PURPOSE: To evaluate 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 conducted a randomized, parallel-group trial of slow-paced respiration to improve perceived stress and autonomic dysfunction as potential contributors to overactive bladder. Ambulatory women reporting 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 use an identical-appearing control device reprogrammed to play music without guiding breathing. Over 12 weeks, changes in urinary symptoms were evaluated by voiding diaries, perceived stress and anxiety were assessed by validated questionnaires, and autonomic function was examined using heart rate variability and impedance cardiography. RESULTS: Among the 161 participants randomized (82 to paced respiration, 79 to control), the average baseline frequency of voiding or incontinence associated with moderate-to-severe urgency was 6.9 (+/- 3.4) episodes/day. Compared to controls, participants randomized to paced respiration demonstrated greater improvements in perceived stress (average decrease in Perceived Stress Scale score of 2.8 versus 1.1, p = 0.03), but not autonomic function markers. Over 12 weeks, the average frequency of voiding or incontinence associated with moderate-to-severe urgency (primary outcome) decreased by 0.9 (+/- 3.2) episodes/day, but no significant between-group differences were detected. CONCLUSIONS: Among women with overactive bladder, slow-paced respiration was associated with modest improvements in perceived stress over 12 weeks, but was not superior to a music-listening control in reducing urinary symptoms or changing autonomic function.

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