Overactive bladder & urinary incontinence…dietary factors that can help
Overactive bladder and/or urinary incontinence, are common problems after a brain injury and spinal cord injury. Approximately 63% of people with a brain injury and 70-84% of people with a spinal cord injury, struggle with one or both of these conditions. 1, 2, 3 Bladder dysfunction can also occur in 11-40% of the general population, due to hormonal changes, urinary tract infections and/or side effects of medication. 4 , 5
Normally, sensors in the bladder wall are designed to send information to the brain indicating how full the bladder is. This helps the brain decide when it’s time to empty the bladder. However, after a brain injury or spinal cord injury, these signals between the bladder and the brain can become disrupted. This is sometimes labelled “neurogenic bladder.” In a spinal cord injury, damage to the nerves can stop or hinder signalling between the bladder and the brain. In a brain injury, sometimes the nerves are functioning as they should, but the brain is unable to interpret the signals that are being sent.
Regardless of the reason, bladder dysfunction can interfere with sleep, cause people to avoid exercise and socialisation (due to fear of having “accidents” when out) and generally have a negative impact on quality of life.
- A sudden, uncontrolled urge to urinate that cannot be ignored.
- Leaking urine after feeling a sudden need to empty the bladder. The involuntary leaking of urine is called “incontinence.” Overactive bladder can occur with and without incontinence.
- Urinating at least eight times during the day.
- Urinating at least twice during the night.
Clients can be screened for overactive bladder by using the Overactive Bladder Assessment Tool.
Ensure that clients see a GP or urologist to get an accurate diagnosis for any type of bladder dysfunction. For example, overactive bladder, stress urinary incontinence, interstitial cystitis and bladder pain are all different conditions that require different forms of treatment. For more information go to the Urology Care Foundation website.
While clients with overactive bladder and urinary incontinence are often prescribed medication such as solifenacin, oxybutynin, or mirabegron to help manage bladder dysfunction, the symptoms sometimes persist. In spinal cord injuries, sometimes clients will end up using indwelling or intermittent catheterisation to manage the condition. In other cases, bladder botox may be recommended.
There are several dietary and lifestyle factors which “irritate” (or stimulate) the bladder and/or otherwise worsen overactive bladder and urinary incontinence. The list below outlines the most common offenders with the greatest amount of research. People are affected by dietary and lifestyle factors to varying degrees, so some people may benefit greatly and others may not achieve much benefit. However, considering it’s a low-cost strategy with no side effects, it’s worth at least trialling these suggestions to see if they help provide symptom relief. Keeping a bladder symptom diary before and after making any changes will help to identify any improvements.
1. Drink enough fluid (but not too much)
Most clients with bladder dysfunction try to manage symptoms by just drinking less overall. However, dehydration makes urine more concentrated and acidic which then “irritates” the bladder and can actually make symptoms worse. Dehydration also increases the risk of urinary tract infections and constipation, both of which also worsen bladder dysfunction. The trick is to find the balance between enough fluid, but not too much. An excessive fluid intake will obviously make symptoms worse as well.
Options for setting fluid targets include:
a) consuming a set 1500mL of fluid per 24 hours;
b) calculating 30mL fluid/kg body weight per 24 hours; OR
c) reducing “usual” fluid intake by 25%.
Fluid intake also needs to be carefully timed to avoid waking in the night (e.g. limiting fluid 3-4 hours before bed).
2. Reduce or avoid ingredients known to increase urination and/or increase the frequency and intensity of bladder contractions.
- Caffeine (e.g. in coffee, tea, energy drinks, cola soft drinks & chocolate).
- Artificial sweeteners (specifically acesulfame K, aspartame & saccharin).
- Carbonated soft drinks. These contain ascorbic acid, citric acid, phenylalanine and colourants which all enhance bladder muscle contractions. The artificial sweeteners in diet soft drinks have an additional effect (see above).
- Citrus fruit/juice
- Vitamin C supplements
It’s also worth noting that grapefruit juice can interact with certain medications and should be avoided in people taking oxybutynin and solifenacin.11
3. Prevent or manage constipation
Constipation can increase pressure on the bladder and trigger more frequent urination. Chronic constipation can also result in denervation of the pelvic region. Ensuring a sufficient fibre intake (about 30 grams per day) can help reduce constipation.
Be aware that that many of the medications given to manage overactive bladder have a side effect of constipation, so additional fibre may be required to offset this.
In addition, neurological conditions can also affect signalling between the brain and the bowel resulting in constipation. See our previous article on constipation and laxative use after catastrophic injury for more information on how to manage this problem.
4. Achieve a healthy body weight
Obese people (BMI >30kg/m2) are 2-3x more likely to develop urinary incontinence and are more likely to develop overactive bladder. This is due to an increase in intra-abdominal pressure leading to chronic stress on the pelvic floor and subsequent neurological dysfunction in this region.
5. Get enough vitamin D
Vitamin D deficiency is linked to a worsening of bladder dysfunction. Get vitamin D levels checked with a blood test (target is over 75nmol/L or 30ng/mL) and then take supplements to maintain adequate vitamin D levels.
- Pelvic floor muscle training – with support from a pelvic floor physio if needed.
- Bladder training – this involves having a bathroom schedule and going to the bathroom at the same time each day with progressively increasing intervals.
- Nerve stimulation – examples include sacral nerve stimulation or percutaneous tibial nerve stimulation, which aim to block abnormal signals from the bladder and/or prevent bladder spasms.
Dietitians can help clients make dietary changes to benefit overactive bladder and urinary incontinence (amongst many other conditions). To refer a case management client for a comprehensive dietetic assessment and report, please contact Specialist Nutrition Rehab at 0121 384 7087 or firstname.lastname@example.org.
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