercises, stretching, strengthening exercises, and individualized progression according to clinical needs. Participants will also complete a structured home-based exercise program (25-30 minutes, three times per week) and receive telephone support between face-to-face sessions to reinforce adherence.
Exercise support intervention
BehavioralParticipants will receive a 12-week supervised exercise support program consisting of one initial 60-minute supervised session followed by five 30-minute follow-up sessions every two weeks. The intervention supports adherence to routine physical activity recommendations through supervised practice, exercise progression, and correction of movement technique. Participants will perform a standardized home-based high-intensity interval training (HIIT) program lasting approximately 25-30 minutes, three times per week. The intervention does not include urotherapy or bladder-bowel management education.
Usual obesity care
Other interventionParticipants will continue the standard multidisciplinary obesity treatment routinely delivered at the Pediatric Outpatient Clinic. Standard care includes regular follow-up appointments with a pediatrician, nutritionist, and exercise physiologist approximately every three months, including medical evaluation, nutritional counseling, and individualized physical activity counseling according to routine clinical practice. No targeted bladder-bowel dysfunction treatment will be provided during the intervention period unless clinically indicated.
Change in bladder-bowel dysfunction symptom severity
Change in bladder-bowel dysfunction (BBD) symptom severity from baseline to 12 weeks, assessed using the Vancouver Symptom Score (VSS). The VSS is a validated 14-item questionnaire with total scores ranging from 0 to 52, where higher scores indicate greater symptom severity. The primary analysis will compare changes in VSS scores between the two intervention groups and the usual care group. A validated version of the instrument for Portuguese will be used.
Change in bladder-bowel dysfunction symptom severity at follow-up
Change in bladder-bowel dysfunction symptom severity from baseline to the 3-month follow-up after completion of the intervention, assessed using the Vancouver Symptom Score (VSS) for Dysfunctional Elimination Syndrome. The VSS is a validated 14-item questionnaire with a total score ranging from 0 to 52, where higher scores indicate greater bladder-bowel dysfunction symptom severity. A reduction in the total score indicates improvement in symptoms. A validated version of the instrument for Portuguese will be used.
Change in adolescent bladder-bowel dysfunction symptoms severity
Change in bladder and bowel symptoms assessed using the Childhood Bladder and Bowel Dysfunction Questionnaire 12-18 (CBBDQ-12-18). Total score ranges from 0 to 72, with higher scores indicating greater symptom severity. A validated version of the instrument for Portuguese will be used.
Change in health-related quality of life
Change in health-related quality of life from baseline to 12 weeks and 3-month follow-up, assessed using the Pediatric Quality of Life Inventory (PedsQL). The PedsQL is a validated 23-item questionnaire that generates scores ranging from 0 to 100, with higher scores indicating better health-related quality of life. An increase in the total score indicates improvement in health-related quality of life. A validated version of the instrument for Portuguese will be used.
Change in psychological functioning
Change in psychological functioning from baseline to 12 weeks and 3-month follow-up, assessed using the Strengths and Difficulties Questionnaire (SDQ). The SDQ is a validated 25-item questionnaire. The Total Difficulties Score ranges from 0 to 40, with higher scores indicating greater emotional and behavioral difficulties (worse psychological functioning). A decrease in the Total Difficulties Score indicates improvement in psychological functioning. A validated version of the instrument for Portuguese will be used.
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University of Lisbon
Lead sponsor
NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa
Collaborator
CIDEFES - Universidade Lusofona
Collaborator
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