Purpose: To test a novel bladder health tutorial on use of the Knack for overcoming bladder control challenges. The Knack-tutorial is a self-administered vignette-based instructional program on preempting bladder challenges in daily life (urgency, stress-leakage, or urge-leakage) through anticipatory, well-timed pelvic floor muscle contraction at the moment of challenge. Materials and Methods: This is a randomized controlled trial pilot test of 108 women with stress or mixed urinary incontinence. The Knack-tutorial group saw a 15-minute slide show with 10 vignettes portraying use of the Knack in daily life. The slide show format used inserted narrated videos, dubbed and animation enhanced pictures and cartoons, and automatic slide advancement. A control group saw a similarly constructed slide show on incorporating good diet/exercise habits. Outcomes were self-perceived improvement (yes/no, and as 0%-100%) 1 month after viewing the tutorial. Results: We enrolled 123 women, randomizing 64 to Knack-tutorial group and 59 to diet/exercise tutorial group. Eleven and one participant, respectively, did not return. Three did not fill out the self-perceived improvement report. Significant improvement was reported by 71% in the Knack-tutorial group compared to 25% in the diet/exercise group ( p < 0.001). Self-perceived improvement was 21%-22% higher (Model I Est: 21.01, SE: 4.25, p < 0.001) in the Knack-tutorial group. Conclusions: An electronic tutorial viewed independent of a health care provider with vignettes showing Knack application to manage the everyday bladder challenges women face shows benefit of a magnitude that warrants more widespread use and rigorous testing. A professional remake of the intervention is now available (www.myconfidentbladder.com).

Caffeine is a stimulant thought to activate the pleasure centre in the brain, commonly used in the general public for purposeful attempt to alter mood, and also commonly perceived to be a bladder irritant with associated urgency and frequency symptoms. Mental health diagnosis, such as depression, is also associated with overactive bladder. Taken together, it is plausible that women with overactive bladder symptoms along with comorbid mental health symptoms may also show higher caffeine intake but no data exist. This pilot study's purpose was to determine in women with overactive bladder, if those with a mental health diagnosis (we included anxiety, depression, post‐traumatic stress disorder and bipolar diagnosis) consume a significantly higher amount of caffeine than those without any of these diagnoses. Secondary analysis was performed on data from women with overactive bladder recruited into a longitudinal parent study on beverage management. All parent study participants met criteria of urgency and voiding more than seven times per day. Each kept a detailed 3‐day diary of beverage intake. From the total parent study pool of 61, we identified 14 women with a comorbid mental health diagnosis as described above and 47 without when interviewed at baseline. Women with mental health diagnosis demonstrated higher median baseline caffeine intake per day than their counterparts without mental health diagnosis: 240·2 mg (range: 72·3–576·0 mg) versus 174·3 mg (range: 0–567·6 mg), which was marginally significant (p = · 053). Volume of caffeinated beverage intake did not differ significantly. In women with overactive bladder and comorbid mental health symptoms, higher caffeine intake may be a previously unrecognized link. Cause and effect is unknown between the three conditions of overactive bladder, mental health disorders and higher caffeine intake; but this initial data support the need for further research.

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