• Advise, and give information on, weight loss if the woman has a body mass index of 30 kg/m² or greater (see the CKS topic on Obesity).
• Advise the woman to avoid drinking either excessive amounts, or small amounts, of fluid each day. The recommended daily intake is six to eight glasses of water (or other fluid).
• Although there is no evidence that modification of other behaviours improves incontinence symptoms, consider providing advice on regulating bowel habit, stopping smoking, or increasing physical exercise. Improving mobility may be helpful to disabled elderly women.

Weight loss if obese

• The National Institute for Health and Clinical Excellence (NICE) found consistent evidence from observational studies that obesity is associated with stress urinary incontinence and urgency incontinence, and good evidence from two randomized controlled trials that losing weight may improve symptoms.
• Intra-abdominal pressure is higher in women who are obese than in those who are not, and the chronically high pressure may weaken the pelvic floor support structures and narrow the gap between the pressure inside the bladder and the intra-abdominal pressure. Incontinence is likely if the pressure outside the bladder is higher than the pressure inside the bladder [Nygaard et al, 2002].
• NICE recommends weight loss only in women with urgency incontinence or overactive bladder. However, the Scottish Intercollegiate Guidelines Network (SIGN) recommends weight loss in overweight women with either stress urinary incontinence or urgency incontinence [SIGN, 2004].

Adjusting fluid intake if it is either excessive or inadequate

• Although evidence from poor-quality randomized controlled trials on modifying fluid intake is inconclusive, NICE [National Collaborating Centre for Women's and Children's Health, 2006] and SIGN [SIGN, 2004] have commented that both excessive and inadequate fluid intake may lead to lower urinary tract symptoms.
• A combination of low urine output and frequent voiding may reduce the functional capacity of the bladder [DTB, 2001].
• The Food Standards Agency recommends six to eight glasses of fluid a day [FSA, 2008].

Lifestyle interventions

• NICE does not make any recommendations on treating constipation, stopping smoking, or exercising because there is no evidence for their benefit. However:
• Constipation may contribute to urinary incontinence, and straining may weaken pelvic floor muscles [National Collaborating Centre for Women's and Children's Health, 2006] and cause voiding difficulties due to bladder outflow obstruction [DTB, 2001]. There is also evidence from observational studies that constipation may be associated with prolapse. Preliminary evidence suggests that chronic straining and constipation may increase the latency time of the pudendal nerve, which supplies the muscles responsible for pelvic support. Pudendal nerve damage may be partly reversible. Therefore, treating constipation may decrease urinary incontinence by improving the function of the pudendal nerve [Nygaard et al, 2002]. No studies were found on the effect of modifying bowel habit on urinary incontinence.
• Smoking is associated with urinary incontinence and overactive bladder, but there is no evidence that smoking cessation improves symptoms. However, smoking is linked to coughing, which may exacerbate stress incontinence.
• The evidence regarding physical exercise is based on observational studies and is inconclusive.
• Weak evidence from a small trial whose results did not reach statistical significance indicates that improving mobility and toileting skills in disabled elderly women may reduce the number of episodes of incontinence.