By Elizabeth Houser, MD
Everywhere we look in the media, we find claims that different diets can improve our quality of life. Experts and gurus suggest that we increase our water intake, avoid sugar, become vegetarian, or try a vegan or gluten-free diet. If we follow this advice, experts say, our heart, pancreas, and colon will become healthier.
Sadly, very few experts discuss diets that support and promote bladder health. At the same time, with baby boomers continuing to age, bladder problems such as urinary urgency, frequency, and leakage are becoming very common.
Consider these statistics:
- One in four women over age 26 experiences stress incontinence (urinary leakage when laughing, sneezing, or putting stress on the bladder) at some point in her life.
- About 17 percent of women in the United States suffer from urge incontinence or overactive bladder (urinary urgency, frequency, and leakage).
- Some women have both stress and urge incontinence (mixed urinary incontinence), and these often have the most severe urinary symptoms.
The good news? Research indicates that diet modifications can be an effective conservative therapy for all three types of urinary incontinence. Believe it or not, what you put in your mouth really can affect the health and the behavior of your bladder, especially if you suffer from symptoms of urinary incontinence.
Your Bladder and Your Diet
The old adage says, You are what you eat. Many of us know that spicy foods can affect our bowels, and food choices can also affect bladder health and bladder control.
For example, drinking beer can increase the number of trips you make to the bathroom. Why? Because alcohol is a diuretic, which puts the kidneys into overdrive and causes urinary frequency. Alcohol has a secondary and lesser-known effect on the bladder as well: it has a direct irritating effect on the bladder lining, which can increase urinary urgency, frequency, and leakage.
It turns out that alcohol is only one of many potential bladder irritants in our diet. You may be surprised by the number of foods and beverages in your current diet that can cause your bladder to overreact.
The good news for those with urinary incontinence is that symptoms can be greatly alleviated by making smart dietary modifications:
- Manage fluid intake.
- Avoid bladder irritants.
- Take emergency measures as needed.
- Maintain bowel regularity.
These four types of diet modification are neither complicated nor difficult to integrate into your lifestyle. Best of all, these conservative therapies can help you regain bladder control.
Avoiding Bladder Irritants
A bladder irritant is any food, beverage, or substance that you eat or drink that affects the bladder, causing symptoms such as urinary urgency, frequency, or leakage. But not only foods and beverages can affect your bladder—other substances can also have an adverse effect. These can include certain food additives, preservatives, and some dietary supplements. Some of these substances directly irritate the bladder, while others are acidic, which lowers the bladder pH and causes bladder spasms.
Common bladder irritants include caffeine, alcohol, citric fruits, and foods containing arylalkylamines (tryptophan, tyrosine, tyramine, and phenylalanine). The toxic effect of some substances may not become apparent unless other bladder irritants are present. For instance, your bladder may not react when you eat enchiladas with jalapeño sauce, but add a few margaritas with lime and you may find your bladder start to spasm.
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Citric Foods and Drinks
Many fruits and certain vegetables are acidic and can cause urinary urgency and frequency. Tomatoes are among the worst offenders, as they are extremely acidic and can often be a hidden ingredient in soups and sauces.
Lemons, limes, oranges, grapefruit, and pineapples are some of the most acidic fruits. In addition, beware of fruit juices, which usually have added sugar and preservatives, both of which may affect the bladder. Low-acid fruits include watermelons, papayas, pears, and apricots.
Meat and meat products can also irritate the bladder. Lean meats are a great source of protein, but they are also a source of acid. All meats and some vegetables contain purines. When the body breaks down purines, the result is uric acid. The body needs uric acid, and the kidneys are responsible for monitoring and regulating its excretion. But excess uric acid in the system can lead to health issues, such as gout, kidney stones, and gastrointestinal disturbances. Excess acid in the body can lead to intestinal bloating, gas, and flatulence as well as urinary urgency and frequency.
One of the most popular current dietary guidelines involves avoiding eating wheat or, more specifically, gluten. Although not much has been written about the effects of gluten on the bladder, patients in my practice have seen improvements in their symptoms of bladder irritation when they eat a gluten-free diet. For these patients, avoiding gluten along with other dietary changes to reduce bladder irritation resulted in decreased urinary urgency, frequency, and incontinence. Others have noted that avoiding bread that has preservatives, such as BHT (butylated hydroxytoluene) and propionic acid, decreased their overactive-bladder symptoms.
Consuming alcohol can negatively affect the bladder in multiple ways. First, alcohol is a potent diuretic, which forces the bladder to store more urine. Second, alcohol has a direct irritating effect on the mucosa, or lining, of the bladder. Finally, many alcoholic drinks combine alcohol with other bladder irritants, such as fruit juice and carbonated liquids.
If you do drink alcohol, you can reduce the effects on your bladder by diluting your alcohol intake with water. A good rule of thumb is to drink an 8-ounce glass of water for every alcoholic beverage you consume. While this increased water intake may send you to the bathroom more often, the dilution effect may decrease your chances of having an embarrassing leakage accident.
Coffee and Tea
Both coffee and tea are major bladder irritants because of their caffeine content. Even decaffeinated coffees and teas can irritate the bladder because they still contain some caffeine. Caffeine affects the body and the bladder in ways similar to alcohol. The diuretic effect causes increased urine production, while the acidic nature of coffee and tea can cause direct bladder irritation.
Herbal teas and coffee substitutes may be good options for some people with urinary incontinence symptoms, whereas others will need to dilute the effects of caffeine with water or some other alkalinizing agent.
Artificial Sweeteners and Preservatives
The use of artificial sweeteners is somewhat controversial in nutrition literature. While these sugar substitutes may help control caloric intake, most nutritionists recommend using natural sweeteners, such as stevia, instead of artificial sweeteners.
Remember the big scare in the seventies when lab rats developed bladder cancer after being force-fed saccharin? Subsequent research on humans showed that artificial sweeteners did not result in increased incidences of bladder cancer. In fact, no studies on humans have linked the development of cancer to artificial sweeteners, but they can still irritate the bladder. This is because the body converts certain of these sweeteners to sugar alcohols during metabolism; and because alcohol is a bladder irritant, this can lead to urinary urgency, frequency, and leakage.
Many food preservatives are also bladder irritants. Benzoic acid, a preservative in many fruit juices and carbonated beverages, is often combined with citric acid to improve flavor. Sulfites, or sulfur dioxide, are also acidic in nature and are used in wines, fruits, and vegetables to preserve color and flavor. When you put any form of acid in your body, the result may be an overactive bladder.
If you tend to have urinary urgency, frequency, or incontinence, it is wise to avoid any preservative that has a color, number, or initial in its name. Bladder-healthy preservatives include salt, sugar, and rosemary. Read labels carefully, and remember that the first three ingredients listed are the predominant ingredients in the product.
The Bottom Line
Many ingested substances can irritate the bladder lining, resulting in increased trips to the bathroom and, in some cases, leakage accidents along the way. You can limit or eliminate some of these ingredients from your diet, minimizing their negative effects. With other ingredients, you may have better luck counteracting their effects with other measures.