If you are a coffee drinker and you suffer from symptoms of overactive bladder (OAB) such as frequent urination or urgent urination, it is a very safe bet that someone (very often your health care provider) has told you to cut out the caffeine. Caffeine can serve as both a stimulant, an irritant, and a diuretic so it should follow that it must lead to overactive bladder, right? That has been the conventional wisdom for years, though we should always be careful to check that our wisdom is really based on facts.

A recent review article by Palma and Staak provides an overview of the most recent studies about the effects of caffeine on the bladder. When taken together, these studies demonstrate that drinking more than 2 cups of coffee per day (>200mg caffeine) is associated with worsening symptoms of overactive bladder. The effect does depend on the dose and more than 4 cups of coffee per day may result in developing symptoms of OAB even in patients with no symptoms before.

One bit of good news is that the small amount of caffeine found in decaffeinated coffee does not appear to have a negative effect on OAB symptoms.

In this case, the conventional wisdom, dispensed for years by friends, family and even your health care provider appears to be spot on. You may want to skip that extra cup of coffee tomorrow if you have a long meeting in the morning.

Colin M. Goudelocke, M.D.

In a digital world that provides endless distraction, we tend to focus on those things that directly affect us or those we care about. We are drawn to the local news, the posts of our friends, or just tomorrow’s weather forecast. Judged by this standard, for most of us, Overactive Bladder (OAB) doesn’t always seem to have that personal impact. But whether we realize it or not, almost all of us know someone well who suffers with OAB (or we suffer ourselves).  And the impact of these symptoms – financial, social, personal – is immense.

A recent review article by Reynolds et al. is an eye-opening reminder not only of how prevalent OAB is but also what an out-sized impact it has on the lives of those who live with it.  The authors note that the development of a precise and easily-used definition of OAB based on patient symptoms rather than invasive testing has allowed a better sample of how common OAB really is in the United States. Though there is some variation among the larger studies looking at the prevalence of OAB, it seems likely that around 30% of women and 16% of men report symptoms of urinary frequency or urgency at least some of the time. Up to 11% of women report urinary incontinence associated with OAB. This means that about 37 million women in the United States have overactive bladder with 14 million of them experiencing urinary leakage. To put this in perspective, more people have OAB than diabetes, asthma, or arthritis.

The individual impact of OAB on daily life can be enormous. Much of this effect can be attributed to the embarrassment and distress that urinary leakage can cause. OAB isolates, forcing people to avoid friends, family and many of the activities that they may enjoy.  For someone who has to rush to the bathroom every 30 minutes, worshiping at church, seeing a movie with friends, or going to a basketball game is virtually impossible. The authors in this review note studies finding that over 1/3 of people with OAB report their daily activities curtailed by OAB symptoms and 12% even report staying at home because of their OAB. It is not surprising that many people with OAB gain weight when they are not able to exercise regularly due to their symptoms.

Even if you don’t personally have overactive bladder or know someone who does (though you almost certainly do), as a society we pay a heavy price for OAB. Overactive bladder costs each of us the equivalent of $426 per year in lost productivity and more than three times that in pads, medications and other treatments. The review by Dr. Reynolds and collegues cites a study estimating that by 2020 OAB may cost us over $82 billion. That is more then the US government spends on education each year.

For those who personally experience OAB, there is little question of its enormous impact on everyday life. But for the rest of us, there is no denying that overactive bladder should demand our attention.

Colin M. Goudelocke, M.D.

Overactive bladder (OAB) is a very common health problem that is often a source of discomfort and embarrassment. Perhaps as a result of the stigma attached to incontinence, many patients are reluctant to bring up their issues of urinary frequency, urgency or urinary incontinence with their health provider. While it is our goal to make these conversations easier, it helps to have steps you can take on your own to help control your overactive bladder.

1.    Balance your Fluid Intake

In some people with OAB, decreasing fluid intake can noticeably reduce urinary frequency. However, be cautious not to shift to far in the opposite direction as drinking too little fluid may result in constipation or kidney stones. Ideal fluid intake is controversial but should be responsive to your thirst.

2.    Say No to Alcohol and Caffeine

Caffeine and alcohol consumption may worsen the symptoms of overactive bladder. They can act as diuretics and bladder irritants. Keep in mind that caffeine does not only include your morning cup of coffee. Caffeine-loaded drinks/foods may include soda, tea, chocolates and certain medications. It helps to keep caffeine to less than 200mg per day (or less than 2 cups of coffee). The small amount of caffeine in decaffeinated coffee does not have an effect on OAB symptoms.

3.    Avoid Artificial Sweeteners

Artificial sweeteners have become increasingly common as a weight control entity to reduce calorie intake. The National Association for Continence has stated that artificial sweeteners in diet drinks may increase OAB symptoms as much or  more as compared to regular sugary drinks.

4.    Exercise your Pelvic Muscles

Women can effectively strengthen their pelvic muscles to avoid and reduce leak and control involuntary urge. These are often referred to as Kegel exercises. You may read more about these on our web site or watch these videos describing them. Some patients may benefit from learning these exercises from a pelvic floor therapist.

5.    Lose Weight

Being obese or overweight can pose a number of health risks, one of which includes an overactive bladder. The increased weight may apply pressure on your bladder and pelvic muscles affecting urination frequency and urgency. Weight loss has been shown to reduce urinary incontinence.

Colin M. Goudelocke, M.D.