Fluid Management for Overactive Bladder

Content provided by the Faculty of the Harvard Medical School

Do you have a drinking problem? Not just alcohol, but water, soda, coffee, tea, or juice? For some people, eliminating excess fluid intake is all it takes to bring incontinence under control. For example, in a British study, reducing fluid intake by 25% — enjoying your usual beverages, but pouring each cup or glass only three-quarters full — significantly reduced overactive bladder symptoms and nocturia. Or you can use the following fluid-management technique along with your bladder-training program or other treatments.

Review your bladder diary to see how much fluid you're drinking each day. Once your physician reviews this information, he or she may suggest changes in the amount of fluid you consume. If your urine output is much higher than 48 ounces, you may be drinking too much fluid. This isn't necessarily unhealthy, but it forces your bladder to handle more urine and may invite or aggravate incontinence. Cutting back may be helpful.

On the other hand, if your output is much lower than 30 to 40 ounces, it can increase your risk for urinary tract infection and, in some people, create a frequent urge to urinate because the concentrated urine irritates the bladder lining. Unless you engage in strenuous exercise or have a medical condition (such as a propensity toward forming kidney stones) that requires more fluid consumption, you can try these guidelines to improve your symptoms:

  • Watch your fluid intake. Drink only when you feel thirsty, and don't exceed six to eight 8-ounce cups of fluid per day from all sources, including soup or milk in your cereal, unless you have a medical condition that requires more. Note that an 8-ounce cup is only two-thirds of a standard soda can.

  • Don't drink more than 8 ounces at a time.

  • Don't guzzle. The faster your bladder fills, the more likely you are to feel urgency.

  • Minimize caffeinated and carbonated drinks.

  • Decrease or eliminate alcohol consumption.

  • If you are thirsty because it is hot or you have exercised, don't hesitate to drink water.

How much should you drink?

The old advice to drink at least eight cups of water a day no longer holds water, particularly if you are prone to urinary incontinence.

Where did this recommendation come from? Some experts think it was based on a misunderstanding. It has been traced to the 1940s, when the National Academy of Sciences published a recommended daily allowance of 1 milliliter of fluid for each calorie burned — a little over eight cups for a typical 2,000-calorie diet. However, the statement then explained that most of this fluid could be obtained via the liquid contained in foods.

Regardless, the eight-glasses-a-day dictum caught on. Indeed, today people frequently consume much more as they tote giant water bottles, buy super-sized soft drinks, and follow the dictates of programs that promise you can lose weight by drinking as much as a quart of fluid at a time. Other people drink extra water or other liquids as part of a special diet that purports to purify or detoxify the liver or other body organs.

In a 2000 survey conducted for Rockefeller University and the International Bottled Water Association, 2,818 adults in 14 cities reported drinking about six cups of water a day — a result that was presented as alarming evidence that Americans were becoming dehydrated. But if you include the sodas, coffee, tea, milk, juice, sports drinks, and alcoholic beverages these respondents drank, their average fluid consumption was 17.6 cups a day — enough to have you urinate every waking hour, even if you don't have any problem with bladder capacity.

A kidney specialist at Dartmouth Medical School searched the scientific literature for studies that might support the idea that people need eight glasses of fluid a day. Not only did he determine that no such evidence exists, but he concluded that the research that has been done "strongly suggests that such large amounts are not needed."

Additionally, the concept of detoxifying the liver or other organs by drinking extra water or other liquids is not based on fact. A person with normal liver and kidney function can rest assured that these organs will rid the body of toxins as part of their normal function. And drinking water won't help you lose weight unless you are drinking it to replace high-calorie drinks you might ordinarily consume, such as soda and fruit juice.

Last Annual Review Date: 2011-08-01 Copyright: Harvard Health Publications

Reference: Overactive Bladder section on Better Medicine


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Which of the following is NOT a symptom of overactive bladder?