Certain foods and beverages contain ingredients that can irritate the bladder. The best documented is caffeine; any product with this substance (like cocoa, chocolate, cola, etc.) may encourage that urge to void. Caffeine can lurk where you least expect it, cautions Diane Newman, MSN, CRNP, Co-Director of the Penn Center for Continence & Pelvic Health at the University of Pennsylvania Health System in Philadelphia. "Over 300 over-the-counter medications contain caffeine; read the label carefully! Even decaf has a bit of caffeine; whether it's enough to affect you depends on how sensitive you are. Brewed coffee is stronger than instant and has more of an impact," she notes.

Identifying the Dietary Culprits
How can you tell if foods affect you? "The only way to know whose symptoms will respond to the removal of dietary irritants is to eliminate them," explains Deborah J. Lightner, MD, Associate Professor of Urology at Mayo Medical School in Rochester MN. She begins by having a patient avoid "the 4 Cs: caffeine, carbonated beverages, citrus juices and vitamin C (usually in tablet form) for seven to ten days." These dietary irritants are most likely related to the resultant acidity of urine, Dr. Lightner notes.

"Patients need to drink adequate fluids - not necessarily eight glasses a day, which produces a physiological urge to urinate - but enough to produce approximately 1,800 cc of urine per day." Logically enough, many people with overactive bladders reduce their fluid intake, but that's a mistake. "They end up with concentrated, acidic urine, which aggravates their problem," she finds. Another tactical error is choosing to urinate often, to avoid accidents. "By going every hour, you train your bladder to hold less fluid. Let it hold a normal amount," urges Newman.

When eliminating the 4 Cs makes a difference, Dr. Lightner discusses avoiding other high acid foods, like tomatoes and vinegar. Dairy products may also cause a problem, because of their high fat content. Once dietary culprits are identified, it's up to the patient to decide what she's willing to avoid. "It does not make a chronic problem irreversibly worse if they have coffee, but might make a good day less bearable," says Dr. Lightner. Newman agrees, citing alcohol, a natural diuretic and bladder irritant. "You can have wine with dinner, but it may get you up at night. Tailor your choices to their impact," she suggests.

Sometimes the problem isn't what you consume, but when. "See when your symptoms occur in order to address the problem," Newman advises. For example, do you usually have coffee after dinner? If your bladder is waking you during the night, "cut back on fluids after 6pm, and avoid both diuretics and coffee at night. Drink your last fluids of the day not later than three hours before bedtime," recommends Dr. Lightner.

When To Seek Help
At what point should you seek medical help? "Leaking when you sneeze, or get on a trampoline, or do jumping jacks, is not usually a major intrusion into your normal life. But if you leak frequently or during your everyday activities, that's more significant," says Dr. Lightner. "It's time to call a doctor when your activities of daily living are being affected."

Who should you call? Not all gynecologists or urologists are trained in this area, so you might look for one who's doing incontinence research at an academic institution, Dr. Lightner suggests. The National Association For Continence (NAFC), the world's largest consumer organization devoted to incontinence, can help locate a specialist in your area. It's well worth seeking a knowledgeable doctor, nurse or physical therapist: "For the majority of women with urinary leakage, behavioral techniques really help. Nonsurgical therapy for incontinence is 60 to 75% successful," reports Dr. Lightner, president of the Society for Women In Urology.

A Frequently Occurring Problem
Urinary incontinence (leaking or losing urine when you don't want to) is common in the U.S., affecting about 10 million women. While not a normal consequence of aging, its occurrence does increase over time, partly because the capacity of the bladder gradually decreases. As nerve pathways age, you don't get that warning signal as quickly -- "it's a muscle losing its flexibility," Newman explains.

As many as 50% of people with urinary incontinence do not even report their problem to a doctor! They simply turn to absorbent products. Nancy Muller, Executive Director of NAFC in Spartanburg, SC, suggests experimenting to see if you can find a dietary cause. "Eliminating a certain food may not make your symptoms go away altogether, but may mitigate them enough for you to manage them," she says.

RESOURCES FOR READERS
These three websites have clear, detailed information about incontinence:
www.nafc.org 1-800-BLADDER
www.afud.org 1-410-468-1800 American Foundation For Urologic Disease
www.seekwellness.com/incontinence
A useful book is "The Urinary Incontinence Sourcebook" by Diane Newman (McGraw Hill, 1999)