Introduction and Hypothesis <p>There is limited literature regarding concomitant initiation of pelvic floor physical therapy (PFPT) and medications for overactive bladder treatment. PFPT improves patient symptoms, although adherence tends to be low. This retrospective cohort study assessed PFPT adherence of female patients with overactive bladder at a tertiary care center who were referred to PFPT. We hypothesized that concomitant PFPT and medication would correlate with decreased PFPT adherence among patients with overactive bladder.</p> Methods <p>Adherence to PFPT (defined as ≥ 50% attendance of the recommended sessions) was compared in patients with (PT + Med group) and in those without (PT group) concomitant medication prescription.</p> Results <p>We evaluated 346 patients, with 196 in the PT group and 150 in the PT + Med group. The PT + Med group had a higher body mass index (30.0 kg/m² vs 27.5 kg/m², <i>p</i> &lt; 0.001), a higher rate of diabetes (20.7% vs 11.7%, <i>p</i> = 0.02), and higher urogenital distress inventory scores at baseline (<i>p</i> &lt; 0.001). The PT group completed more PT sessions (<i>p</i> &lt; 0.001) and was more likely to be adherent (30.6% vs 15.3%, <i>p</i> &lt; 0.001). The PT + Med group was more likely to progress to minimally invasive therapy (10.0% vs 4.1%, <i>p</i> = 0.03). On multivariable logistic regression model, PFPT adherence remained significantly lower for the PT + Med group when controlling for comorbidities (adjusted OR 0.38, <i>p</i> = 0.001).</p> Conclusions <p>The addition of medication at the time of PFPT referral was associated with decreased PFPT adherence in overactive bladder patients.</p>