Ah, the dreaded smoking soapbox. In the orthopedic world, we know that smoking has been correlated in many studies with impaired healing following spinal surgery. Urinary urgency and incontinence has also been linked to the habit of smoking. Women who smoke are three times more likely to have urinary urgency and frequency than women who have never smoked according to a study in Obstetrics and Gynecology.
Researchers received completed surveys from over 2000 women in Finland ages 18-79. Urinary frequency was reported by 7.1% of the women, nocturia by 12.6%, stress urinary incontinence (SUI) by 11.2%, urinary urgency by 9.%, and urinary urge by 3.1%. In the analyses, smoking was correlated with both urinary urgency and with urinary frequency. Smoking did not correlate in this study with SUI or with nocturia (excessive urination at night.)
As mentioned in prior posts, sometimes having research make a point feels less confrontational to a patient or provider versus asking a question such as, "So when are you going to quit smoking?" Some ways to share this issue with a patient may include the following: post this abstract on your bulletin board, include the question on your intake forms, or create an informational brochure that is sent with the patient's pre-visit paperwork. Once you have gained some rapport with a patient, you might say, "Research does suggest that smoking can aggravate the bladder symptoms you have. Is quitting smoking something you are actively working on right now?" Recall that many patients have tried to quit smoking multiple times, and that research shows it takes many attempts before most people are able to quit. Your patient may be quite understandably defensive about this issue, yet it is very valuable to discuss as a part of bladder health education.
This study suggests a dose-response relationship between smoking and bladder symptoms. We can point out to a patient that a decrease in the amount of smoking may influence the bladder positively. Also keep in mind that each person's body and behaviors are different; maybe it's the seven diet sodas, or the poor hydration, or a familial factor in genetics that is the causative factor for her. I know spinal surgeons who refuse to perform surgery on patients who are currently smoking. They basically say, "come back when you have quit smoking." Most pelvic rehabilitation providers who I know would never take this approach because of our kind nature and our desire to have the patient return. It is important, however, for us to continue to acknowledge the research and educate our patients in all strategies for maximizing bladder health.