An evidence-based approach to lifestyle interventions in urogynaecology

Urinary incontinence, urgency, overactive bladder symptoms, cystitis and urinary tract infections are common conditions that collectively trouble over one-third of the female population around and beyond the time of menopause, with a detrimental effect on physical, social and mental wellbeing. Apart from pharmacological and surgical treatments, a long list of lifestyle, behavioural, physical and complementary interventions have been introduced over the years to relieve lower urinary tract symptoms. This review examines the effect on these symptoms of lifestyle factors (such as weight, smoking, dietary components, fluid intake, exercise and bowel habit), complementary therapies (such as herbal remedies, acupuncture and hypnotherapy), behavioural therapies (bladder training and timed and prompted voiding), pelvic floor muscle training and some over-the-counter preparations. The high prevalence of the above conditions in combination with the increasing publicity for and awareness of the subject has contributed to the popularity of the interventions considered in this review. Many of them, however, lack a solid evidence base with regard to their efficacy and few have been subjected to robust randomized trials. It is widely recognized that there is a need for further prospective interventional studies of all lifestyle interventions to evaluate the effects of modifying these factors on lower urinary tract symptoms.