You Are What You Eat: How Your Diet Affects Your Bladder
If you suffer from Overactive Bladder (OAB) you are likely way too familiar with the desire to find anything at all to help control your bladder symptoms. While therapies range from bladder training to Botox injections, it is tempting to wish that you could just find the one thing you are eating or drinking that is causing all your troubles. Then, maybe things would return to normal.
The honest answer is that there simply isn’t one food or beverage that is likely to be causing your bladder symptoms. Overactive Bladder is complex and what may irritate one bladder may be perfectly fine in another. Furthermore, even for very common bladder irritants, dietary factors just don’t fully explain OAB. For most people without OAB, even very irritating foods have no effect on bladder behavior. But what is clear is that for many people, identification and moderation of foods and beverages that make their symptoms worse, can often lead to significant improvements in symptoms, even if not usually resolution. So, I encourage my patients to try keeping a food and beverage diary for a few days to see how it impacts your symptoms. It is also helpful to remember that if you identify bladder irritants in your diet, reducing your intake is often easier and more sustainable than eliminating them completely.
It is worth repeating that lists of bladder “triggers” in Overactive Bladder are often misunderstood. You can see these throughout social media and they seem to imply that most or even all of these things are likely to be causing your bladder symptoms: “5 Foods You Need to Stop Eating NOW!!!!”. While there certainly are some foods and drinks that commonly act as irritants to the bladder of many people and affect the symptoms of OAB, this is far from universal. In addition, few people would find that every one of these common irritants affects their bladder. Finally, in my practice which focuses on OAB, I often meet people who never identify a relationship between what they drink or eat and their bladder symptoms. There is a great deal of myth surrounding the effects of food and drinks on the bladder; lets try to see what the science is able to reveal.
Caffeine
There are a couple of ways in which caffeinated beverages such as tea, coffee or sodas could have a negative impact on bladder symptoms. Caffeine is a stimulant elsewhere in the body and it may play a similar role in the bladder. This stimulant effect could help to explain reports from several studies finding increased bladder symptoms with higher intake of caffeine. Furthermore, caffeine also acts as a diuretic (like a fluid/water pill) which can temporarily increase urine production by increasing urine release from the kidneys. If you have OAB, a drug like caffeine which can both stimulate your bladder and increase the amount of urine you make at the same time could cause considerable difficulty. In fact, there is a study suggesting that taking in more than 400mg of caffeine per day may mimic the symptoms of OAB even in people without a history of OAB.
Even if you are one of the many people with OAB who are negatively affected by caffeine, you do not necessarily have to cut caffeine out of your life completely. Instead, most studies of the effects of caffeine on the bladder suggest that elimination is not necessary. Reduction of caffeine to less than 100-150 mg per day is associated with improvement in bladder symptoms. An 8oz cup of coffee contains about 100 mg of caffeine so cutting down instead of cutting out is likely to help. And moderation not elimination may be more sustainable long-term.
Carbonated Drinks
Many carbonated beverages such as colas have caffeine but even carbonated drinks without caffeine may have a negative impact on the bladder symptoms of many people with Overactive Bladder. Carbonated beverages are slightly acidic. But this acid doesn’t stay in your body for long after you drink them. While some of the extra acid is cleared out by your lungs (released as carbon dioxide), the extra acid is also released into the urine, making your urine somewhat more acidic. Acidic urine has been suggested in numerous studies to be a bladder irritant and this may explain the relationship seen between drinking carbonated beverages and worsening bladder symptoms in some people. While this effect is certainly not universal, it may be worth tracking your intake of carbonated drinks to see if they could be affecting your bladder.
Other Acids
While carbonated drinks are slightly acidic, many foods, including fruits and fruit juices can be even more acidic. This would include tomato juices and sauces. Citrus fruits and juices are even more acidic, with orange juice roughly 10 times more acidic than tomato juice. Just as with carbonated drinks, the extra acid in these fruits and juices increases the acidity of your urine and can aggravate your bladder symptoms. Finally, many people do not realize that cranberry is likely the most acidic of common fruit juices. For people who may mistake their OAB symptoms for Urinary Tract Infections, this can be a problem because many people are told to drink cranberry juice to prevent UTI. They may find their symptoms becoming worse, not better. Others have just heard that cranberry juice “is good for your bladder” not knowing that they may be increasing their OAB symptoms by drinking it.
Alcohol
Much like caffeine, alcohol can also have an impact on bladder symptoms both by acting as a bladder irritant and a diuretic. Alcohol acts throughout the body mainly as a depressant not a stimulant so the way that it might lead to worsening OAB symptoms in the bladder is likely different than with caffeine. But like caffeine, the combination of bladder irritation and increased urine production can make OAB symptoms worse in some people. There are theories that other chemicals found in some alcoholic drinks, such as wine, may be responsible for the bladder irritation. If you enjoy alcohol in moderation, it may be worth trying different alcoholic drinks to see if you tolerate some better than others.
Artificial Sweeteners
The final bladder trigger I am covering is actually quite interesting. For many years, people have reported that artificial sweeteners seemed to provoke their bladder symptoms. This was puzzling because it was not clear how sweeteners would cause such a reaction. However, in 2011, it was reported that sweet taste receptors were found in the bladder lining of humans. In addition, stimulation of these taste receptors increased muscle activity in the bladder. It was imagined that artificial sweeteners that are released into the urine may activate these sweet receptors leading to increased bladder activity in those with OAB. In addition to possibly explaining the effect artificial sweeteners seem to have on some bladders, this may also serve as a valuable lesson about how much we still have to learn about bladder function and Overactive Bladder. If you notice this pattern in your own symptoms, it may be wise to decrease your intake of artificial sweeteners, especially if found in beverages that are either carbonated, caffeinated or both.
While few people would report a sensitivity to all of the bladder irritants listed here, it can be helpful to consider whether some of these could be contributing to your OAB symptoms. A food and beverage diary can help to reveal a pattern relating certain foods to your urinary frequency or urgency. If you can identify foods that cause problems for you, reducing them may help to improve your symptoms.
