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Published: November 5, 2018

OAB TALK

LIFESTYLE MODIFICATION IN THE MANAGEMENT OF OAB | DATESH DANESHWAR

WHAT IS IT?

  • GOOGLE BABA SAYS THE FOLLOWING:
    • Lifestyle modification involves altering long-term habits, typically of eating or physical activity, and maintaining the new behaviour for months or years. Lifestyle modification can be used to treat a range of diseases, including obesity.

the mantra is….

  • Ideally, the treatment with the lowest risk should be recommended first in the treatment for OAB and UUI

The outline

  • Ideally, the treatment with the lowest risk should be recommended first in the treatment for OAB and UUI

THE INTAKE DEVIL

  • Some foods and beverages are known to promote diuresis or bladder irritability, which in some people can exacerbate OAB symptoms and UUI. Caffeine in particular has been shown to have a diuretic effect (51) and is a constituent of a variety of beverages and foods. Caffeine-containing products (foods and fluids) may increase OAB symptoms by increasing detrusor pressure (52) and by promoting detrusor muscle excitability (53).
  • Although the strength of the correlation of caffeine intake with OAB symptoms and UI remains to be resolved, the effects of caffeine are likely dose dependent (54). Patients should therefore be queried for their caffeine intake and advised of adverse effects of caffeine on detrusor overactivity and of the potential benefits of reducing its intake.
  • Patients should also be advised to replace their caffeinated dietary intake with non-caffeinated alternatives and to note any changes in bladder symptoms. If there is no change in bladder symptoms and if patients wish to continue to consume caffeine, they should be advised to restrict this to < 200 mg/day (or two cups of coffee), to decrease urgency and frequency (32).
  • Caffeine is also listed in labels for over 1000 over-the-counter and prescription medications (55).
  • Other dietary factors that may contribute to OAB symptoms and UUI include carbonated drinks in women (56); there is some anecdotal evidence that eliminating these from the diet may promote continence (32).
  • There is also evidence to suggest that aspartame and other artificial sweeteners induce detrusor contraction in rats (57) and thus may contribute to OAB symptoms.

Waterholics…

  • Excessive fluid intake can exacerbate OAB symptoms and incontinence, whereas restriction of fluids may result in an increase in urine concentration that may irritate the bladder mucosa and promote urgency, frequency and urinary tract infections (58).

HOW MUCH IS TOO MUCH

  • Notably, it is common for clinicians to advise patients to reduce fluid intake to alleviate urinary frequency, emphasising the need to assess the patient’s current fluid intake prior to making any recommendations. An appropriate level of fluid intake is particularly important for older adults, for whom a strong relationship between evening fluid intake and nocturia has been reported (59). The daily volume of fluid intake should be approximately six 8-oz glasses per 24 h (i.e. approximately 1500 ml or 30 ml/kg body weight per 24 h) (60).
  • To reduce nocturia, clinicians often advise patients to reduce fluid intake after 6 pm (or approximately 3–4 h before bedtime) and shift their intake to the morning and afternoon, which anecdotally appears to have good results (61).

THE REAR END

  • Constipation is defined clinically as passing < 3 stools per week; however, from the patient’s perspective, this definition also includes straining while passing a stool (61). In a study of constipation in geriatric hospital patients, the prevalence of constipation was found to be directly correlated to UI (62). Higher rates of constipation have also been found in women and men with OAB than those without OAB (19). Severely constipated women appear to have changes in pelvic floor neurological function (63), including denervation of the external anal sphincter and PFMs (64). Alleviation of constipation has been shown to significantly improve urgency and frequency in older patients (65).
  • Because chronic constipation is a likely risk factor for OAB and UUI, patients can be advised of lifestyle changes that alleviate the associated straining. These may include self-care practices such as increasing dietary fibre (e.g. wheat bran), moderately increasing fluid intake, engaging in exercise and establishing a routine defecation schedule. Patients should also be advised not to ignore the urge to defecate, but rather to respond promptly to the opportunity to move their bowels.

MANAGING YOUR WEIGHT

  • Obesity is associated with increased risk for the onset of OAB symptoms (56), and having a body mass index > 30 kg/m2 is an independent risk factor for OAB in women (66,67) and UI in older men (68).
  • Obesity has been hypothesised to promote UI by increasing intra-abdominal pressure leading to chronic stress on the pelvic floor that may lead to overt structural damage and neurological dysfunction resulting in UI (69). Surgical weight loss has been shown to reduce UUI in women who are morbidly obese (70). Even moderate weight loss has been shown to improve UI symptoms in overweight women (71–73).
  • Thus, weight loss should be considered as a first-line option for the treatment of UUI in overweight women.

KEEPING IN SHAPE

  • Heavy exercise can exacerbate urinary incontinance and can lead to excessive fluid intake potentially.
  • Best to advice PFMT whilst doing moderate exercises initially.
  • Studies using bladder training have reported UI resolution ranging from 12% to 73% and improvement rates ranging from 57% to 87%

STRESS

  • Both physical stress and psychological stress or anxiety can cause OAB.
  • Must remember that OAB may be a symptom of a more sinister issue rather then the disease requiring the treatment per se.

Multicomponent behavioural therapy

  • Using biofeedback or other teaching methods, patients learn strategies to inhibit bladder contraction using pelvic floor muscle contraction and other urge suppression strategies.
  • Multicomponent behavioural training is a new response to urgency based on the use of PFM contraction as a critical component to suppress urgency, control incontinence and restore a normal voiding interval. The efficacy of behavioural training alone or in combination with other interventions on both the frequency of UUI episodes and patient-reported outcomes has been established in clinical trials (30,43–45). Reductions in frequency of incontinence range from 60% to 80% (29). One study reported a cure rate of 31% for UI episodes in community-dwelling women receiving a behavioural training regimen (30), which is comparable with those reported for pharmacotherapy with antimuscarinics (35).

Managing co morbidities

  • The complete medical history along with detailed drug history is important.
  • Simple things like  diuretics may need to be reduced or have their timings changed to solve the symptoms.
  • Alpha blockers used in women for hypertenion
  • Antidepresents may cause overflow incontinance
  • Sleeping medications may make one wet their bed at night.

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