Fluid management

Continence is affected by the type of fluids consumed as well as the amount.

Fluid type

Caffeine (found in coffee, tea, drinking chocolate and fizzy drinks, such as cola and IRN-BRU) can stimulate the bladder and exacerbate frequency, urgency and nocturnal voiding.

Caffeine is a mild diuretic. It can increase the amount of urine produced if >250-300mg is consumed per day – the equivalent of 3-5 cups of coffee, 5-8 cups of tea or 5-6 cans of caffeinated soft drinks^[1].

However, as the Cochrane review has shown, the evidence is not clear about the effects of caffeine and while reducing caffeine intake may not improve urinary incontinence, it may improve symptoms of urgency and frequency^{[2, 3]}.

Clinical practice point. A ‘trial’ of caffeine reduction is recommended, for at least two weeks, so the person can self-monitor whether they are ‘caffeine-sensitive’ and will benefit from reducing caffeine or changing to decaffeinated drinks.

Alcohol has both a diuretic and a sedative effect. Together, these effects may lead to episodes of incontinence.

Other fluids, such as fruit juices and herbal teas, can also have an impact on both bladder and/or bowel continence.

Fluid amount

Many people who experience bladder leakage will reduce their fluid intake to try to reduce the amount they leak.

This may lead to dehydration and concentrated urine, which irritates the bladder mucosa and leads to increased frequency and urgency, not less.

Some people are incontinent because their fluid intake is too high. It has been known for some people to drink 4-5 litres daily, which means they will be producing in the region of 3.5-4 litres of urine – a huge amount to pass. This is equivalent to 7 to 8 x 500ml voids daily!

Proactive care

Explore the importance of fluids to maintaining healthy bladder and bowel functioning.

Discuss with the person how low fluid intake can contribute to the development of frequency, urgency and inability to hold large volumes of urine in their bladder.

Discuss the increased risk of urinary tract infection (UTI) with chronic low fluid intake.

Support the person to identify ways to increase their fluid intake and negotiate a target to aim for.

Highlight the reasons why it is important to regulate fluid intake and avoid very large or very low amounts. Discuss the person’s preferences and drivers for fluid intake and what might encourage them to change their behaviour.

Your task

Investigate recommendations on daily fluid intake noting any differences in recommendations between fluids and water.

Consider the source of any recommendations and the evidence presented – can they be considered as independent or is there any risk of bias?

Reflect on what you recommend in your practice and share your thoughts with fellow learners.

References

_{1. Gilbert R. Fluid intake and bladder and bowel function. Nursing Times. 2006 Mar;102:12;55 [Cited 28 August 2018] Available from: https://www.nursingtimes.net/fluid-intake-and-bladder-and-bowel-function/201368.article}

_{2. Arya LA, Myers DL, Jackson ND. Dietary caffeine intake and the risk for detrusor instability: a case-control study. Obstet Gynecol. 2000;96:85–9. [Cited 28 August 2018] Available from: https://doi.org/10.1016/S0029-7844(00)00808-5}

_{3. Bryant CM, Dowell CJ, Fairbrother G. Caffeine reduction education to improve urinary symptoms. Br J Nurs. 2002;11:560–5. [Cited 28 August 2018] Available from: https://doi.org/10.12968/bjon.2002.11.8.10165}

Further reading

_{4. Lotan Y, Daudon M, Bruyère F, Talaska G, Strippoli G, Johnson RJ et al. Impact of fluid intake in the prevention of urinary system diseases: a brief review. Curr Opin Nephrol Hypertens. 2013;22(Suppl 1):S1–S10. [Cited 28 August 2018] Summary and full article available from: https://www.h4hinitiative.com/hydration-science/emerging-science/impact-fluid-intake-prevention-urinary-system-diseases-brief-review}