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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Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26. https://doi.org/10.1007/s00192-009-0976-9.
Coyne KS, Sexton CC, Bell JA, et al. The prevalence of lower urinary tract symptoms (LUTS) and overactive bladder (OAB) by racial/ethnic group and age: results from OAB-POLL. Neurourol Urodyn. 2013;32(3):230–7. https://doi.org/10.1002/nau.22295.
WebMD Medical Reference (2019) Food and drink to tame an overactive bladder. https://www.webmd.com/urinary-incontinence-oab/food-drink. Accessed 9 March 2021.
Mayo Clinic. Bladder control: lifestyle strategies ease problems. https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/bladder-control-problem/art-20046597. Accessed 9 March 2021.
Guy’s and St Thomas’ NHS Foundation Trust. How drinks affect your bladder and bowel. https://www.guysandstthomas.nhs.uk/resources/patient-information/elderly-care/How-drinks-affect-your-bladder-and-bowel.pdf. Accessed 9 March 2021.
Miller JM, Garcia CE, Hortsch SB, Guo Y, Schimpf MO. Does instruction to eliminate coffee, tea, alcohol, carbonated, and artificially sweetened beverages improve lower urinary tract symptoms?: a prospective trial. J Wound Ostomy Continence Nurs. 2016;43(1):69–79. https://doi.org/10.1097/WON.0000000000000197.
Schimpf MO, Smith AR, Miller JM. Fluids affecting bladder urgency and lower urinary symptoms (FABULUS): methods and protocol for a randomized controlled trial. Int Urogynecol J. 2020;31(5):1033–40. https://doi.org/10.1007/s00192-019-04209-z.
Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the international continence society. Am J Obstet Gynecol. 2002;187(1):116–26.
Gleason JL, Richter HE, Redden DT, Goode PS, Burgio KL, Markland AD. Caffeine and urinary incontinence in US women. Int Urogynecol J. 2013;24(2):295–302. https://doi.org/10.1007/s00192-012-1829-5.
Tomlinson BU, Dougherty MC, Pendergast JF, Boyington AR, Coffman MA, Pickens SM. Dietary caffeine, fluid intake and urinary incontinence in older rural women. Int Urogynecol J Pelvic Floor Dysfunct. 1999;10(1):22–8. https://doi.org/10.1007/pl00004009.
Bortolotti A, Bernardini B, Colli E, et al. Prevalence and risk factors for urinary incontinence in Italy. Eur Urol. 2000;37(1):30–5. https://doi.org/10.1159/000020096.
Bradley CS, Kennedy CM, Nygaard IE. Pelvic floor symptoms and lifestyle factors in older women. J Womens Health (Larchmt). 2005;14(2):128–36. https://doi.org/10.1089/jwh.2005.14.128.
Hannestad YS, Rortveit G, Daltveit AK, Hunskaar S. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG. 2003;110(3):247–54.
Dallosso HM, McGrother CW, Matthews RJ, Donaldson MM, Leicestershire MRC Incontinence Study Group. The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women. BJU Int. 2003;92(1):69–77.
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. https://doi.org/10.1016/j.juro.2011.01.003.
Bryant CM, Dowell CJ, Fairbrother G. Caffeine reduction education to improve urinary symptoms. Br J Nurs. 2002;11(8):560–5. https://doi.org/10.12968/bjon.2002.11.8.10165.
Juan YS, Chuang SM, Lee YL, et al. Green tea catechins decrease oxidative stress in surgical menopause-induced overactive bladder in a rat model. BJU Int. 2012;110(6 Pt B):E236–44. https://doi.org/10.1111/j.1464-410X.2012.11258.x.
Tsai WH, Wu CH, Yu HJ, Chien CT. L-Theanine inhibits proinflammatory PKC/ERK/ICAM-1/IL-33 signaling, apoptosis, and autophagy formation in substance P-induced hyperactive bladder in rats. Neurourol Urodyn. 2017;36(2):297–307. https://doi.org/10.1002/nau.22965.
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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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). https://doi.org/10.1007/s00192-022-05090-z
- Fluid intake
- Lower urinary tract symptoms
- Quality of life
- Symptom bother
- Urge incontinence