Overactive bladder is a common condition in older adults, affecting about 30% of men and 40% of women. The number of people with the condition may be even higher, as people can have anxiety even talking about the situation.
Women can start experiencing symptoms around perimenopause and menopause.
It seems intuitive that what we drink — and how much — can affect our bladder. But can our diet affect our bladder? And is there an overactive bladder diet?
What is overactive bladder?
Overactive bladder is a group of symptoms that include sudden urges to urinate, waking up from sleep several times a night to urinate, feeling like you have to urinate more often and sometimes having urinary incontinence or leakage.
"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. "So when your bladder gets to its full or urgent point, it may have a bladder spasm before you're in the bathroom, which can cause that strong sense of urgency and sometimes leakage."
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. "Some women are so bothered that they have to know where every bathroom is or have difficulty even going out socially because of the anxiety of not knowing where the bathrooms are."
Can you fix an overactive bladder naturally with your diet?
Switching up what you drink and eat can often be the first step in addressing an overactive bladder.
"In some cases, it can be managed with conservative treatment and dietary behavioral modifications," Dr. Antosh says. "I wouldn't say it's for everybody, but changing certain fluids and diet can have an impact."
It's important to know that there's no universal magic bullet diet for overactive bladders — what upsets one person's bladder may not affect yours.
What foods irritate the bladder?
"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. Antosh says.
Coffee and soda lovers should brace themselves: Dr. Antosh says that caffeine, carbonation and artificial sweeteners are all common irritants that can make an overactive bladder worse. These troublesome three irritants are widely available in coffee, tea, energy drinks and reduced-sugar foods. Alcohol, like caffeine, is a diuretic — a substance that causes the kidneys to produce more urine — so it also has an association with overactive bladder.
"Now, in someone that has discomfort and pain with a full bladder, not just urgency frequency, other things in the diet can sometimes exacerbate the bladder symptoms — anything caffeinated, chocolate, spicy and acidic foods, like lemons, limes, tomatoes, citrus fruits, pineapple," says Dr. Antosh.
So if your day doesn't start without a cup of joe, do you have to forego your morning jolt to control your overactive bladder?
"Some studies show a moderate association with caffeine, some not as much," Dr. Antosh says. "One study showed that taking in a number of milligrams that equaled or exceeded two cups of coffee a day is associated with more overactive bladder. That being said, I think everybody's different, and trying to wean down on caffeine and potentially stop it for a period to see how much that helps their overactive bladder is a good thing to do."
Dr. Antosh says that caffeinated sodas are another beverage that people could benefit from limiting or doing a brief elimination to see if it helps their symptoms.
"Caffeinated sodas are one of the worst things because they are carbonated, have artificial sweeteners and caffeine," Dr. Antosh says. "It's really not good for your bladder, and it is bad for other aspects of your health."
It can come as no surprise that if you're only drinking soda, coffee or tea, that's not good for your bladder.
"For people taking in large amounts of caffeinated drinks and sodas, we do need a very big shift and change," Dr. Antosh says. "I would try an elimination diet, seeing if cutting out some of those irritants can significantly help your bladder. And if it doesn't, you might still be able to have your chocolate and that caffeine in moderation. But you should try limiting those before considering more advanced treatments and medications."
What is the best drink for overactive bladder?
Dr. Antosh recommends that overactive bladder patients shift to drinking water over other types of beverages — and to consider how much they consume throughout the day.
"Sometimes people are overdrinking fluids — they were told they need to drink more than eight glasses of water a day," Dr. Antosh says. "If you have an overactive bladder, that's going to push it to be a lot more symptomatic. Stay hydrated, but try to restrict your fluids a little bit to not be overdrinking."
Dr. Antosh recommends that her patients only drink up to 64 ounces of water a day unless doing heavy exercise (running, cycling, hiking) or going outside in the heat.
"Yes, you might need to drink more than that," Dr. Antosh says. "We want you to stay hydrated with water, but not drink more than is necessary."
What other treatments are available for 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. Dr. Antosh says behavioral modifications, medications and minimally invasive procedures can be explored if patients can't find relief through habit changes.
Strengthening the pelvic floor and bladder retraining are two behavioral options that can help patients change the script around their bathroom habits to regain confidence and control.
"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. We work with pelvic floor physical therapists that can help with these behavioral changes and strengthen a woman's pelvic floor muscles, so they can hold it on the way to the bathroom or defer and wait for those urges to subside."
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. Dr. Antosh says these medications, mirabegron and vibegron, are taken daily and have fewer side effects than other types of bladder medications.
There are also minimally invasive treatments available for overactive bladder. You've likely heard of Botox and its effects on migraines and wrinkles — it can help your bladder, too.
"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. That treatment generally lasts about six months, so if that works well for a woman, we do that twice a year."
Low-amplitude electrical stimulation therapy, often called nerve stimulation, is another option for those wanting to find relief. Two types of nerve stimulation are available for overactive bladders, including percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation.
"Nerve stimulation to the bladder resets those hyperactive nerves telling us to always go to the bathroom," Dr. Antosh says. "It can either be done with a nerve stimulator in the lower back or a tibial nerve stimulator in the lower ankle."
Don't let the bathroom rule your life — if you notice changes, talk to your doctor
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. But just because these symptoms can accompany advancing age doesn't mean it's something you should live with.
"These issues are common, and the main thing is if it's affecting your quality of life," Dr. Antosh says. "If you get to the point where you're having leakage, having to wear pads or the bathroom is ruling your life, seek help whether it's from your primary care doctor, your OB-GYN, or a specialist such as urologist or urogynecologist.
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. We always want to start with these behavioral changes, and we have many other treatment options if conservative treatments fail."
