- Email: [email protected]
Fluid and caffeine intake and urinary symptoms in the UK
BRIEF COMMUNICATIONS
159
Fluid and caffeine intake and urinary symptoms in the UK Dan Selo-Ojeme ⁎, Sonu Pathak, Asma Aziz, Modupe Odumosu Department of Obstetrics and Gynecology, Women’s Health Division, Barnet and Chase Farm Hospitals NHS Trust, Enfield, UK
a r t i c l e
i n f o
Article history: Received 20 January 2013 Received in revised form 4 February 2013 Accepted 19 March 2013 Keywords: Alcohol intake Caffeine intake Fluid intake Overactive bladder Urinary incontinence
Overactive bladder is defined by the Standardization Subcommittee of the International Continence Society (ICS) as a bladder disease characterized by the symptoms of urinary urgency, frequency, and nocturia, with or without urgency incontinence, in the absence of urinary tract infection or other obvious pathology [1]. Current treatment strategies for this distressing disorder revolve around first-line conservative management followed by specialized secondary treatment [2,3]. A primary component of first-line conservative management is the reduction of intake of bladder irritants such as caffeine-containing products, notably tea and coffee. However, there are few epidemiological studies that associate caffeine consumption with overactive bladder. The primary aim of the present study was to investigate the relationship between caffeine intake and overactive bladder in a UK population. The study was a cross-sectional survey of a predominantly local, adult female population in north London conducted using a selfadministered questionnaire. The study population included healthy female hospital workers and their female friends and relations, and the local general population. The study participants had the opportunity to complete the questionnaire online (via SurveyMonkey: www. surveymonkey.com). The questionnaire was designed to capture information on sociodemographic data; caffeine, fluid, and alcohol intake; and symptoms of overactive bladder. The study received Institutional Review Board approval. Data were analyzed using Stata statistical software, version 7.0 (StataCorp LP, College Station, TX, USA). Women with urinary frequency (passing urine 8 or more times per day) were compared with those without frequency. A similar comparison was done with urinary urgency. Differences between groups were tested for significance using the χ 2 or Fisher exact test for categorical variables. Significant differences between groups were quantified by calculating the odds ratio (OR) and 95% confidence intervals (95% CI). P b 0.05 was considered statistically significant. Of the 2244 responses, 34% reported urinary frequency and 38% reported urinary urgency. Women who had frequency were significantly more likely to be over 55 years (P b 0.001), multiparous (P b 0.001), and smokers (P b 0.001). Table 1 shows that women in the frequency group were 3.5 times more likely to drink 6 or more cups of coffee per day (OR 3.6; 95% CI, 2.3–5.7; P b 0.001), 4 times more likely to use 3 spoonfuls or more of ⁎ Corresponding author at: Chase Farm Hospital, The Ridgeway, Enfield, Middlesex, EN2 8JL, UK. Tel.: + 44 20 8375 1252; fax: + 44 1277 203329. E-mail address: [email protected] (D. Selo-Ojeme).
coffee in making a cup of coffee (OR 4.3; 95% CI, 1.4–12.4; P = 0.003), 1.5 times more likely to drink a glass or more of alcohol per week (OR 1.4; 95% CI, 1.1–1.6; P b 0.001), and 2.5 times more likely to drink over 2 liters of fluid per day (OR 2.4; 95% CI, 0.3–0.4; P b 0.001). The results for urgency showed a similar trend. The women with frequency were also significantly more bothered by the symptom of urinary frequency (P b 0.001), experienced urgency (P b 0.001), nocturia (P b 0.001), and urgency incontinence (P b 0.001). They were also more bothered by the symptom of urgency (P b 0.001). The study showed a dose-dependent positive relationship between caffeine intake and overactive bladder. There was an increasing degree of association of overactive bladder symptoms with increasing number of cups of tea and/or coffee consumed per day, increasing number of tea bags used in making a cup of tea, and increasing quantity of coffee used in making a cup of coffee. This is in keeping with the results of some previous studies that showed that high levels of caffeine intake increased the risk of overactive bladder symptoms [4]. It is thought that alcohol induces bladder irritability and, presumably, its consumption can be associated with the risk of developing overactive bladder. However, it is surprising that there are no studies that have demonstrated the existence of a strong relationship between alcohol intake and overactive bladder symptoms. In the present study, the consumption of a minimum amount of alcohol per week was shown to be associated with the presence of overactive bladder symptoms. The study also revealed that drinking over 2 liters of fluid per day was associated with overactive bladder symptoms. It has long been held that reducing the amount of total daily fluid intake can ameliorate the symptoms of overactive bladder and this was demonstrated by past authors [5]. However, caution should be exercised when counseling women on reduction of fluid intake. Severe fluid restriction can precipitate dehydration leading to the production of highly concentrated urine that can irritate the bladder further and thus potentiate the symptoms of overactive bladder. Other factors identified in the present study as having a positive relationship with overactive bladder include age over 55 years, multiparity, and smoking. There may be confounders to these factors and more robust studies are needed to investigate these further. As in most high-resource countries, the consumption of caffeinecontaining products, particularly tea and coffee, is common in the UK. Thus, the results of the study strengthen the argument that for women with overactive bladder, there is ample justification to counsel them on the significance of reducing the intake of caffeine. Conflict of interest The authors have no conflicts of interest to declare. References [1] Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 2003;61(1):37–49. [2] National Collaborating Centre for Women’s, Children’s Health. Urinary incontinence: the management of urinary incontinence in women. www.nice.org.uk/nicemedia/ pdf/CG40fullguideline.pdf. Published October 2006. [3] Yamaguchi O, Nishizawa O, Takeda M, Yokoyama O, Homma Y, Kakizaki H, et al. Clinical guidelines for overactive bladder. Int J Urol 2009;16(2):126–42. [4] Jura YH, Townsend MK, Curhan GC, Resnick NM, Grodstein F. Caffeine intake, and the risk of stress, urgency and mixed urinary incontinence. J Urol 2011;185(5):1775–80. [5] Swithinbank L, Hashim H, Abrams P. The effect of fluid intake on urinary symptoms in women. J Urol 2005;174(1):187–9.
160
BRIEF COMMUNICATIONS
Table 1 Comparison of women with urinary frequency and urgency with those without frequency and urgency.a
Drinks tea or coffee Both Tea Coffee Uses mug for beverage Drinks >5 mugs tea Drinks ≥10 mugs tea Use >2 tea bags Drinks ≥6 cups/mugs of coffee per day Use >3 spoonfuls of coffee Drink ≥1 glass of alcohol per week Drinks ≥2 liters of fluid per day Bothered by frequency symptom a
Frequency (n = 765)
No frequency (n = 1479)
477 162 97 607 291 116 39 56 11 272 211 368
845 (57.1) 492 (33.2) 87 (5.8) 1211 (81.8) 505 (34.1) 198 (13.3) 60 (4.0) 31 (2.0) 5 (0.3) 418 (28.2) 196 (13.2) 44 (2.97)
(62.3) (21.2) (12.6) (79.3) (38.0) (15.1) (5.1) (7.0) (1.4) (35.5) (27.5) (48.1)
OR (95% CI)
1.2 (1.0–1.2) 0.5 (0.4–0.6) 2.3 (1.7–3.1)
3.6 4.3 1.4 2.4 28.9
(2.3–5.7) (1.4–12.4) (1.1–1.6) (0.3–0.4) (20.7–40.3)
P value
Urgency (n = 857)
No urgency (n = 1387)
OR (95% CI)
P value
0.01 b0.001 b0.001 0.6 0.07 0.02 0.02 b0.001 0.003 b0.001 b0.001 b0.001
541 (63.4) 199 (23.3) 83 (9.73) 706 (82.7) 202 (23.6) 41 (4.8) 61 (7.15) 57 (3.1) 11 (1.28) 299 (35.0) 150 (17.5)
704 435 77 1013 314 15 36 28 6 363 243
1.6 (1.4–2.0) 0.6 (0.5–0.7) 1.8 (1.3–2.5)
b0.001 b0.001 b0.001 0.2 0.5 b0.001 b0.001 b0.001 0.01 0.002 0.3
(50.7) (31.4) (5.5) (73.0) (22.6) (1.2) (2.6) (2.02) (0.4) (26.1) (19.2)
4.1 (3.1–7.2) 2.6 (1.7–4.1) 3.7 (2.3–5.8) 3.1 (1.2–8.4) 1.5 (1.2–1.8)
Values are given as number (percentage) unless otherwise indicated.
0020-7292/$ – see front matter © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijgo.2013.03.005
Twinning of obstetric and gynecological societies in Tanzania and the Netherlands Jelle Stekelenburg a,⁎, Projestine Muganyizi b a b
Medical Center Leeuwarden, Department of Obstetrics and Gynecology, Leeuwarden, the Netherlands Muhimbili University of Health and Allied Sciences, Department of Obstetrics and Gynecology, Dar es Salaam, Tanzania
a r t i c l e
i n f o
Article history: Received 1 January 2013 Received in revised form 27 February 2013 Accepted 19 March 2013 Keywords: Capacity building Safe motherhood Tanzania the Netherlands Twinning
This report describes the collaboration between the Association of Gynaecologists and Obstetricians of Tanzania (AGOTA) and the Working Party on International Safe Motherhood and Reproductive Health (www.safemotherhood.nl), a committee of the Dutch Society for Obstetrics and Gynaecology (NVOG) and the Netherlands Society for Tropical Medicine and International Health. The collaboration between the two societies ran from 2006–2012 and was inspired by FIGO’s Saving Mothers and Newborns projects, but was not implemented under FIGO’s umbrella nor was funding provided by FIGO. Funding for the collaboration was provided by NVOG and several civil society organizations. From 1998 onward, several programs were instituted under FIGO’s Safe Motherhood and Newborn Health project, all using a twinning mechanism whereby an active member society was paired with a member society in a country with high rates of maternal and newborn mortality. Although the projects have proven successful in involving health professionals, the project model was not without flaws or challenges. The work was largely undertaken by health workers already engaged ⁎ Corresponding author at: Medical Center Leeuwarden, Department of Obstetrics and Gynecology, Henri Dunantweg 2, 8934 AD Leeuwarden, the Netherlands. Tel.: +31 582863201; fax: +31 582891142. E-mail address: [email protected] (J. Stekelenburg).
in full time jobs and, therefore, the country projects relied heavily on volunteerism [1]. The twinning cooperation agreement between AGOTA and NVOG was signed in 2006 and covered a 5-year period; in 2010 it was extended for 2 years, until the end of 2012. The aim of the program was to increase women’s access to quality obstetric care. Kilwa District was chosen as a pilot district for improving the quality of maternal health services. The most important activity was organizing training in lifesaving skills in emergency obstetric care. The first training session was conducted in Dar es Salaam in 2007 and 24 senior obstetric healthcare workers (gynecologists, midwives, and nurses) were trained. From 2008, 7 training sessions were organized in Kilwa District and 135 healthcare workers (80%) were trained [2–4]. The training materials were left at Kilwa Hospital and management was encouraged to organize refresher courses. A new maternity ward was built and the operation theatre was rehabilitated at Kilwa Hospital. For rural health centers and dispensaries, medical supplies and equipment were purchased to facilitate health workers to use their new skills and knowledge. An exchange program for residents training in obstetrics and gynecology was organized. Between 2008 and 2012, 5 Tanzanian residents visited the Netherlands for a 4 to 6-week period to become familiar with different aspects of gynecological and obstetric care in the Netherlands. Unfortunately, the exchange remained unidirectional. Several Dutch residents had wanted to go to Tanzania; however, logistic problems concerning working permits and the hesitation of Dutch supervisors to give permission eventually turned out to be impassable barriers. It is difficult to evaluate the program because it lacked a structured approach. A situational analysis and needs assessment were not well done and there was no plan of activities. Outcome indicators were not defined. The exchange program for residents was evaluated positively by all people involved. The residents who came to the Netherlands have continued to play an important role in fighting poor neonatal and maternal
159
Fluid and caffeine intake and urinary symptoms in the UK Dan Selo-Ojeme ⁎, Sonu Pathak, Asma Aziz, Modupe Odumosu Department of Obstetrics and Gynecology, Women’s Health Division, Barnet and Chase Farm Hospitals NHS Trust, Enfield, UK
a r t i c l e
i n f o
Article history: Received 20 January 2013 Received in revised form 4 February 2013 Accepted 19 March 2013 Keywords: Alcohol intake Caffeine intake Fluid intake Overactive bladder Urinary incontinence
Overactive bladder is defined by the Standardization Subcommittee of the International Continence Society (ICS) as a bladder disease characterized by the symptoms of urinary urgency, frequency, and nocturia, with or without urgency incontinence, in the absence of urinary tract infection or other obvious pathology [1]. Current treatment strategies for this distressing disorder revolve around first-line conservative management followed by specialized secondary treatment [2,3]. A primary component of first-line conservative management is the reduction of intake of bladder irritants such as caffeine-containing products, notably tea and coffee. However, there are few epidemiological studies that associate caffeine consumption with overactive bladder. The primary aim of the present study was to investigate the relationship between caffeine intake and overactive bladder in a UK population. The study was a cross-sectional survey of a predominantly local, adult female population in north London conducted using a selfadministered questionnaire. The study population included healthy female hospital workers and their female friends and relations, and the local general population. The study participants had the opportunity to complete the questionnaire online (via SurveyMonkey: www. surveymonkey.com). The questionnaire was designed to capture information on sociodemographic data; caffeine, fluid, and alcohol intake; and symptoms of overactive bladder. The study received Institutional Review Board approval. Data were analyzed using Stata statistical software, version 7.0 (StataCorp LP, College Station, TX, USA). Women with urinary frequency (passing urine 8 or more times per day) were compared with those without frequency. A similar comparison was done with urinary urgency. Differences between groups were tested for significance using the χ 2 or Fisher exact test for categorical variables. Significant differences between groups were quantified by calculating the odds ratio (OR) and 95% confidence intervals (95% CI). P b 0.05 was considered statistically significant. Of the 2244 responses, 34% reported urinary frequency and 38% reported urinary urgency. Women who had frequency were significantly more likely to be over 55 years (P b 0.001), multiparous (P b 0.001), and smokers (P b 0.001). Table 1 shows that women in the frequency group were 3.5 times more likely to drink 6 or more cups of coffee per day (OR 3.6; 95% CI, 2.3–5.7; P b 0.001), 4 times more likely to use 3 spoonfuls or more of ⁎ Corresponding author at: Chase Farm Hospital, The Ridgeway, Enfield, Middlesex, EN2 8JL, UK. Tel.: + 44 20 8375 1252; fax: + 44 1277 203329. E-mail address: [email protected] (D. Selo-Ojeme).
coffee in making a cup of coffee (OR 4.3; 95% CI, 1.4–12.4; P = 0.003), 1.5 times more likely to drink a glass or more of alcohol per week (OR 1.4; 95% CI, 1.1–1.6; P b 0.001), and 2.5 times more likely to drink over 2 liters of fluid per day (OR 2.4; 95% CI, 0.3–0.4; P b 0.001). The results for urgency showed a similar trend. The women with frequency were also significantly more bothered by the symptom of urinary frequency (P b 0.001), experienced urgency (P b 0.001), nocturia (P b 0.001), and urgency incontinence (P b 0.001). They were also more bothered by the symptom of urgency (P b 0.001). The study showed a dose-dependent positive relationship between caffeine intake and overactive bladder. There was an increasing degree of association of overactive bladder symptoms with increasing number of cups of tea and/or coffee consumed per day, increasing number of tea bags used in making a cup of tea, and increasing quantity of coffee used in making a cup of coffee. This is in keeping with the results of some previous studies that showed that high levels of caffeine intake increased the risk of overactive bladder symptoms [4]. It is thought that alcohol induces bladder irritability and, presumably, its consumption can be associated with the risk of developing overactive bladder. However, it is surprising that there are no studies that have demonstrated the existence of a strong relationship between alcohol intake and overactive bladder symptoms. In the present study, the consumption of a minimum amount of alcohol per week was shown to be associated with the presence of overactive bladder symptoms. The study also revealed that drinking over 2 liters of fluid per day was associated with overactive bladder symptoms. It has long been held that reducing the amount of total daily fluid intake can ameliorate the symptoms of overactive bladder and this was demonstrated by past authors [5]. However, caution should be exercised when counseling women on reduction of fluid intake. Severe fluid restriction can precipitate dehydration leading to the production of highly concentrated urine that can irritate the bladder further and thus potentiate the symptoms of overactive bladder. Other factors identified in the present study as having a positive relationship with overactive bladder include age over 55 years, multiparity, and smoking. There may be confounders to these factors and more robust studies are needed to investigate these further. As in most high-resource countries, the consumption of caffeinecontaining products, particularly tea and coffee, is common in the UK. Thus, the results of the study strengthen the argument that for women with overactive bladder, there is ample justification to counsel them on the significance of reducing the intake of caffeine. Conflict of interest The authors have no conflicts of interest to declare. References [1] Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 2003;61(1):37–49. [2] National Collaborating Centre for Women’s, Children’s Health. Urinary incontinence: the management of urinary incontinence in women. www.nice.org.uk/nicemedia/ pdf/CG40fullguideline.pdf. Published October 2006. [3] Yamaguchi O, Nishizawa O, Takeda M, Yokoyama O, Homma Y, Kakizaki H, et al. Clinical guidelines for overactive bladder. Int J Urol 2009;16(2):126–42. [4] Jura YH, Townsend MK, Curhan GC, Resnick NM, Grodstein F. Caffeine intake, and the risk of stress, urgency and mixed urinary incontinence. J Urol 2011;185(5):1775–80. [5] Swithinbank L, Hashim H, Abrams P. The effect of fluid intake on urinary symptoms in women. J Urol 2005;174(1):187–9.
160
BRIEF COMMUNICATIONS
Table 1 Comparison of women with urinary frequency and urgency with those without frequency and urgency.a
Drinks tea or coffee Both Tea Coffee Uses mug for beverage Drinks >5 mugs tea Drinks ≥10 mugs tea Use >2 tea bags Drinks ≥6 cups/mugs of coffee per day Use >3 spoonfuls of coffee Drink ≥1 glass of alcohol per week Drinks ≥2 liters of fluid per day Bothered by frequency symptom a
Frequency (n = 765)
No frequency (n = 1479)
477 162 97 607 291 116 39 56 11 272 211 368
845 (57.1) 492 (33.2) 87 (5.8) 1211 (81.8) 505 (34.1) 198 (13.3) 60 (4.0) 31 (2.0) 5 (0.3) 418 (28.2) 196 (13.2) 44 (2.97)
(62.3) (21.2) (12.6) (79.3) (38.0) (15.1) (5.1) (7.0) (1.4) (35.5) (27.5) (48.1)
OR (95% CI)
1.2 (1.0–1.2) 0.5 (0.4–0.6) 2.3 (1.7–3.1)
3.6 4.3 1.4 2.4 28.9
(2.3–5.7) (1.4–12.4) (1.1–1.6) (0.3–0.4) (20.7–40.3)
P value
Urgency (n = 857)
No urgency (n = 1387)
OR (95% CI)
P value
0.01 b0.001 b0.001 0.6 0.07 0.02 0.02 b0.001 0.003 b0.001 b0.001 b0.001
541 (63.4) 199 (23.3) 83 (9.73) 706 (82.7) 202 (23.6) 41 (4.8) 61 (7.15) 57 (3.1) 11 (1.28) 299 (35.0) 150 (17.5)
704 435 77 1013 314 15 36 28 6 363 243
1.6 (1.4–2.0) 0.6 (0.5–0.7) 1.8 (1.3–2.5)
b0.001 b0.001 b0.001 0.2 0.5 b0.001 b0.001 b0.001 0.01 0.002 0.3
(50.7) (31.4) (5.5) (73.0) (22.6) (1.2) (2.6) (2.02) (0.4) (26.1) (19.2)
4.1 (3.1–7.2) 2.6 (1.7–4.1) 3.7 (2.3–5.8) 3.1 (1.2–8.4) 1.5 (1.2–1.8)
Values are given as number (percentage) unless otherwise indicated.
0020-7292/$ – see front matter © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijgo.2013.03.005
Twinning of obstetric and gynecological societies in Tanzania and the Netherlands Jelle Stekelenburg a,⁎, Projestine Muganyizi b a b
Medical Center Leeuwarden, Department of Obstetrics and Gynecology, Leeuwarden, the Netherlands Muhimbili University of Health and Allied Sciences, Department of Obstetrics and Gynecology, Dar es Salaam, Tanzania
a r t i c l e
i n f o
Article history: Received 1 January 2013 Received in revised form 27 February 2013 Accepted 19 March 2013 Keywords: Capacity building Safe motherhood Tanzania the Netherlands Twinning
This report describes the collaboration between the Association of Gynaecologists and Obstetricians of Tanzania (AGOTA) and the Working Party on International Safe Motherhood and Reproductive Health (www.safemotherhood.nl), a committee of the Dutch Society for Obstetrics and Gynaecology (NVOG) and the Netherlands Society for Tropical Medicine and International Health. The collaboration between the two societies ran from 2006–2012 and was inspired by FIGO’s Saving Mothers and Newborns projects, but was not implemented under FIGO’s umbrella nor was funding provided by FIGO. Funding for the collaboration was provided by NVOG and several civil society organizations. From 1998 onward, several programs were instituted under FIGO’s Safe Motherhood and Newborn Health project, all using a twinning mechanism whereby an active member society was paired with a member society in a country with high rates of maternal and newborn mortality. Although the projects have proven successful in involving health professionals, the project model was not without flaws or challenges. The work was largely undertaken by health workers already engaged ⁎ Corresponding author at: Medical Center Leeuwarden, Department of Obstetrics and Gynecology, Henri Dunantweg 2, 8934 AD Leeuwarden, the Netherlands. Tel.: +31 582863201; fax: +31 582891142. E-mail address: [email protected] (J. Stekelenburg).
in full time jobs and, therefore, the country projects relied heavily on volunteerism [1]. The twinning cooperation agreement between AGOTA and NVOG was signed in 2006 and covered a 5-year period; in 2010 it was extended for 2 years, until the end of 2012. The aim of the program was to increase women’s access to quality obstetric care. Kilwa District was chosen as a pilot district for improving the quality of maternal health services. The most important activity was organizing training in lifesaving skills in emergency obstetric care. The first training session was conducted in Dar es Salaam in 2007 and 24 senior obstetric healthcare workers (gynecologists, midwives, and nurses) were trained. From 2008, 7 training sessions were organized in Kilwa District and 135 healthcare workers (80%) were trained [2–4]. The training materials were left at Kilwa Hospital and management was encouraged to organize refresher courses. A new maternity ward was built and the operation theatre was rehabilitated at Kilwa Hospital. For rural health centers and dispensaries, medical supplies and equipment were purchased to facilitate health workers to use their new skills and knowledge. An exchange program for residents training in obstetrics and gynecology was organized. Between 2008 and 2012, 5 Tanzanian residents visited the Netherlands for a 4 to 6-week period to become familiar with different aspects of gynecological and obstetric care in the Netherlands. Unfortunately, the exchange remained unidirectional. Several Dutch residents had wanted to go to Tanzania; however, logistic problems concerning working permits and the hesitation of Dutch supervisors to give permission eventually turned out to be impassable barriers. It is difficult to evaluate the program because it lacked a structured approach. A situational analysis and needs assessment were not well done and there was no plan of activities. Outcome indicators were not defined. The exchange program for residents was evaluated positively by all people involved. The residents who came to the Netherlands have continued to play an important role in fighting poor neonatal and maternal