Caffeine reduction is an internationally accepted treatment strategy for patients with urinary symptoms. However, there is little trial evidence in support of a caffeine/urinary symptom effect. A prospective randomized trial was conducted among 95 consecutive adult patients with urinary symptoms presenting to two nurse continence advisers. Frequency, urgency and leakage outcomes were tested 1 month postenrolment. Trial findings indicate that caffeine intake was reduced (P<0.0001) in the experimental group and that urgency (P=0.002) and frequency (P=0.037) outcomes were significantly improved. Caffeine practices and habits were surveyed and self-reports of caffeine effects indicate that urinary symptoms figured prominently as a reported effects but less so as a driver of caffeine reduction.

The urethral occlusive device provides a further nonsurgical treatment option which is useful for a range of incontinence types.

Because of recent development of a number of intravaginal and urethral occlusive devices for the treatment of urinary incontinence, we aimed to develop a linear analog scale that measured women's attitudes to becoming familiar with their genital anatomy and to placing devices into or upon the vagina or urethral orifices. We also investigated whether such attitudes were affected by previous tampon or diaphragm use, or were age dependent. After pilot studies, a 10-item questionnaire was given to 104 consecutive incontinent women, only 30% of whom were quite comfortable about the concept of touching their genitalia: this attitude was age dependent. Only 21% were quite willing to insert a continence device into their vagina: this attitude varied weakly with age but was significantly affected by previous tampon or diaphragm usage. Only 15% felt very comfortable about placing a continence device on to their urethra, but the likelihood of a positive response to this concept was not at all affected by age and was only slightly more common in previous tampon users. Thus older women are less likely to understand the anatomy of their genitalia or to be comfortable about the idea of exploring it, but age is no barrier to willingness to employ urethral or vaginal continence devices per se. We suggest that such a linear analog questionnaire may help gynecologists determine which patients might respond well to the use of vaginal or urethral continence devices.

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