In today’s health-conscious world, the choices we make about what we consume can significantly impact our well-being. Diet soda, often marketed as a healthier alternative to regular soda, comes with its own set of concerns, particularly for urological health. Overactive bladder is a common condition in older adults, affecting about 30% of men and 40% of women. It seems intuitive that what we drink - and how much - can affect our bladder. But can our diet affect our bladder?
What is Overactive Bladder?
"What's going on is there's both a hyperactive bladder muscle and a mismatched nerve signal between the bladder and the brain," says Dr. Danielle Antosh, a urogynecologist at Houston Methodist. Overactive bladder can be very distressing to live with, according to Dr. Antosh. "Women may never know when those urges are going to hit, and it can be an urgent rush to the bathroom, or they will have leakage," Dr. Antosh says. "In some cases, it can be managed with conservative treatment and dietary behavioral modifications," Dr. Antosh says. "There are certain irritants that can be especially bothersome in the bladder and cause more urgent and frequent urination, which exacerbates an overactive bladder," Dr.
The Impact of Diet Soda on Urinary Health
Several factors in diet soda can affect the bladder and urinary tract.
- Artificial Sweeteners and Kidney Stones: Diet sodas contain artificial sweeteners like aspartame, which studies suggest may contribute to the formation of kidney stones.
- Caffeine as a Diuretic: The caffeine content in diet sodas acts as a diuretic, increasing urinary frequency and potentially irritating the bladder. Caffeinated diet sodas have diuretic properties, meaning they can increase urine production and contribute to dehydration if consumed excessively. This effect is due to caffeine’s ability to stimulate the kidneys to produce more urine, leading to fluid loss from the body. While moderate consumption may not pose significant hydration risks for most people, relying heavily on caffeinated diet sodas as a primary source of fluids can potentially disrupt the body’s water balance over time.
- Alteration of Bacterial Flora: Artificial sweeteners can alter the bacterial flora in the urinary tract, making it more susceptible to infections.
- Metabolic Syndrome Risk: Despite their lack of calories, diet sodas have been associated with an increased risk of metabolic syndrome. Metabolic syndrome is a cluster of conditions that include elevated blood pressure, high blood sugar levels, abnormal cholesterol levels, and excess abdominal fat.
- Disruption of Urinary Tract Function: Regularly consuming diet soda can disrupt normal urinary tract function, potentially leading to issues such as overactive bladder. The disruption is often attributed to the artificial sweeteners and caffeine found in diet sodas. These ingredients can irritate the bladder and increase urinary frequency or urgency.
Foods and Drinks to Avoid with OAB
Doctors have identified a number of foods and drinks that can worsen overactive bladders, including:
- Caffeinated beverages and foods
- Alcohol
- Spicy foods
- Citrus fruits and juices
- Carbonated beverages
- Milk and milk products
- Sugar or honey
- Artificial sweeteners
When these foods and drinks collect in the bladder, it can cause irritation resulting in bladder muscle spasms. Those spasms can create the sudden urge to urinate and increase your frequency of urination. Because each person will react differently to trigger foods - coffee might bother one person, while dairy can be problematic for someone else - doctors suggest keeping a food journal so you can see which foods affect you the most.
Read also: Benefits of couples massage detailed
But there are certain beverages that are known to cause repeat trips to the bathroom. Even a moderate amount of alcohol, coffee, tea, or soda will increase the amount of urine your bladder must manage. One study showed that nearly one-half of people over the age of 60 who drink more than 300 milligrams (mg) of coffee a day (a little over a cup) suffered from overactive bladder symptoms, which was significantly higher than peers who did not consume large amounts of caffeine.
Also, chemicals in cigarettes have been shown to irritate the bladder and increase the risk of bladder cancer. Smoking can cause coughing spasms that increase problems with stress incontinence. The American Cancer Society offers extensive resources on quitting, noting smokers are at least 3 times more likely to get bladder cancer compared with nonsmokers.
Foods to Eat and Drink for Optimal Health
Tackle incontinence by making your diet as simple as possible.
Since constipation can cause or exacerbate urinary incontinence, you should also make sure you’re getting enough fiber by filling your daily diet with the following foods:
- Noncitrus fruits
- Grains
- Legumes
- Vegetables
“For most of these things you can do a little trial and error - try certain elimination diets or eliminate certain fluids to see if there’s a positive impact,” says Benjamin M. Brucker, MD, a urologist at NYU Langone Health in New York City. He advises that it’s best to start with bland foods and slowly add things back.
Read also: How digestive health affects weight loss
There are a number of juices that are less irritating to your bladder than others, including apple, grape, cherry, and cranberry. These juices also help by making urine more acidic, preventing the spread of bacteria and controlling urine odor. But beware of additives in these drinks. One study noted that artificial sweeteners can increase the likelihood of OAB. And remember to drink plenty of water, which is the best way to hydrate your body.
Overall, you should drink six to eight 8-ounce glasses of fluid every day. If you drink less, your urine might become concentrated and irritate your bladder. If you drink more, you might overtax your bladder and make matters worse.
“If you’re complaining of peeing too frequently or having leakage episodes, 40 to 60 ounces a day is reasonable,” says Dr. Brucker.
To further ease your overactive bladder, avoid drinking a lot of fluid at one time. Sip 2 or 3 ounces every 20 to 30 minutes between meals. Cutting off fluid intake a few hours prior to bedtime also will help.
“We know that surgeries and medication can be very effective, but we also know that lifestyle modifications can be very effective,” says Brucker.
Read also: Weight Loss Meds & BCBS
The Women’s Health Initiative Observational Study
We conducted a secondary analysis of data from the Women’s Health Initiative Observational Study. Our analytic cohort included 80,388 women. Participants who answered questions about beverage consumption and urinary incontinence symptoms at a 3 year follow up visit were included. Demographic characteristics were compared between three groups of beverage consumers: never to <1 serving/week, 1-6 servings/week, and ≥1 serving/day. Most participants (64%) were rare consumers of artificially sweetened beverages, with 13% (n= 10,494) consuming ≥1 serving/day. The unadjusted odds of reporting urinary incontinence were 10-12% higher in women consuming 1-6 servings/week (OR 1.10, 95% CI 1.06-1.14) or ≥1 serving/day (OR 1.12, 95% CI 1.07- 1.18) vs never to <1 serving/week. In multivariable analyses, women consuming ≥1 serving/day (ref: never to <1 serving/week) had 10% higher odds of reporting mixed urinary incontinence (OR 1.10, 95% CI 1.02- 1.19). When compared to never to <1 serving/week, women consuming ≥1 serving/day of artificially sweetened beverages had 10% greater odds of reporting mixed urinary incontinence after adjustments.
Lower urinary tract symptoms (LUTS) affect approximately 30% of women (1,2), and urinary incontinence (UI) affects nearly 20% of women over age 50 (3,4). UI is also associated with significant comorbidities, including cognitive impairment, functional decline, falls, fractures, stroke, depression, and poor quality of life (5-7). Anecdotally, several foods and drinks such as artificially sweetened beverages (ASB)s are thought to have adverse effects on the bladder and lower urinary tract. Thus, many clinicians recommend avoiding ASBs to reduce LUTS and UI, though evidence to support this recommendation is lacking. In rat models, artificial sweeteners have been shown to enhance detrusor muscle contraction (16), but limited evidence exists establishing a relationship between ASB intake and UI symptoms in humans. The objective of this study was to examine the association between ASB consumption and UI symptoms. We hypothesized that higher levels of reported ASB consumption would be associated with higher prevalence of reported UI symptoms.
The Women’s Health Initiative Observational Study (WHI-OS) is a prospective, multicenter cohort study of 93,676 postmenopausal women. Detailed methods have been previously published elsewhere (17). Briefly, women between the ages of 50 and 79 years old were identified at 40 clinical centers across the United States and enrolled from 1993 to 1998. Women completed several self-administered questionnaires and WHI staff collected anthropometric measures at enrollment and throughout follow-up. In a follow up visit 3 years after enrollment, participants completed a questionnaire that asked them to estimate their consumption of ASB. Women also completed self-administered UI questionnaires at baseline and after 3 years of follow-up. In this study, we included data from all women who participated in the WHI-OS who answered questions about ASB consumption and UI symptoms at their year 3 follow-up visit (n = 80,388). We excluded participants if they did not complete the incontinence questions or did not complete the annual follow-up question at year 3 about ASB consumption (n = 13,288). The question regarding ASBs was as follows: “During the past three months, how often did you drink these beverages?” (Beverages refer to “diet drinks such as diet [soda] or diet fruit drinks,” with a 12 fl. oz. can as a reference serving size.) Frequency of ASB consumption was described in nine categories: never or less than one serving per month (reference), 1-3 per month, 1 per week, 2-4 per week, 5-6 per week, 1 per day, 2-3 per day, 4-5 per day, 6 or more per day. We defined prevalent UI as answering “yes” to the question “Have you ever leaked even a very small amount of urine involuntarily and you couldn’t control it?” on the year 3 follow-up questionnaire. We further categorized UI subtype using responses to the question “When do you usually leak urine?” Participants were defined as having urgency UI (UUI) if they selected only “When I feel the need to urinate and can’t get to the toilet fast enough,” stress UI (SUI) if they selected only “When I cough, laugh, sneeze, lift, stand up or exercise,” and mixed UI (MUI) if they selected multiple responses to this question.
We collected data on demographic variables of participants including age, race, ethnicity, neighborhood socioeconomic status (nSES), body mass index (BMI), parity, use of diuretic medications, diabetes, hypertension, hormone therapy use, history of myocardial infarction, and history of congestive heart failure that was reported either during the participant’s initial screening visit or at their year 3 follow up visit. We also abstracted data on additional dietary or activity variables that could possibly relate to UI symptoms, including smoking history, alcohol intake, recreational physical activity, diet quality or healthy eating index (HEI), caffeine intake, and water consumption. census tracts from the 2000 census, with index ranges from 0 to 100 where higher scores indicate more affluent tracts (18). Diet quality was assessed using the Healthy Eating Index 2015 score, which is a measure of diet quality that assesses conformity to US Dietary Guidelines 2015 (19).
Descriptive statistics were reported by ASB consumption groups, and comparisons were made using chi-square tests for categorical variables and ANOVA for continuous variables. A multivariable logistic regression model was constructed to estimate odds of reporting UI and adjusted for potential confounders including age, race, ethnicity, nSES, smoking, alcohol, caffeine, parity, diuretic use, diabetes, water consumption, BMI, hormone therapy use, physical activity, and diet quality (HEI). Cases with incomplete data were not included in adjusted models.
Demographic features of the cohort are shown in Table 1. Most participants (64%) were infrequent consumers of ASBs, with 13% (n= 10,494) consuming ≥1 serving/day. Women who consumed a higher number of ASBs were younger, had lower neighborhood socioeconomic status, were more likely to be White and not of Hispanic origin, had higher BMIs and lower parity. They were also more likely to have diabetes, hypertension, congestive heart failure (CHF), a history of a myocardial infarction (MI), and use diuretic medications and hormone therapy. Most women (74.7%) in the cohort reported UI symptoms, with 27.2% reporting SUI, 27.3% reporting UUI, 14.4% reporting MUI, and 5.8% reporting other/unknown type of incontinence (Table 2).
Adjusted odds of reporting UI symptoms relative to level of ASB consumption are shown in Table 3. The unadjusted odds of reporting UI were 10-12% higher in women who consumed 1 serving of ASB at least weekly vs rare consumption (OR 1.10, 95% CI 1.06-1.14 for those who consumed 1-6 servings of ASBs/week, and OR 1.12, 95% CI 1.07- 1.18 for those who consumed ≥1 servings of ASBs daily). These associations were no longer seen after adjustments (Figure 1). Frequency of ASB consumption is self-reported approximate number of 12 oz. servings consumed per unit time.
In this analysis of the Women’s Health Initiative Observational Study, the largest US cohort study of postmenopausal women, we found that higher ASB consumption was not associated with odds of reporting SUI or UUI symptoms. When compared to <1 serving/week, women consuming ≥1 ASB per day had 10% greater odds of reporting MUI after adjusting for potential confounders. This study is the largest study to date investigating the relationship between artificially sweetened beverages and urinary incontinence symptoms in postmenopausal women. In this cohort, we found higher ASB consumption to be associated with factors known to be associated with UI symptoms, including elevated BMI, increased caffeine consumption, diagnosis of diabetes, and diuretic use, among others. Since these variables were likely to be significant confounders in the association between ASB intake and UI symptoms, our multivariable logistic regression models were important in understanding the role that ASBs specifically may play in reporting incontinence symptoms. We constructed a model to adjust for variables like BMI, physical activity, diet quality, and other medical comorbidities known to be related to UI (22), and after adjustments neither SUI nor UUI symptoms were associated with ASB consumption. These findings suggest that the association of ASB intake with UI was confounded by BMI and comorbidities. It is possible that women with UI chose to limit beverage consumption, and reverse causation bias may have led to more UI in women reporting lower beverage consumption. While the association between ASB consumption and MUI symptoms was significant, potential reasons for this link while other incontinence types lack a relationship are not clear. It is possible that the association of ASBs with bladder irritation may be synergistic when multiple UI pathologies exist, and it is also possible that additional confounders were present in the group that reported MUI which were not measured and influenced our results. Additionally, a 10% increased odds of reporting MUI symptoms with high ASB consumption is of uncertain clinical significance, and this study utilized a sample with extremely high statistical power to detect even small differences between groups. Since the lower bound of the confidence interval was low (1.01), it is possible that the clinical significance of this finding is limited. As behavior change is often difficult to achieve, particularly regarding reduction of fluid intake and reduction in consumption of bladder irritants (14), these findings suggest that clinicians may find greater utility in focusing behavior change counseling on behaviors likely to have more of an impact on UI symptoms like total volume of fluid intake rather than beverage type.
Strengths of this study include the use of a large sample of postmenopausal women with detailed information on numerous demographic and behavioral variables. The ability to adjust for multiple potential confounders, including variables not commonly available in most databases like diet quality and physical activity, makes this study uniquely suited to isolating the potential relationship between ASBs and UI symptoms. However, there are also several limitations to this study. The primary limitation of this study is the cross-sectional design, as causation and directionality of the results cannot be determined. Additionally, while the WHI-OS has detailed information about a large number of variables and behaviors, additional variables that were not measured or included in our models may have influenced our findings. Specifically, dietary factors known to influence urinary incontinence symptoms such as carbonated beverages may have varied among groups, and this could have confounded our results. We also did not have data regarding potentially confounding factors for incontinence treatment, including use of overactive bladder medications or history of surgical treatment for SUI that may have reduced UI prevalence. ASB consumption was also self-reported, and thus this data may contain inaccuracies from recall bias. Also, the urinary incontinence question on the year 3 questionnaire included all participants who reported ever having a urinary incontinence episode, rather than participants who reported frequent or regular UI episodes. Thus, the association of ASBs may have been more or less pronounced in women with more frequent incontinence episodes. Our analysis also did not investigate whether higher daily ASB intake (e.g. 2 or more servings daily) correlates more substantially with UI symptoms. Lastly, this study was also observational rather than a clinical trial, and observed associations do not necessarily indicate causation.
In this study of postmenopausal women in the United States, consumption of ASBs was not significantly associated with UI symptoms, a finding that may directly impact patient counseling with respect to beverage and fluid management.
Practical Steps to Relieve an Overactive Bladder
Limiting bladder irritants in our food and beverages and limiting our fluids during the day can be steps one and two to relieve an overactive bladder.
"Sometimes people get into this cycle of going to the bathroom really frequently, and the bathroom is kind of ruling their lives," Dr. Antosh said. "With bladder retraining, we gradually start spacing out the time between urinations.
Medical Treatments for Overactive Bladder
Dr. Antosh says that medications are available for those who have trouble managing their symptoms with dietary and behavior changes alone. These medications relax the bladder's smooth muscle, which can ease the symptoms of an overactive bladder. This newer class of medications, Beta-3 agonists, can help increase the bladder's capacity as well as ease the urination urge.
There are also minimally invasive treatments available for overactive bladder. "Botox is an in-office procedure that we can do to help relax that overactive bladder muscle," Dr. Antosh says. "It's done through a small scope, and we inject small amounts of Botox. Low-amplitude electrical stimulation therapy, often called nerve stimulation, is another option for those wanting to find relief. "Nerve stimulation to the bladder resets those hyperactive nerves telling us to always go to the bathroom," Dr. Antosh says.
Dr. Antosh says that while overactive bladder can occur at younger ages, many women can expect urinary changes in the years leading to and after menopause. "These issues are common, and the main thing is if it's affecting your quality of life," Dr. Antosh says. There are pelvic floor physical therapists and many conservative treatment options, and it's not just 'Do your kegels.'" Dr. Antosh adds. "Early in the treatment process, I encourage people to pay attention to what they're taking in their bodies.
General Dietary Advice
Food isn't just a source of energy and nutrition for the body. People with healthy bladders don't need to worry about foods that can be irritating, but those with overactive bladder or bladder pain need to pay attention to what they eat. People who experience a sudden urge to urinate may have overactive bladder. The urgency and frequency of overactive bladder symptoms can increase after eating certain foods. If you have an overactive bladder, you don't need to cut these foods out of your diet completely. Being aware of your food choices and planning accordingly can help decrease symptoms. For example, limit yourself to one cup of coffee before you leave on a three-hour car trip instead of having two or three cups. Some foods cause more intense symptoms than others. Keep track of the foods you eat and your symptoms in a bladder diary. Certain foods exacerbate bladder pain for some people, causing intense pain as their bladders fill. Instead of feeling the relief of urinating, they report feeling their bladders being squeezed or wrung out. Multiple conditions can cause bladder pain, including interstitial cystitis and chronic bladder pain syndrome.
Many people with overactive bladder or bladder pain restrict their fluid intake due to worry about possible symptoms. Some people avoid drinking any fluids all day. While there's no universally recommended amount, most people should aim to drink approximately 60 ounces of fluids each day. Talk with your health care team if you are concerned about your urinary health.