lifestyle changes and behavioral therapy

by Diane K. Newman, RNC, MSN, CRNP, FAAN

Many people with symptoms of urinary incontinence (UI) or overactive bladder (OAB, symptoms of which include urinary urgency, frequency and frequent trips to the bathroom at night) find their symptoms improve as a response to changes in their behavior, environment or lifestyle. The learning of new skills, habits, and strategies for preventing UI are combined into a group of interventions called behavioral treatments. Lifestyle changes, such as smoking cessation, weight reduction, dietary and fluid intake changes, bowel regulation, and exercise are all included in this group as are toileting programs, bladder retraining, and pelvic floor muscle exercises and training using biofeedback, vaginal weights and electrical stimulation.

Smoking

Smokers are subject to a group of conditions and diseases including asthma, emphysema and chronic coughing, all of which may cause increase sin the pressure in the stomach (called intra-abdominal pressure). When the pressure is increased as in coughing, urinary leakage may occur (especially in women.) In general, smoking increases the risk for all types of urinary incontinence and the risk is directly associated with the number of cigarettes smoked. People who smoke the most experience the most violent types of coughing and do so more frequently. The resulting increase in pressure may cause damage to the urinary sphincter and vaginal support in women. Prolonged and violent coughing bouts may also damage the pelvic floor by stretching the nerves in the pelvic (pudendal and pelvic nerves). Smoking is also the most important risk factor for bladder cancer.

Women who smoke experience over a two-fold increase in stress UI and it is estimated that the risk for UI in women attributed to smoking is 28%. The risk increases both with the number of cigarettes smoked and the length of time smoking has occurred. Women are not the only ones affected by smoking. In a large study, men who smoked experienced more lower urinary tract symptoms (LUTS) than men who didn’t smoke, including incomplete bladder emptying and hesitancy, frequent urination, frequent night time visits to the bathroom, urgency and urge incontinence. The development of these symptoms in male smokers is also probably related to enlargement of the prostate gland as they age.

The risk for developing many of the LUTS symptoms in men decreases after smoking stops and can eventually disappear. Similar study results have not been reported for women so it is possible that smoking-related changes that cause incontinence may not be reversible in women.

Obesity

Many studies have shown a connection between obesity and urinary incontinence in women, especially mixed and stress UI. Excess body weight tends to increase bladder pressure (increases weight on the bladder and pelvis) and may impair blood flow and nerve impulses to the bladder.

Body Mass Index (BMI) is an accepted measure of weight status and is calculated by dividing the weight in kilograms by the squared height in meters. A BMI of 29 or less is considered normal or low weight and anything over 30 is considered overweight or obese. Studies show a positive correlation between high BMI and urinary incontinence, and the correlation is more pronounced in women than in men. Research has also shown that very obese women who undergo extreme weight loss due to gastric surgery see a decrease in their stress UI symptoms. In other studies, women who achieved a greater than 5% weight loss experienced a greater than 50% reduction in their UI symptoms.

Weight reduction and maintaining normal weight throughout adulthood may be important approaches to controlling or eliminating UI symptoms, especially in women.

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Posted October 2006