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Overactive bladder (OAB) and lifestyle modification

Up to 50% of patients will benefit from lifestyle changes in combination with behavioural therapies such as bladder retraining and pelvic floor physiotherapy.

Lifestyle changes include:

  • Reduction in the intake of fluids containing things that can irritate the bladder such as:
    • Caffeine – including coffee, tea, cola drinks, caffeine containing energy drinks, chocolate drinks.
      • Patients should try and reduce caffeinated drinks to 1 or 2 cups per day.
    • Alcohol
  • Fluid management
    • Avoid excessive drinking or excessive fluid restriction.
    • Excessive fluid intake is not better for your general health and can be detrimental to people who have urinary symptoms such as OAB. Remember that what goes in has to come out. Generally speaking, a urine output of about 1.5 litres for 24 hours indicates good hydration.
    • This is best monitored by using a bladder diary that will help determine if the urine output is within the normal range. Fluid intake can then be adjusted accordingly.
    • Fluid intake also includes fluid that is taken in through the diet e.g. soups, stews, yoghurts, fruits and vegetables. While this cannot be specifically measured, it can account for up to 20% of the total daily fluid intake.
    • Avoid excessive drinking due to a dry mouth when it is established on the bladder diary that the urine output is within the normal range. In this situation more fluid intake generally does not get rid of the dry mouth sensation. The feeling of a dry mouth is commonly a side effect of many medications and is not due to dehydration if the total urine output is normal or high (as measured by the bladder diary). If a dry mouth sensation persists, use techniques that stimulate saliva production such as:
      • Chewing on sugar free gum
      • Sucking on a sugar free boiled lolly
      • Take a sip of water rather than a whole glass
      • Use dry mouth products that act as moisturisers for the mouth which are available at chemists e.g. Biotene® products.
    • Don’t drink all your fluids at once. Try and space out the fluid intake evenly during the day.
    • Reduction in fluid intake in the evening (and particularly of bladder irritants in the 4 hours before bed) can help reduce nocturia or frequent urination at night
  • Changing the timing of diuretic medications
  • Timed voiding
    • In some people leakage episodes can be helped by voiding on a schedule every few hours before the bladder feels full. Over time with bladder retraining techniques and pelvic floor physiotherapy, the time between passing urine can be gradually extended aiming to ultimately pass urine every 3 to 4 hours.
    • Using a bladder diary helps both awareness of bladder habits and the creation of new bladder habits.
  • Weight loss in overweight people has been shown to reduce incontinence episodes.
  • Treat constipation
    • Problems with chronic constipation (hard and infrequent bowel actions) make bladder problems worse.
    • Methods of treating chronic problems with constipation include:
      • Ensuring adequate dietary fibre
      • Regular exercise
      • Ensuring adequate fluid intake
      • Use of stool softeners and other medications to improve bowel function
  • Use of continence aids (e.g. pads). Advice regarding the appropriate choice of continence aids can be provided through specialist Urology Nurses and specialist Continence Advisors.