Management

Having established the type of incontinence, lifestyle and behavioural advice can be given and patients can then decide what they want to try or whether they would prefer to be assessed by a doctor or nurse at their GP practice as their next step. NICE has produced a guideline on the management of incontinence in women but not in men. However, the lifestyle and behavioural changes discussed are also relevant to men.

Lifestyle changes

The lifestyle interventions recommended by NICE are:

• Weight loss (if body mass index (BMI) is over 30)
• Caffeine reduction (OAB only)
• Fluid management, including timing of fluid intake in relation to bedtime. Restricting fluids in the evening, especially coffee, caffeinated beverages and alcohol
• Adjusting timing of medicines. Timing intake of diuretics (take them mid- to late afternoon, six hours before bedtime)
• Reduction of physical exertion (e.g. lifting)
• Smoking cessation
• Resolution of chronic constipation and prevention of recurrence.