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Fluids affecting bladder urgency and lower urinary symptoms: results from a randomized controlled trial


Introduction and hypothesis

Caffeinated, alcoholic, artificially sweetened, carbonated, and acidic beverages are pervasive and consumed in large quantities. Reputedly, these beverages are “irritating to the bladder” and result in heightened void frequency, but prior studies lack control for intake volume. We tested the null hypothesis that women recruited from the community who demonstrate overactive bladder symptoms will show no difference by groups in void frequency when one group is instructed to replace listed beverages by substituting non-irritants (emphasis on water or milk) and the other group is instructed in healthy eating.


This was a parallel-group randomized controlled trial design with a three-period fixed sequence (baseline and 2 and 6 weeks post-baseline). We recruited 105 community women with overactive bladder symptoms. Inclusion criteria: >7 voids per day or 2 voids per night, daily intake of ≥16 oz. (473 ml) of beverages containing the ingredients listed above, and ≥ 32 oz. (946 ml) of total fluid intake. Stratified randomization was conducted. The primary outcome was average daily void frequency on a 3-day diary.


Participants were 86% white, mean (SD) age was 46.6 (17.6) years, and baseline void frequency was 9.2 (2.9) voids per day. At 2 and 6 weeks, estimated average (SD) difference in void frequency between group 1 and group 2 was −0.46 (0.57) and −0.31 (0.57) voids per day (p > 0.05); the null hypothesis was not rejected.


Women who reduce potentially irritating beverages while maintaining total fluid volume intake is not predictive of void frequency. Further research on type and volume of beverage intake is recommended.

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The authors thank Ruta Misiunas for her valuable contributions to the investigation, supervision, project administration, and resources for this project, as well as for her participation in the review of the manuscript.


Pfizer Global Investigator-Initiated Research Grant [grant number GA6120A8] and Blue Cross Blue Shield of Michigan Foundation, Investigator-Initiated Grant [grant number 002607.II]. The sponsors played no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

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Authors and Affiliations



J.M. Miller: protocol/project development, data collection/management, data analysis interpretation, manuscript writing/editing; M.O. Schimpf: protocol/project development, data management, manuscript writing/editing; K. Hawthorne: data analysis, manuscript writing/editing; S.B. Hortsch: data collection/management, manuscript writing/editing; C. Garcia: project development, data collection, manuscript editing; A.R. Smith: data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Janis M. Miller.

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Appendix 1

Fig. 3

Fig. 3
figure 3

Voiding diary

Appendix 2

Table 5

Table 5 Repeated measures model for time-dependent void frequency

Appendix 3

Table 6

Table 6 Repeated measures model for time-dependent urgency score (day-time)

Appendix 4

Table 7

Table 7 Repeated measures model for time-dependent urgency score (night-time)

Appendix 5

Table 8

Table 8 Repeated measures model for time-dependent inability to delay voiding

Appendix 6

Table 9

Table 9 Repeated measures model for time-dependent bother score

Appendix 7

Table 10

Table 10 Demographics and baseline diary data by phase

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Miller, J.M., Schimpf, M.O., Hawthorne, K. et al. Fluids affecting bladder urgency and lower urinary symptoms: results from a randomized controlled trial. Int Urogynecol J 33, 1329–1345 (2022).

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  • Fluid intake
  • Lower urinary tract symptoms
  • Prevention
  • Quality of life
  • Symptom bother
  • Urge incontinence