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Excerpt
This prospective, observational, randomized crossover investigation attempts to document the effect of fluid manipulation, a widely practiced but not well documented intervention, on stress incontinence and detrusor overactivity. It also attempts to clarify the effect of caffeine intake on these problems.
Women were recruited following urodynamic diagnosis of either stress incontinence (SI) or detrusor overactivity (DO). Sixty-nine women (mean age 54.8 years) were included (SI n = 39, DO n=30). Each was instructed to drink normally for the first baseline week, and to restrict caffeine but drink normally during week 2. Women were randomized into either fluid increase (3 L) or decrease (5 cups) decaffeinated fluid daily for week 3, and then crossed over to the other group for week 4. Daily bladder diaries were kept for the entire study period. A 24-hour pad test and the Bristol Female Lower Urinary Tract Symptoms symptom questionnaire were completed at the end of each week. The paired samples t and Wilcoxon signed rank tests were used to assess differences at the 2-sided 5% level.
Mean fluid intake for week 1 was 1,639 ml. No significant difference in urgency, frequency, pad weight increase, daily wetting episodes, and quality of life was observed between the baseline week 1 and the caffeine-restricted week 2 in either group. Pad weight increase also did not change in any of the weeks for either group. The number of wetting episodes for the SI group significantly increased during the week of decreased fluid when compared to week 2 (P=0.006), and increased during the week of increased fluids when compared to the week of decreased fluids (P = 0.006). For the DO group, there were significant differences between the baseline and the fluid decrease week (P = 0.006), and between week 2 and the fluid increase week (P = 0.003). Voiding frequency and urgency increased significantly (both P < 0.003) during the increased fluid week, and voiding frequency decreased (P < 0.003) during the decreased fluid week. Urgency episodes also decreased during the reduced fluid week compared to baseline (P = 0.006). “Similar statistically significant effects on voiding frequency were seen in the SI group.” Decreasing fluid intake showed significant improvement in quality of life compared to baseline in both groups (both P < 0.003).
The authors feel that this study demonstrated a positive effect of decreasing fluids in women with SI or DO, and that, while ensuring adequate fluid intake to prevent constipation, women with these complaints should be “advised to drink less fluid to improve symptoms as part of conservative treatment.
