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Uti coffee: What to eat (and what to avoid) during a UTI

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What to eat (and what to avoid) during a UTI

Most women have experienced a urinary tract infection, or UTI.

While men can get UTIs, they mainly occur in females.

Once you’ve had an infection, it’s pretty easy to recognize the most common symptoms:

  • Abdominal pressure and pain
  • A burning feeling while urinating
  • A near-constant feeling of having to urinate, even if you just went, and often only going a small amount

Left untreated, these symptoms quickly intensify from annoying to painful.

If you start to feel the symptoms of a suspected urinary tract infection, don’t wait to see a doctor. The sooner you begin antibiotics, the better.

Along with an antibiotic, what you drink and eat during a UTI can help you get better faster.

Drink

DO drink a lot of water, even if you’re not thirsty. This will help flush out the bacteria.

DON’T drink coffee, alcohol or caffeine until the infection is gone. These drinks can irritate your bladder.

DO drink a shot of sugar-free cranberry juice, if you like it. Cranberry juice may help fight infection, though the effectiveness is still being studied.

Eat

DO eat blueberries. They may have the same effect as cranberries, which is keeping bacteria from sticking to the lining if your urinary tract.

DON’T eat spicy food. It could irritate your bladder.

DO eat probiotics — plain Greek yogurt and fermented food such as sauerkraut and pickles. They contain “good” bacteria that can help keep the bad bacteria at bay.

DON’T eat a lot of acidic fruit, such as oranges, lemons or limes during the infection. They can irritate your bladder. However, once your infection is gone, eating acidic fruit with vitamin C can help prevent future infections. Add grapefruit and strawberries to your diet, along with spinach and green peppers.

Once you are prescribed an antibiotic, take the entire course. Don’t stop, even if you feel better.

During the infection — and after — make sure to drink a lot of water, at least 12 8-ounce cups per day. This will flush out your system and help prevent future infections.

If you feel like you’ve got to go, GO! Don’t hold it, as this simply delays getting rid of more bacteria. Holding your urine also provides the perfect environment inside your bladder for bacteria to grow.

Besides holding your urine, other causes of UTIs include sex (always urinate before and after), kidney stones or a lack of estrogen, which helps protect women’s bladders against bad bacteria. Some women are genetically more likely to get UTIs.

Urinary tract infections are very common. Knowing what to eat and drink can go a long way toward preventing these annoying infections from disrupting your life.

When your medical needs can’t wait, Edward-Elmhurst Health has board-certified providers ready to treat your non-emergency urgencies.



Foods You Shouldn’t Eat When Treating a UTI

According to the National Kidney Foundation, one in five women will have at least one urinary tract infection (UTI) in her lifetime — 20 percent of them will have more than one. In fact, bladder infections result in nearly 10 million doctor’s visits each year as women seek treatment for the pain, pressure, and constant urge to urinate.

A bladder infection occurs when bacteria enter the urinary tract. The bacteria irritate the urinary tract, which often results in painful urination and even lower abdominal pain or cramping. Though certain antibiotics can treat a bladder infection, it’s important to know the symptoms of a bladder infection to help your body heal — and to prevent further bladder irritation.

Not everyone with a bladder infection has obvious symptoms. But according to the Mayo Clinic, common signs of a bladder infection may include the following:

  • Blood in the urine (urine that looks red, bright pink, or cola-colored)
  • Feeling of pressure or cramping in the lower abdomen
  • Foul smelling urine
  • Kidney or bladder stones
  • Low-grade fever or chills
  • Pain during intercourse
  • Passing frequent, small amounts of urine
  • Pelvic pain
  • Stinging or burning feeling when urinating
  • Strong persistent need to urinate
  • Urine that is cloudy

A bladder infection can be irritating and painful, but it can become a very serious health problem if the bacterial infection spreads to your kidneys. That’s why understanding your body is important and seeking treatment early on for bladder infections helps you manage the symptoms.

Women are 10 times more likely than men to get bladder infections because they have a shorter urethra. In women, bacteria can reach the bladder faster because of the shorter distance.

While being a woman puts you at greater risk for bladder infections, other risk factors that are common include:

  • Abnormal urinary tract shape or function
  • Certain types of contraception, particularly diaphragms with spermicidal agents
  • Diabetes
  • Genetic predisposition — bladder infections run in some families
  • Postmenopausal. In postmenopausal women altered hormone levels are linked to bladder infections.
  • Pregnancy. Changes in a woman’s hormones during pregnancy increase the risk of a bladder infection.
  • Sexual activity. Bacteria is pushed into the urethra during intercourse. Also, having multiple sex partners increases the risk of bladder infections.

Additionally, a number of common foods and drinks — artificial sweeteners, spicy foods, alcohol, coffee, acidic fruits, citrus, or caffeinated drinks — can irritate your bladder, and may worsen UTI symptoms — so you should steer clear of them if you have signs of a bladder infection.

Causes and Risk Factors of UTI

Urinary tract infections happen when bacteria from the skin or rectum enter the urethra— the tube that takes urine out of the body — and infect the urinary tract. Up to 90 percent of urinary tract infections (UTIs) are caused by E.coli, a type of bacteria that lives normally in your intestines (1), but other types of bacteria may cause UTIs too.

A urinary tract infection may result in symptoms such as painful urination or a frequent urge to use the bathroom, even if your bladder is empty.

UTIs are common. Men and women can get UTIs, but they are especially prevalent among women. About 40 to 60 percent of women will experience a UTI in their lifetime. (2) That’s compared with about 12 percent of men, according to the American Urological Association. (2)

RELATED: The Link Between UTIs and Sex: Causes and How to Prevent Them

Kids can get UTIs too. About 3 percent of girls and 1 percent of boys will have a UTI by age 11, according to the American Academy of Pediatrics. (3)

UTI symptoms in kids may look a little different from UTI symptoms in adults. Kids, especially young children and infants, can’t tell you that it hurts to pee. In kids, fever, unexplained irritability, foul-smelling or cloudy urine, and even vomiting or refusal to eat may be signs of a UTI. (3)

Some common risk factors for UTIs differ between men, women, and kids, while other things that increase your risk of UTIs are the same for everyone.

UTI Causes and Risk Factors for Everyone (4)

  • Holding Your Pee Not going to the bathroom when you have to or not emptying your bladder completely when you go can lead to a buildup of bad bacteria in your bladder.
  • Kidney Stones Kidney stones can obstruct your urinary tract and block the normal flow of urine.
  • Diabetes Diabetes can cause higher sugar levels in the blood and urine. Higher sugar levels in the urine can promote the growth of bacteria.
  • Having Recently Used a Bladder or Urinary Catheter These are flexible tubes that drain urine from your bladder into a bag, so that you don’t have to pee on your own. They’re common after some surgeries.
  • Having had a UTI in the past

UTI Causes and Risk Factors for Women (5 , 6)

  • Being Sexually Active The bacteria that cause UTIs live in the area around your anus. Having sex can move bacteria toward the front, where it can more easily enter your urethra and travel to your bladder.
  • Using Spermicides or a Diaphragm  These forms of birth control can make it easier for harmful bacteria to enter the urinary tract. Spermicides may kill off good bacteria in and around the vagina, making it easier for harmful bacteria to thrive.
  • Pregnancy Pregnancy leads to changes in the urinary tract, which can make it harder to fully empty your bladder. Pregnancy hormones may also change the chemical makeup of your urine in ways that could encourage bad bacterial growth.
  • Menopause The increased vaginal dryness that often results from a drop in estrogen levels when transitioning to menopause can increase your odds of getting a UTI.
  • Wearing Tiny Lingerie There’s not much space between the opening to your urethra, your vagina, and your rectum, and wearing a thong, a teddy, or string-bikini underwear can trap bacteria in the vaginal area.
  • Wiping the Wrong Way Wiping from back to front can introduce bacteria into the urinary tract after using the toilet. Wipe from front to back instead.
  • Enlarged Prostate An enlarged prostate, also known as benign prostatic hyperplasia (BPH), can make it harder to fully empty the bladder. An enlarged prostate also may block the flow of urine out of the bladder. (7)
  • Older Age UTIs are more common in men over 50.
  • Unprotected Anal Sex The harmful bacteria that cause UTIs can be found in and around the anus.

RELATED: Can Essential Oils Help to Safely Get Rid of UTIs?

UTI Causes in Children (3,8)

  • Prematurity Being born prematurely may make infants more likely to experience UTIs. Premature babies have immune systems that aren’t fully formed, so they’re not as good at fighting off infections as babies born at full term.
  • Being Uncircumcised Uncircumcised boys have slightly more UTIs than those who have been circumcised, according to the American Academy of Pediatrics, though proper foreskin hygiene can cut the risk.
  • Poor Bathroom Hygiene This may be an issue especially for girls, who have a shorter distance for bacteria to travel between the anus and urinary tract. Making sure to wipe front to back and completely wiping away all fecal material can help.
  • Urinary Tract Abnormalities About 20 to 30 percent of infants and toddlers with a UTI have a condition called vesicoureteral reflux (VUR), which causes urine to flow backward from the bladder to the ureters, the tubes that carry urine from the kidneys to the bladder. (8) Sometimes VUR will get better and go away on its own. Other times, surgery may be needed to correct the abnormality. (9)
  • Sitting Around in a Wet Swimming Suit Warm, moist areas can be a breeding ground for bacteria.
  • Sexual Trauma

Bacteria-Covered Sex Toys and UTI Risk

Bacteria that live in the anal area and cause UTIs can easily pass to the urinary tract when your partner’s genitals, anus, fingers, or sex toys get pushed toward your urethra. (6)

Sex toys that go into your anus or your partner’s anus should be thoroughly washed before touching other genital areas. (6)

RELATED: Everything You Need to Know About Sex Toy Care and Cleanliness

Does Wearing Tight Pants or Cycling Cause UTIs?

According to a 2018 study published in The Journal of Sexual Medicine, women cyclists are more likely to report a UTI than noncyclists. (10) The exact reason for the connection isn’t clear.

Tight pants, such as those worn for cycling or yoga, won’t cause a UTI. UTIs are caused by harmful bacteria entering the urinary tract. However, bacteria thrive in moist, sweaty environments. Tight pants or shorts can trap this bacteria against the skin of the genitals, where it can potentially enter the urinary tract and cause an infection.

Wearing cotton underwear, practicing good bathroom hygiene, changing out of your workout clothing immediately after you finish exercising, and washing sweaty clothing after each use may help to cut that risk.

Can Essential Oils Help To Safely Get Rid of UTIs?

Not another urinary tract infection! Anyone who’s ever gotten a urinary tract infection (UTI) — and that’s most women — know how irritating and perilous it can be. Some of us are also prone to recurrent UTIs, where infections keep coming.

Fortunately, there are steps you can take to keep UTIs at bay.

One of them is aromatherapy, or using high-quality essential oils to aid your body and mind. If you’re prone to UTIs or are actively battling an infection, it can be helpful to use oils in a supportive way, says Heidi Chesla, a medical aromatherapy specialist in and around Baltimore and an instructor to physicians at the University of Maryland School of Medicine.

Symptoms of UTIs

The all-too-common condition of a UTI happens when bacteria typically found around the anus migrates into the sterile urethra (the tube where pee flows out) or bladder and starts to multiply.

Symptoms include a burning sensation (especially while urinating), the need to pee frequently, the urge to go even if you’ve just emptied your bladder, cloudy or bloody urine, and pain or pressure in your lower abdomen.

RELATED: Urinary Tract Infections (UTI) Symptoms

See a Doctor for Needed Drugs to Treat Infection

UTIs are potentially dangerous, because if the bacteria migrate further upwards, they can enter your kidneys and cause a serious infection there. For this reason, Chesla recommends that when you have a UTI you see your physician to get it treated.

Treatment for UTIs typically involve a short course of oral antibiotics, such as trimethoprim and sulfamethoxazole (Bactrim, Septra).

Your doctor can also instruct you how to best prevent recurrent UTIs. For example, people should stay well hydrated, urinate before and after sex, and women should always wipe from front to back (and even use different sheets of toilet paper for each side).

RELATED: Herbal Remedies for Natural Pain Relief

Fact or Myth: UTIs Can Be Treated With Essential Oils

Essential oils can be used to both support healing and make you feel better when you have a UTI. “You don’t want to use them in place of a drug,” Chesla says. But essential oils are uniquely helpful because chemical constituents within the aromatic oils create physiological responses in the body, and because “there’s a direct connection with the sense of smell and the limbic system in the brain, where your emotions arise,” she says.

Essential oils have not been scientifically studied for UTIs. However, some small studies have shown they can help battle other types of bacterial infections. For example, a review published in December 2019 in Complementary Therapies in Medicine on topical aromatherapy for the skin infection MRSA found significantly lower level of new MRSA emergence compared to routine care.

RELATED: All You Need to Know About Essential Oils and Cancer

How Is Aromatherapy Used?

Aromatherapy uses quality essential oils that are cold-pressed or steam-distilled from plants to support your mind and your body, according to the National Cancer Institute. The oils can come from a plant’s leaves, bark, or peel. Different plants have different oils that have varying effects on the mind and the body.

Essential oils can be inhaled, massaged into the body, rubbed onto the skin, or put in a bath. If you do rub them directly onto your skin, you’ll want to dilute them in a carrier oil, such as fractionated coconut oil (Chesla’s favorite), almond oil, or avocado oil.

Using essential oils if you are prone to UTIs can support your body and help you feel better, Chesla says.

Is Aromatherapy Safe?

Using essential oils, ideally in conjunction with your physician, is very safe, Chesla says. Sometimes, an allergic reaction or skin irritation or rash can occur, especially if you put the oil directly on your skin. This is why experts advise that you dilute the oils with a carrier oil before massaging them into your skin.

You also don’t want to swallow essential oils, because this increases the chances of an allergic or other negative reaction.

The safety of essential oils, not to mention their effectiveness, holds only when you use high-quality, pure and natural products, she says. “Most of what’s on the market as essential oil actually have synthetic ingredients, some of which can be irritating. People need to be aware of that and stay away from these,” Chesla cautions.

Since essential oils are not considered to be drugs by the U. S. Food and Drug Administration (FDA), the products are not regulated by the FDA. Therefore, it is crucial that you buy oils from a manufacturer who is concerned about quality.

It’s up to each person to take care about where they get their oils from. This might mean paying a little more, since cheap oils are unlikely to be of high enough quality to give you the results you want, Chesla says.

Related: Vegetarian Diet Linked to Lowered Risk of Urinary Tract Infection

Look for Companies That Test Essential Oil Quality

The best companies hire an independent third party to test each batch of oil as it is made. The tests they perform are called gas chromatography–mass spectrometry (GC-MS) reports. They show how much of each bioactive compound is present in the oil.

Also, because oils can degrade over time, good manufacturers also print an expiration date on the label, Chesla says.

The results of these tests should be made available to you, either on the company’s website or sent to you if you phone and ask. Chesla recommends that you take the report to your doctor, who should recognize the chemical components. That way if there are any concerns with interactions with other medicines you might be taking, your doctor will be informed.

The Best Essential Oil Blends to Prevent UTIs

If you’re wondering how to use essential oils for UTIs, the best approach is to apply them to the areas of your body most affected, Chesla says.

People prone to recurrent UTIs can try to stave them off by applying a blend of oils to the skin of their lower abdomen and lower back, she says. You’ll want to mix the oils into a carrier oil before you do this.

The blend Chesla recommends are a few drops, in equal parts, of the essential oils cypress (Cupressus sempervirens), juniper berry (Juniperus communis), and cedarwood (Juniperus virginiana). The cypress and juniper berry help to move fluid through your system, while the cedarwood helps kill germs. Rub a small amount of the blend onto your lower abdomen and lower back twice each day, in the morning when you wake up and two hours before bed. (You don’t want fluid moving through you — making you need to pee — too close to bedtime.)

Aromatherapy When You’re Battling an Active UTI

If you have an active infection and are working with your physician to combat it, aromatherapy can assist these medical efforts, Chesla says.

You can continue using the same blend as you use for prevention, but add a few extra drops of cedarwood. Tea tree oil (Melaleuca) can also battle bacteria, so you can substitute this for the cedarwood if you desire. You’ll need to source this oil extremely carefully, though, because so much of what is sold as tea tree oil is actually synthetic, Chesla says.

Chesla also recommends supporting your painful abdomen by massing it with a blend of equal parts clary sage (Salvia sclarea), geranium (Pelargonium graveolens), and lavender (Lavandula angustifolia), again mixed into a carrier oil. Clary sage can have anti-spasmodic effects, while the others are said to induce calm.

Lowering Stress Can Help With UTIs

Stress plays a role in so many of our bodily conditions, so it’s not surprising it may be involved with recurrent UTIs. A review published in February 2017 in Current Opinion in Urology points to this potential link between emotional stress and bladder symptom.

Here, too, aromatherapy may help, because soothing scents can calm the stress response down, Clesla says. Good oils for de-stressing include lavender, sandalwood, and vetiver, alone or in combination.

Find an Aromatherapy Practitioner

You can locate a certified aromatherapist near you on the websites of two national organizations, the National Association for Holistic Aromatherapy and the Alliance of International Aromatherapists.

Or you can buy oils directly from an online company or from a store that sells quality brands. Be sure to buy only from companies that carefully source and test their products.

Does instruction to eliminate coffee, tea, alcohol, carbonated, and artificially sweetened beverages improve lower urinary tract symptoms: A Prospective Trial

J Wound Ostomy Continence Nurs. Author manuscript; available in PMC 2017 Jan 1.

Published in final edited form as:

PMCID: PMC4799659

NIHMSID: NIHMS730874

, PhD, RN, APRN,1, BA,1, MSW, RN,1, MS,1 and , MD2

Janis M. Miller

1400 N. Ingalls, School of Nursing, University of Michigan, Ann Arbor, MI 48100-5482

Caroline E. Garcia

1400 N. Ingalls, School of Nursing, University of Michigan, Ann Arbor, MI 48100-5482

Sarah Becker Hortsch

1400 N. Ingalls, School of Nursing, University of Michigan, Ann Arbor, MI 48100-5482

Ying Guo

1400 N. Ingalls, School of Nursing, University of Michigan, Ann Arbor, MI 48100-5482

Megan O. Schimpf

2Department of Obstetrics and Gynecology, Division of Urogynecology, University of Michigan

1400 N. Ingalls, School of Nursing, University of Michigan, Ann Arbor, MI 48100-5482

2Department of Obstetrics and Gynecology, Division of Urogynecology, University of Michigan

Corresponding/reprints author: Janis Miller, PhD, APRN, FAAN, Associate Professor and Research Associate Professor, School of Nursing, Obstetrics and Gynecology, University of Michigan, 400 N. Ingalls, Ann Arbor, MI 48109, Phone (734) 764-4545 Fax (734) 615-1666, [email protected]

Ying Guo was a graduate student at the University of Michigan at the time of this study

See other articles in PMC that cite the published article.

Abstract

Purpose

Common advice for lower urinary tract symptoms (LUTS) of frequency, urgency and related bother includes elimination of potentially irritating beverages (coffee, tea, alcohol, and carbonated and/or artificially sweetened beverages). The purpose of this study was to determine compliance with standardized instruction to eliminate these potentially irritating beverages, whether LUTS improved after instruction, and if symptoms worsened with partial reintroduction.

Design

The three-phase fixed sequence design was: 1) baseline, 2) eliminate potentially irritating beverages listed above, and 3) reintroduce at 50% of baseline volume, with a washout period between each 3-day phase. We asked participants to maintain total intake volume by swapping in equal amounts of non-potentially irritating beverages (primarily water).

Subjects and Setting

The study sample comprised 30 community-dwelling women recruited through newspaper advertisement.

Methods

Quantification measures included 3-day voiding diaries and detailed beverage intake, and LUTS questionnaires completed during each phase.

Results

During Phase 2, we found significant reduction in potentially irritating beverages but complete elimination was rare. Despite the protocol demands, total beverage intake was not stable; mean (± standard deviation) daily total intake volume dropped by 6.2±14.9oz (p=0.03) during Phase 2. In Phase 3, the volume of total beverage intake returned to baseline, but intake of potentially irritating beverages also returned to near baseline rather than 50% as requested by protocol. Despite this incomplete adherence to study protocols, women reported reduction in symptoms of urge, inability to delay voiding, and bother during both phases (p≤0.01). The number of voids per day decreased on average by 1.3 and 0.9 voids during phases 2 and 3 respectively (p=0.002 and p=0.035).

Conclusions

Education to reduce potentially irritating beverages resulted in improvement in LUTS. However, eliminating potentially irritating beverages was difficult to achieve and maintain. Study findings do not allow us to determine if LUTS improvement was attributable to intake of fewer potentially irritating beverages, reduced intake of all beverages, the effect of self-monitoring, or some combination of these factors.

Keywords: overactive bladder, bladder irritants, incontinence, lower urinary tract symptoms, artificial sweeteners, caffeine, women

Introduction

Lower urinary tract symptoms (LUTS) including urinary urgency, voiding frequency and related bother, with or without incontinence, were reported in 30% of women in a recent community-based study. 1 Frequency (defined as 8 or more voids per day2) and urgency are associated with anxiety, reduced health related quality of life, and depression.3

There is general agreement among health professionals and the public that certain beverages act as bladder irritants. Community-dwelling women accessing web-based information even from respected organizations such as the National Association for Continence4 and the Mayo Clinic5 will readily find advice to reduce coffee, tea, alcohol, and carbonated and artificially sweetened beverages. We will refer to these in total as “potentially irritating beverages” (PIBs).

Despite the widespread notion that PIBs intake is associated with LUTS, evidence to either support or refute the efficacy of this behavioral intervention is scant. We tested the effects of instructing women to eliminate PIBs for the purpose of reducing LUTS. We also tested whether LUTS resume with reintroduction of PIBs. Specifically, in a pre- and post-test design, we tested the following hypotheses: 1) LUTS are significantly reduced as measured by 3-day diaries (primary outcome) and questionnaires (secondary outcome) after women view a DVD instructing them to eliminate PIBs from their diets and 2) LUTS (measured via voiding diary and questionnaires) increase with reintroduction of PIBs at half the woman’s baseline volume.

Methods

We employed a 3-phase fixed sequence design (). An instructional DVD, detailed below, introduced participants to expectations for each phase including when reminder information would be provided. In Phase 1, participants were asked to complete a 3-day beverage intake and bladder habits diary along with symptom questionnaires, reflecting usual (baseline) beverage intake patterns. During Phase 2, participants was asked to document LUTS while completely eliminating of PIBs. During Phase 3, participants were asked to document LUTS while reducing their baseline intake of PIBs by 50%. To keep total intake volume consistent during the three phases, participants were to swap in non-PIBs (mostly water). A 4-day wash-out period was introduced between each of the 3-day study phases so that participants could have a break from the tedious effort of daily diary recording. Participants were told that this was a rest period from the study and that they could drink whatever they wanted during the 4 days between baseline Phase 1 recording and Phase 2 recording, and between Phase 2 recording and Phase 3 recording.

Study Sample

We recruited community-dwelling women through a newspaper advertisement. We chose community-dwelling women rather than patients presenting for care because our target population was women accessing information available to the public, regardless of whether they had sought counselling from a health care provider. Initial screening occurred by telephone; women were invited to participate in the study if they reported consuming a daily intake of ≥32 ounces total beverages and ≥16 ounces of PIBs. We chose the screening threshold of ≥32 ounces total beverage intake to avoid concern for dehydration should total volume not be maintained over the study. We chose the screening cut point of ≥16 ounces/day of PIBs as a compromise between needing to show intervention-related reduction in PIBs intake and being inclusive in sampling women who consume any PIBs.

Additional inclusion criteria included answering “yes” to 2 of the following 3 questions: “Do you experience frequent urination, defined as greater than 8 times per day or 2 times at night?”, “Do you experience frequent (greater than every 2 waking hours) strong feelings of urgency to empty your bladder?”, and “Do you experience frequent (routinely >2 times) night-time urination?” We based the wording of these questions on the 2002 International Continence Society (ICS) definitions of urinary frequency and urgency.6

We excluded women who were currently pregnant, <12 months postpartum, breastfeeding, had a history of vaginal or bladder-related surgery, or taking diuretic medications. We also excluded women with the following medical conditions: diabetes mellitus, multiple sclerosis, muscular dystrophy, cerebral palsy, dementia, Alzheimer’s disease, stroke, or spinal cord injury. Women with current symptoms of dysuria or a history of frequent urinary tract infections (defined as >4/year) were excluded. We excluded men as our intended population of community dwelling adults with LUTS was likely to include men in the latter half of their fifth decade and above, when the common condition of prostate gland enlargement might confound the outcome variables of frequency. Study procedures were reviewed and approved by IRBMED, University of Michigan: HUM00050865. All participants signed an informed consent document.

Study Instruments

We adapted a traditional bladder diary format to provide more granular detail for beverage consumption (Appendix 1). Briefly, women recorded the following information daily for 3 consecutive days: time of beverage intake, type of beverage intake (in detail) and volume consumed, time of voids, voided volume, number of incontinence episodes, time to bed and time awake.

During each phase of the study, participants also completed 3 brief questionnaires on LUTS. This first was a visual analog scale that assessed urinary urgency for each day a voiding diary was completed. This urgency scale was adapted from Bower and colleagues. They used the question “Whenever I need to go to the toilet I can…” and offered 5 response options presented equidistantly on a 10 unit undemarcated line. The response options were: 1)make the wee go away, 2) easily hold on, 3) wait a little while, 4) hardly wait, and 5) feel wee already coming out.”.7 We replaced the term “wee” with the terms “urine” or “urge” and treated the options as an ordered 5-point choice rather than as an equidistant labeling on a 10-unit scale, for cultural relevancy and improved face validity on response to pilot testing in our setting. The question was placed on the 3-day diary at the end of each day’s recording, for each phase of the study.

The OAB-q is a reliable and valid measure used to differentiate between normal and clinically diagnosed continent and incontinent participants with LUTS8. It was administered to assess symptom bother and health-related quality of life associated with a variety of different LUTS. The original instrument includes 33 items, but we used only the first eight questions that pertained to bother, and which are designed to be scored separately. We modified the 8 questions by changing the introductory phrase “During the past 4 weeks, how bothered were you by…” to “During the past 3 days, how bothered were you by…” to characterize the bother of LUTS under the 3-day conditions of each phase

Women were also asked at the end of the 3-day diary logging, during each phase, to evaluate their ability to delay voiding that day. This modified grading bladder fullness scale is an ordinal scale with different time-lengths of ability to delay relative to desire to void. The scale was modified from one suggested in a study performed by De Wachter and Wyndaele.9 We modified by replacing the word “voiding” with the word “urinating,” to render the responses more relevant to participants, and we made slight adjustments to wording and time increments for clarity and logic (Appendix 2).

Study Procedures

Descriptive data, including age, height, weight, race, parity, education, and yearly income were collected. Baseline diary and symptom questionnaires were also obtained. These baseline measures, as well as repeated measures of diary and symptom questionnaires for each phase of the study, were distributed and returned via US mail. Each woman received a plastic container (sometimes referred to as a “Texas hat”) for measuring voided urine.

These community-dwelling women were provided with an instructional DVD about study procedures and expectations. The DVD contained a voice-over slide presentation, which played like a video. It was 34 slides long and required about 30 minutes to view. Two of the 34 slides were devoted to defining “potentially irritating beverages,” which in this study we described as coffee (even decaf), tea (even decaf), alcohol, carbonated, and artificially sweetened beverages. The remainder of the slides included a welcome slide, background and study purpose, extensive “tips and tricks” for accurate recording on the diary and the location and importance of the questionnaires. The DVD standardized the instruction to remove the potential for bias that comes from extensive nurse contact at face-to-face visits, and to offer convenience for the participants. An added advantage was that women were able to refer back to their DVD at any time throughout the study if they desired a review of instructions. Participants were given the option of viewing the presentation in our office if preferred (for instance, if they did not have computer access or a DVD player). One participant requested this option.

After completion of the Phase 1, a study investigator examined each voiding diary, calculated the amount of PIBs and non-PIBs consumed, and provided individualized mailed instruction to each participant on the desired PIBs and overall fluid consumption during the next two study phases. Participants were asked to complete diaries on the same 3 days of the week for each phase so that typical habits reflective of specific days would be consistent throughout the study period. We also asked women to record an output volume in the diary for every void, even if they did not void into the container provided. We further instructed them to note that it was an estimate in a column labeled for this, rather than leaving that as missing data (appendix A). Women were reimbursed for each completed phase of the study for a possible total of $70.

Data Analysis

Diary data were reduced such that there was a mean 3-day score for each diary variable at each time period. For example, for the urgency visual analogue scale was assessed each day of the 3-day diary7 but the average of the 3 days was used as the score across that phase. Differences between study phases were evaluated using paired 2-sample t-tests were used for variables with a normal distribution and Wilcoxon Signed-Rank tests for variables that were not normally distributed. We used the Bland and Altman measures of agreement graphical methods to portray variance from protocol to maintain total beverage intake or to reduce intake at the appropriate study intervals.10 Statistical Analysis Software version 9.3 (SAS Institute, Inc., Cary, NC) was used for most of the statistical analysis, and SPSS (IBM, Armonk, New York) was used for other selected data management and analysis procedures. A p-value <0.05 was considered statistically significant.

Results

Eighty-six women were screened and 35 were enrolled into the study. Five were excluded from the final analyses for various screening or protocol violations discovered during the later data analysis procedures. Analysis was based on data from 30 women. Their mean age was 57.5±10.2 years (mean ± SD) and 90.0% identified themselves as Caucasian (). Baseline beverage diary data showed that all met enrollment criteria for PIB consumption (>16oz/day). No woman in this study reported juice as her only potentially irritating beverage.

Table 1

Participant Characteristics

Variable Mean (SD)

Age (years) (n=30) 57.53 (10.24)

Weight (pounds) (n=29) 159.22 (38.21)

Height (inches) (n=30) 64.6 (2.4)

BMI (n=29) 26.8 (6.01)

Variable N (%)

Yearly Income (dollars)
<$20,000 3 (10.34%)
$20,000–40,999 9 (31.03%)
$41,000–60,000 7 (24.14%)
>$60,000 10 (34.48%)

Race
Black/African American 1 (3.33%)
White 27 (90.0%)
Other/did not disclose 2 (6.66%)

Education level
12th grade 3 (10%)
Some college 6 (20%)
College (4 yrs or tech writing) 9 (30%)
Graduate school 12 (40%)

Total number of children
0 8 (27.59%)
1 4 (13.79%)
2 8 (27.59%)
3 4 (13.79%)
4 3 (10.34%)
5 0 (0%)
6 1 (3.45%)
7 1 (3.45%)

Number of normal vaginal deliveries
0 11 (37.93%)
1 4 (13.79%)
2 6 (20.69%)
3 4 (13.79%)
4 3 (10.34%)
5 0 (0%)
6 0 (0%)
7 1 (3.45%)

At baseline, average total daily beverage intake was 74.7±26.1 ounces, with PIBs accounting for 63.3±39.3 ounces (85% of total) (). Despite instructions otherwise, the total fluid volume intake over all diary days of the study was not stable. During Phase 2, when women were instructed to avoid consuming any PIBs, diaries showed wide variability in intake volume. Specifically, the total beverage intake was reduced by a mean of 6.2 ounces, which was significantly lower than Phase 1 (p=0.03) and Phase 3 (p=0.02). During Phase 3, total beverage intake was essentially equal to Phase 1, but again variability was noted between individual diaries. The Bland and Altman scatter plot and accompanying measures of agreement analysis () showed that any individual woman in the study might vary her total beverage intake by 20 ounces or more from phase to phase (nearly 30 ounces from Phase 1 to Phase 2), despite being requested to maintain a steady intake volume.

a and b: Bland and Altman plots showing percent change of potentially irritating beverages compared to baseline. The horizontal line portrays the protocol expectation for each phase). At Phase 2 when all potentially irritating beverages should have been eliminated (−100% on the graph), instead several women showed very little change and some ranged up to nearly 200% above baseline (Fig A). At Phase 3, when potentially irritating beverages by protocol should have been down by half (−50% on the graph) from baseline, again a substantial number of women showed little behavioral change or even up to 200% above baseline in one case (Fig B).

Table 2

Results of symptoms and bladder habits at baseline (Phase 1), on attempt at complete elimination of potentially irritating beverages (Phase 2), and on attempt to reintroduce potentially irritating beverages at ½ of baseline (Phase 3).

Outcomes Phase 1:
Baseline
Phase 2:
All PIBs
eliminated
Phase 3:
Add back ½
PIBs
Phase 1 vs Phase 2 Phase 1 vs Phase
3
Compare
Phase 2 vs Phase
3
n Mean
(SD)
n Mean
(SD)
n Mean
(SD)
Mean
(SD)
p-value Mean
(SD)
p-
value
Mean
(SD)
p-
value
Average total daily intake per 24 hours over 3 days (oz) 30 74.7
(26.1)
30 68.6
(28.7)
30 74.8
(30.3)
−6.16
(14.88)
0.031 +0.08
(10.03)
0.965 +6.24
(13.67)
0.018
Average “Potentially Irritating Beverage” intake per 24 hours over 3 days (oz) 30 63.3
(39.3)
30 38.0
(37.0)
30 52.8
(27.6)
−25.3
(53.4)
0.015 −10.5
(37.1)
0.132 +14.8 0.04
Average number of voids per 24 hours over 3 days 30 10.5
(2.64)
30 9.2
(2.71)
30 9.6
(2.86)
−1.27
(2.05)
0.002 −0.9
(2.29)
0.040 +0.37
(1.54)
0.202
Average total daily voided volume per 24 hours over 3 days (oz) 30 77.72
(22.66)
30 70.99
(27.98)
30 72.07
(24.69)
−6.74
(20.73)
0.086 −5.66
(14.0)
0.035 +1.08
(14.28)
0.681
Average self-reported urge symptoms* reflecting on past 24 hours on each day of 3 days (ranging from 1–5 points with higher scores indicating worse urge) 29 3.21
(0.63)
30 2.80
(0.57)
30 2.91
(0.71)
−0.43
(0.55)
0.000 −0.339
(0.67)
0.011 +0.11
(0.64)
0.377
Self-report ability to delay reflecting on past 3 days (ranging from 0–4 points, with higher scores indicating worse ability to delay) 29 2.91
(0.67)
30 2.25
(0.91)
30 2.37
(0.78)
−0.66
(0.64)
<0.000 −0.53
(0.64)
0.000 +0.12
(0.73)
0.387
Self-report of bother reflecting on past 3 days (ranging from 8 –48 points, with higher scores indicating more bother) 29 29.77
(15.49)
30 18.95
(13.4)
30 22.05
(14.78)
−10.46
(14.82)
0.001 −7.65
(12.14)
0.002 +3.09
(8.03)
0.044

Although women were instructed to entirely eliminate PIBs during Phase 2, PIB intake was still on average 38.0 ounces per day, which was a reduction of 25.3 ounces per day from baseline (). Eight participants reported increasing their intake, one participant did not change her intake volume, five complied with 100% elimination of PIBs, and the remaining 17 women decreased PIB intake to varying degrees (). There was no relationship between reducing PIBs during Phase 2 and original PIB intake volume, as shown in a plot of individual data in .

Participants were individually instructed on how to add back 50% of their personal baseline PIBs intake during Phase 3. Nevertheless, they experienced difficulty achieving this goal, and 11 women (37%) did not reduce the amount of PIBs from baseline at all. Overall, women reported a mean 15% reduction in PIB consumption rather than the requested 50% (, ).

Despite incomplete adherence to the protocol, the greatest reduction in LUTS was achieved during Phase 2, when PIB consumption was lowest (). When compared to their baseline (Phase 1) self-reported urinary urgency (p=0.0003), ability to delay voiding (p<0.0001) and bother scores (p=0.0007) improved significantly during Phase 2. In addition, the mean daily voided volume was reduced by 6.7±20.8 ounces; this change was consistent with a decrease in total beverage intake. Nevertheless, this difference was not statistically significant compared to baseline, (p=0.09). The number of voids per day in Phase 2 was significantly reduced compared to Phase 1 (10.5 voids vs. 9.2 voids, p=0.002), but it was not different from Phase 3.

When participants were asked to add back some PIBs during Phase 3, there was still a significant reduction in LUTS compared to baseline (). During this phase, total beverage intake volume was similar to baseline (p=0.1), while the improvements in bladder function demonstrated at Phase 2 were maintained. The number of voids/day continued to be significantly lower than baseline (10.5 voids compared to 9.6 voids; p=0.04). Total voided volume was also significantly reduced by 5.6 ounces (p=0.04) relative to baseline. Symptom scores for urgency, ability to delay voiding and degree of bother were all significantly improved compared to baseline ().

Comparing Phases 2 and 3, women consumed more total beverages and more PIBs in Phase 3 than Phase 2. Voided volume and number of voids per day were similar in the two phases (). Bother scores did show a significant worsening from Phase 2 to Phase 3 (p=0.04), although both phases were improved compared to baseline.

Discussion

This feasibility study evaluated the effects on LUTS of two different intake volumes of PIBs, none or half of baseline consumption, while holding total beverage intake constant by swapping in primarily plain water. While we noted LUTS improvement with PIB reduction, truly eliminating PIBs proved difficult for a majority of study participants. As a result, we cannot yet conclude if the improvement we noted was from fewer PIBs, reduced total intake of beverages, the effect of self-monitoring bladder habits, or some combination of these.

Complete elimination of PIBs was not achieved by many women in this study. We therefore recommend that clinicians carefully consider the difficulty of achieving and adhering to PIB elimination as a treatment strategy. We did not specifically analyze reasons for lack of adherence to PIB and overall fluid intake, so we can only speculate about the numerous possible reasons women were unable to eliminate PIBs. Many PIBs are habit-forming11, 12, and many social events are tied to PIB intake. As a result, persons may find it difficult to avoid consuming a cup of coffee at a meeting or an alcoholic beverage as when participating in an after-work social gathering. Based on these considerations, we believe that partial elimination of PIBs may be a more feasible goal. Women still improved in our study when average PIBs intake was reduced to almost half of their initial intake, making this still a reasonable treatment option. The cultural, societal, familial, biological and other influence on PIB intake are an important future area of future investigation.

We observed wide variability in daily fluid intake across the study phases, despite instructions to try to maintain the same cumulative volume of beverage intake. Multiple reasons may account for this variability, including physical activity levels, weather conditions, and their effects on thirst.

While women’s LUTS improved based on group averages at both study phases, variability in the concentration of certain ingredients or in total amount of irritating substances in these beverages renders it impossible to draw conclusions about the relationship of LUTS to each specific substances or the cumulative amount consumed. All we can determine from this 3-phase study design is that following instruction to reduce total amount of PIBs while swapping in non-PIB alternatives, while recording intake, output and LUTS women achieved reductions in LUTS. [0]Our findings were confounded by inconsistent protocol compliance across the women and wide variability in concentration or total amount of potentially irritating substances in these commonly consumed beverages.

While the effect of various PIBs on LUTS is clinically relevant, we cannot draw conclusions based on specific ingredients of each PIB. For example, we did not assess the type and strength of coffees consumed. Similarly, findings from this study cannot differentiate which of the multiple ingredients in a diet cola that may act as a bladder irritant, considering it is carbonated, caffeinated, artificially sweetened, and acidic. We hope to study this interesting question in future work.

There are pros and cons to the various study designs and protocols available. A laboratory study that rigorously controls participants’ intake would offer more precise determination of ingredients and control for overall intake volume. However, since LUTS are driven by the social environment, evaluation of these environmentally triggered symptoms (e.g. urgency on arrival home) poses a validity issue. A community-based study that limits ingredients by providing pre-packaged standardized amounts of an ingredient of interest is a feasible and likely worthwhile design, but does not reflect the reality of our complex beverage-choice environment and is unlikely to provide real-world clinical treatment guidance. A randomized controlled trial asking participants in the intervention group to eliminate all PIBs is a logical next step and has the advantage of a control group who is equally exposed to the simple learnings that can occur from self-monitoring, such as awareness of how much one is actually drinking. However, since we do not yet fully understand the reasons for lack of compliance to PIB reduction, it seems logical to initiate investigation with real-life, qualitative work to learn more about this phenomenon. Clearly, the data from our study show that reliance on simple instruction to “eliminate coffee, tea, alcohol, and carbonated beverages” is not adequate motivation for women to do so. This area is also worthy of further investigation.

A relationship between PIBs such as the ones measured in our study and LUTS has been demonstrated in prior studies, but many of these studies have focused only on caffeine. In one study, mean dietary caffeine intake of women with detrusor overactivity on cystometry was significantly higher than that of women without detrusor overactivity.13 Total beverage intake and bladder capacity were not reported. Other studies link a decrease in caffeine consumption to reduction in LUTS. A recent pilot study of 11 women demonstrated a reduction in urgency and frequency, quality of life and bladder symptoms in general while drinking decaffeinated drinks compared to when they drank caffeinated beverages14. In a study by Bryant and colleagues, 26 adult participants who routinely consumed at least 100 mg of caffeine per day were randomly assigned to an intervention or control group.15 All participants received education about bladder training, but participants in the control group continued caffeine intake, while the intervention group received additional education on caffeine reduction. The intervention group achieved a significant reduction in daily episodes of leakage. It is unclear if other beverages were substituted for caffeine, so symptom reduction could have resulted from a decrease in total volume intake.

The biochemical mechanism of how caffeine contributes to LUTS is unclear, but does not appear to be the same in all women. This was supported by a study in which a standardized drink of caffeine was associated with a rise in bladder pressure only in a group of women with detrusor overactivity compared to asymptomatic women.16 It can be hypothesized that caffeine is perhaps metabolized differently in symptomatic women, or that some other factor predisposes symptomatic women to bladder symptoms when exposed to caffeine. Nevertheless, our knowledge of these mechanisms are not entirely understood, as another study showed. In that cohort, decreasing overall beverage intake significantly improved LUTS, but decreasing caffeine intake did not result in significant improvement when replacing caffeinated beverages with non-caffeinated drinks.17

The question of different PIBs affecting LUTS differently is a fascinating one that additionally merits further work. If different PIBs have different effects on symptoms, this would be welcome and germane information to patients. This is suggested in a recent study that showed that women who increased consumption of coffee or soda, especially diet soda, experienced an increase in LUTS.18

We also included as PIBs those containing alcohol and artificial sweeteners. Data concerning sugar substitutes in humans are limited, but laboratory studies have shown that ascorbic acid and citric acid augment bladder muscle contraction via a hypothesized enhanced calcium ion influx.19 Three artificial sweeteners, acesulfame K, aspartame, and sodium saccharin have been evaluated using isolated animal detrusor specimens and found to stimulate the contractile response of bladder muscle and significantly enhance contractions.

The strengths of our study, which is one of the only of its kind studying this important clinical recommendation, include enrolling community-dwelling women who may be amenable to modification of PIBs versus treatment with drugs or other interventions with a higher likelihood of side effects. We used diaries to minimize recall bias, and we had good compliance with diary recording throughout the 3 phases of the study. We believe this was partially due to the provided detailed instruction and “tips and tricks” on easing the burden of the diary recording in the standardized educational slideshow. Diary recording is a burden for patients, and hence we abided by recommendations of only three days at a time, followed by four days of non-recording.20 While this likely did ease the burden on study participants, it raises other interesting potential implications as the “wash-out period” most likely included increased PIB intake compared to the study phases, likely skewing results of the first diary day of each study period. This supported using an average value of the three study periods for our data interpretations. The trade-off of preventing recording fatigue was important to preserve subject completion of the study.

Limitations

Our three phase study design limited our ability to make causal inferences. Whether a DVD-based slide show delivery of information is the best method of study instruction is unknown, as are the many social factors discussed above regarding societal encouragement of PIB consumption. While our diary permitted the collection of a large amount of discrete data, the intensive self-monitoring that occurs with use of intake-output diaries acted as intervention. Translating this into clinical practice is always complex, and we tried to mitigate the artificial environment of a study versus real-world clinical care by keeping the study period short, providing tips on PIBs substitution and allowing subjects the washout period. All of these factors, however, are also limitations. We do not know from this study whether the length of the intervention influenced the outcomes, nor in what direction. We also do not know how the washout period influenced the outcomes. It is one thing to commit to a 3-day period of limiting PIBs, but quite another to do so for the duration.

We recommend that future studies better document specific PIBs and sweetener intake to improve counseling about specific PIBs. Compliance on counselling women about giving up sweeteners versus caffeine, for example, may increase if women are allowed to keep one or the other. Additionally, PIBs are not only found in beverages. We did not measure the presence of sweeteners in food, such as yogurt. We did not collect data on reasons why so many of our participants were unable to eliminate PIBs, and recommend future investigation into the barriers of changing this intake pattern in future studies.

Additionally, given the primarily Caucasian and well-educated demographics of our sample, our current results cannot be generalized to the broader public. Future studies will ideally include a wide range of demographic backgrounds.

Conclusions

Findings from this study supports instructing women to reduce PIBs to improve LUTS. Nevertheless, the reasons why reduction in PIB intake alleviates LUTS remain unclear. LUTS improvement observed in this study may result from changing the type of beverages consumed, changing overall volume of beverages consumed, or some combination of these factors. We believe that findings from this feasibility study set the stage for additional research. In addition, we believe that the data collection tool used in this study offers a level of precision previously not available to clinicians or researchers interested in the relationship between PIB consumption and LUTS.

Acknowledgments

Funding sources:

This project was funded by The Michigan Center for Health Intervention, University of Michigan School of Nursing, National Institutes of Health, National Institute of Nursing Research (P30 NR009000-01). Additional investigator support was provided through the Office for Research on Women’s Health (ORWH) Specialized Center of Research (SCOR) on Sex and Gender Factors Affecting Women’s Health and National Institute on Child and Human Development (NICHD) (Grant #P50 HD044406)).

Appendix 1

Three-day diary (last page shown)


Time Arise: _______________ Trial: 1 2 3

Time to Bed: _______________ Today I should: Maintain usual habits Drink no “irritating” beverages Drink____oz. of “irritating” beverages

Beverage Intake Urine Output
Beverage
Type
Caffeinated Artificially
Sweetened
Beverage
Amount
(ounces)
Volume of Urine Output Episodes
of
Leakage
Yes
No
Yes
No
Urine
Amount
(oz)
Measured
Close
estimate
Wild
Guess
✓✓✓
Morning (6am-noon)
Afternoon (noon-6pm)
Evening (6pm-midnight)
Night (midnight-6am)

Appendix 2

Over the past 3 days, when you urinated, what was your usual perception of your bladder fullness? (Adapted with permission from De Wachter & Wyndaele)8

0 No bladder sensation
1 Urinating could easily be delayed for more than 30–60 minutes
2 Urinating could only be delayed for 30 minutes
3 Urinating could only be delayed for 5 minutes
4 Immediate urinating was mandatory and/or fear of leakage

Footnotes

Conflict of Interest: None of the authors have a conflict of interest.

References

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Does instruction to eliminate coffee, tea, alcohol, carbonated, and artificially sweetened beverages improve lower urinary tract symptoms: A Prospective Trial

J Wound Ostomy Continence Nurs. Author manuscript; available in PMC 2017 Jan 1.

Published in final edited form as:

PMCID: PMC4799659

NIHMSID: NIHMS730874

, PhD, RN, APRN,1, BA,1, MSW, RN,1, MS,1 and , MD2

Janis M. Miller

1400 N. Ingalls, School of Nursing, University of Michigan, Ann Arbor, MI 48100-5482

Caroline E. Garcia

1400 N. Ingalls, School of Nursing, University of Michigan, Ann Arbor, MI 48100-5482

Sarah Becker Hortsch

1400 N. Ingalls, School of Nursing, University of Michigan, Ann Arbor, MI 48100-5482

Ying Guo

1400 N. Ingalls, School of Nursing, University of Michigan, Ann Arbor, MI 48100-5482

Megan O. Schimpf

2Department of Obstetrics and Gynecology, Division of Urogynecology, University of Michigan

1400 N. Ingalls, School of Nursing, University of Michigan, Ann Arbor, MI 48100-5482

2Department of Obstetrics and Gynecology, Division of Urogynecology, University of Michigan

Corresponding/reprints author: Janis Miller, PhD, APRN, FAAN, Associate Professor and Research Associate Professor, School of Nursing, Obstetrics and Gynecology, University of Michigan, 400 N. Ingalls, Ann Arbor, MI 48109, Phone (734) 764-4545 Fax (734) 615-1666, [email protected]

Ying Guo was a graduate student at the University of Michigan at the time of this study

See other articles in PMC that cite the published article.

Abstract

Purpose

Common advice for lower urinary tract symptoms (LUTS) of frequency, urgency and related bother includes elimination of potentially irritating beverages (coffee, tea, alcohol, and carbonated and/or artificially sweetened beverages). The purpose of this study was to determine compliance with standardized instruction to eliminate these potentially irritating beverages, whether LUTS improved after instruction, and if symptoms worsened with partial reintroduction.

Design

The three-phase fixed sequence design was: 1) baseline, 2) eliminate potentially irritating beverages listed above, and 3) reintroduce at 50% of baseline volume, with a washout period between each 3-day phase. We asked participants to maintain total intake volume by swapping in equal amounts of non-potentially irritating beverages (primarily water).

Subjects and Setting

The study sample comprised 30 community-dwelling women recruited through newspaper advertisement.

Methods

Quantification measures included 3-day voiding diaries and detailed beverage intake, and LUTS questionnaires completed during each phase.

Results

During Phase 2, we found significant reduction in potentially irritating beverages but complete elimination was rare. Despite the protocol demands, total beverage intake was not stable; mean (± standard deviation) daily total intake volume dropped by 6.2±14.9oz (p=0.03) during Phase 2. In Phase 3, the volume of total beverage intake returned to baseline, but intake of potentially irritating beverages also returned to near baseline rather than 50% as requested by protocol. Despite this incomplete adherence to study protocols, women reported reduction in symptoms of urge, inability to delay voiding, and bother during both phases (p≤0.01). The number of voids per day decreased on average by 1.3 and 0.9 voids during phases 2 and 3 respectively (p=0.002 and p=0.035).

Conclusions

Education to reduce potentially irritating beverages resulted in improvement in LUTS. However, eliminating potentially irritating beverages was difficult to achieve and maintain. Study findings do not allow us to determine if LUTS improvement was attributable to intake of fewer potentially irritating beverages, reduced intake of all beverages, the effect of self-monitoring, or some combination of these factors.

Keywords: overactive bladder, bladder irritants, incontinence, lower urinary tract symptoms, artificial sweeteners, caffeine, women

Introduction

Lower urinary tract symptoms (LUTS) including urinary urgency, voiding frequency and related bother, with or without incontinence, were reported in 30% of women in a recent community-based study.1 Frequency (defined as 8 or more voids per day2) and urgency are associated with anxiety, reduced health related quality of life, and depression.3

There is general agreement among health professionals and the public that certain beverages act as bladder irritants. Community-dwelling women accessing web-based information even from respected organizations such as the National Association for Continence4 and the Mayo Clinic5 will readily find advice to reduce coffee, tea, alcohol, and carbonated and artificially sweetened beverages. We will refer to these in total as “potentially irritating beverages” (PIBs).

Despite the widespread notion that PIBs intake is associated with LUTS, evidence to either support or refute the efficacy of this behavioral intervention is scant. We tested the effects of instructing women to eliminate PIBs for the purpose of reducing LUTS. We also tested whether LUTS resume with reintroduction of PIBs. Specifically, in a pre- and post-test design, we tested the following hypotheses: 1) LUTS are significantly reduced as measured by 3-day diaries (primary outcome) and questionnaires (secondary outcome) after women view a DVD instructing them to eliminate PIBs from their diets and 2) LUTS (measured via voiding diary and questionnaires) increase with reintroduction of PIBs at half the woman’s baseline volume.

Methods

We employed a 3-phase fixed sequence design (). An instructional DVD, detailed below, introduced participants to expectations for each phase including when reminder information would be provided. In Phase 1, participants were asked to complete a 3-day beverage intake and bladder habits diary along with symptom questionnaires, reflecting usual (baseline) beverage intake patterns. During Phase 2, participants was asked to document LUTS while completely eliminating of PIBs. During Phase 3, participants were asked to document LUTS while reducing their baseline intake of PIBs by 50%. To keep total intake volume consistent during the three phases, participants were to swap in non-PIBs (mostly water). A 4-day wash-out period was introduced between each of the 3-day study phases so that participants could have a break from the tedious effort of daily diary recording. Participants were told that this was a rest period from the study and that they could drink whatever they wanted during the 4 days between baseline Phase 1 recording and Phase 2 recording, and between Phase 2 recording and Phase 3 recording.

Study Sample

We recruited community-dwelling women through a newspaper advertisement. We chose community-dwelling women rather than patients presenting for care because our target population was women accessing information available to the public, regardless of whether they had sought counselling from a health care provider. Initial screening occurred by telephone; women were invited to participate in the study if they reported consuming a daily intake of ≥32 ounces total beverages and ≥16 ounces of PIBs. We chose the screening threshold of ≥32 ounces total beverage intake to avoid concern for dehydration should total volume not be maintained over the study. We chose the screening cut point of ≥16 ounces/day of PIBs as a compromise between needing to show intervention-related reduction in PIBs intake and being inclusive in sampling women who consume any PIBs.

Additional inclusion criteria included answering “yes” to 2 of the following 3 questions: “Do you experience frequent urination, defined as greater than 8 times per day or 2 times at night?”, “Do you experience frequent (greater than every 2 waking hours) strong feelings of urgency to empty your bladder?”, and “Do you experience frequent (routinely >2 times) night-time urination?” We based the wording of these questions on the 2002 International Continence Society (ICS) definitions of urinary frequency and urgency.6

We excluded women who were currently pregnant, <12 months postpartum, breastfeeding, had a history of vaginal or bladder-related surgery, or taking diuretic medications. We also excluded women with the following medical conditions: diabetes mellitus, multiple sclerosis, muscular dystrophy, cerebral palsy, dementia, Alzheimer’s disease, stroke, or spinal cord injury. Women with current symptoms of dysuria or a history of frequent urinary tract infections (defined as >4/year) were excluded. We excluded men as our intended population of community dwelling adults with LUTS was likely to include men in the latter half of their fifth decade and above, when the common condition of prostate gland enlargement might confound the outcome variables of frequency. Study procedures were reviewed and approved by IRBMED, University of Michigan: HUM00050865. All participants signed an informed consent document.

Study Instruments

We adapted a traditional bladder diary format to provide more granular detail for beverage consumption (Appendix 1). Briefly, women recorded the following information daily for 3 consecutive days: time of beverage intake, type of beverage intake (in detail) and volume consumed, time of voids, voided volume, number of incontinence episodes, time to bed and time awake.

During each phase of the study, participants also completed 3 brief questionnaires on LUTS. This first was a visual analog scale that assessed urinary urgency for each day a voiding diary was completed. This urgency scale was adapted from Bower and colleagues. They used the question “Whenever I need to go to the toilet I can…” and offered 5 response options presented equidistantly on a 10 unit undemarcated line. The response options were: 1)make the wee go away, 2) easily hold on, 3) wait a little while, 4) hardly wait, and 5) feel wee already coming out.”.7 We replaced the term “wee” with the terms “urine” or “urge” and treated the options as an ordered 5-point choice rather than as an equidistant labeling on a 10-unit scale, for cultural relevancy and improved face validity on response to pilot testing in our setting. The question was placed on the 3-day diary at the end of each day’s recording, for each phase of the study.

The OAB-q is a reliable and valid measure used to differentiate between normal and clinically diagnosed continent and incontinent participants with LUTS8. It was administered to assess symptom bother and health-related quality of life associated with a variety of different LUTS. The original instrument includes 33 items, but we used only the first eight questions that pertained to bother, and which are designed to be scored separately. We modified the 8 questions by changing the introductory phrase “During the past 4 weeks, how bothered were you by…” to “During the past 3 days, how bothered were you by…” to characterize the bother of LUTS under the 3-day conditions of each phase

Women were also asked at the end of the 3-day diary logging, during each phase, to evaluate their ability to delay voiding that day. This modified grading bladder fullness scale is an ordinal scale with different time-lengths of ability to delay relative to desire to void. The scale was modified from one suggested in a study performed by De Wachter and Wyndaele.9 We modified by replacing the word “voiding” with the word “urinating,” to render the responses more relevant to participants, and we made slight adjustments to wording and time increments for clarity and logic (Appendix 2).

Study Procedures

Descriptive data, including age, height, weight, race, parity, education, and yearly income were collected. Baseline diary and symptom questionnaires were also obtained. These baseline measures, as well as repeated measures of diary and symptom questionnaires for each phase of the study, were distributed and returned via US mail. Each woman received a plastic container (sometimes referred to as a “Texas hat”) for measuring voided urine.

These community-dwelling women were provided with an instructional DVD about study procedures and expectations. The DVD contained a voice-over slide presentation, which played like a video. It was 34 slides long and required about 30 minutes to view. Two of the 34 slides were devoted to defining “potentially irritating beverages,” which in this study we described as coffee (even decaf), tea (even decaf), alcohol, carbonated, and artificially sweetened beverages. The remainder of the slides included a welcome slide, background and study purpose, extensive “tips and tricks” for accurate recording on the diary and the location and importance of the questionnaires. The DVD standardized the instruction to remove the potential for bias that comes from extensive nurse contact at face-to-face visits, and to offer convenience for the participants. An added advantage was that women were able to refer back to their DVD at any time throughout the study if they desired a review of instructions. Participants were given the option of viewing the presentation in our office if preferred (for instance, if they did not have computer access or a DVD player). One participant requested this option.

After completion of the Phase 1, a study investigator examined each voiding diary, calculated the amount of PIBs and non-PIBs consumed, and provided individualized mailed instruction to each participant on the desired PIBs and overall fluid consumption during the next two study phases. Participants were asked to complete diaries on the same 3 days of the week for each phase so that typical habits reflective of specific days would be consistent throughout the study period. We also asked women to record an output volume in the diary for every void, even if they did not void into the container provided. We further instructed them to note that it was an estimate in a column labeled for this, rather than leaving that as missing data (appendix A). Women were reimbursed for each completed phase of the study for a possible total of $70.

Data Analysis

Diary data were reduced such that there was a mean 3-day score for each diary variable at each time period. For example, for the urgency visual analogue scale was assessed each day of the 3-day diary7 but the average of the 3 days was used as the score across that phase. Differences between study phases were evaluated using paired 2-sample t-tests were used for variables with a normal distribution and Wilcoxon Signed-Rank tests for variables that were not normally distributed. We used the Bland and Altman measures of agreement graphical methods to portray variance from protocol to maintain total beverage intake or to reduce intake at the appropriate study intervals.10 Statistical Analysis Software version 9.3 (SAS Institute, Inc., Cary, NC) was used for most of the statistical analysis, and SPSS (IBM, Armonk, New York) was used for other selected data management and analysis procedures. A p-value <0.05 was considered statistically significant.

Results

Eighty-six women were screened and 35 were enrolled into the study. Five were excluded from the final analyses for various screening or protocol violations discovered during the later data analysis procedures. Analysis was based on data from 30 women. Their mean age was 57.5±10.2 years (mean ± SD) and 90.0% identified themselves as Caucasian (). Baseline beverage diary data showed that all met enrollment criteria for PIB consumption (>16oz/day). No woman in this study reported juice as her only potentially irritating beverage.

Table 1

Participant Characteristics

Variable Mean (SD)

Age (years) (n=30) 57.53 (10.24)

Weight (pounds) (n=29) 159.22 (38.21)

Height (inches) (n=30) 64.6 (2.4)

BMI (n=29) 26.8 (6.01)

Variable N (%)

Yearly Income (dollars)
<$20,000 3 (10.34%)
$20,000–40,999 9 (31.03%)
$41,000–60,000 7 (24.14%)
>$60,000 10 (34.48%)

Race
Black/African American 1 (3.33%)
White 27 (90.0%)
Other/did not disclose 2 (6.66%)

Education level
12th grade 3 (10%)
Some college 6 (20%)
College (4 yrs or tech writing) 9 (30%)
Graduate school 12 (40%)

Total number of children
0 8 (27.59%)
1 4 (13.79%)
2 8 (27.59%)
3 4 (13.79%)
4 3 (10.34%)
5 0 (0%)
6 1 (3.45%)
7 1 (3.45%)

Number of normal vaginal deliveries
0 11 (37.93%)
1 4 (13.79%)
2 6 (20.69%)
3 4 (13.79%)
4 3 (10.34%)
5 0 (0%)
6 0 (0%)
7 1 (3.45%)

At baseline, average total daily beverage intake was 74.7±26.1 ounces, with PIBs accounting for 63.3±39.3 ounces (85% of total) (). Despite instructions otherwise, the total fluid volume intake over all diary days of the study was not stable. During Phase 2, when women were instructed to avoid consuming any PIBs, diaries showed wide variability in intake volume. Specifically, the total beverage intake was reduced by a mean of 6.2 ounces, which was significantly lower than Phase 1 (p=0.03) and Phase 3 (p=0.02). During Phase 3, total beverage intake was essentially equal to Phase 1, but again variability was noted between individual diaries. The Bland and Altman scatter plot and accompanying measures of agreement analysis () showed that any individual woman in the study might vary her total beverage intake by 20 ounces or more from phase to phase (nearly 30 ounces from Phase 1 to Phase 2), despite being requested to maintain a steady intake volume.

a and b: Bland and Altman plots showing percent change of potentially irritating beverages compared to baseline. The horizontal line portrays the protocol expectation for each phase). At Phase 2 when all potentially irritating beverages should have been eliminated (−100% on the graph), instead several women showed very little change and some ranged up to nearly 200% above baseline (Fig A). At Phase 3, when potentially irritating beverages by protocol should have been down by half (−50% on the graph) from baseline, again a substantial number of women showed little behavioral change or even up to 200% above baseline in one case (Fig B).

Table 2

Results of symptoms and bladder habits at baseline (Phase 1), on attempt at complete elimination of potentially irritating beverages (Phase 2), and on attempt to reintroduce potentially irritating beverages at ½ of baseline (Phase 3).

Outcomes Phase 1:
Baseline
Phase 2:
All PIBs
eliminated
Phase 3:
Add back ½
PIBs
Phase 1 vs Phase 2 Phase 1 vs Phase
3
Compare
Phase 2 vs Phase
3
n Mean
(SD)
n Mean
(SD)
n Mean
(SD)
Mean
(SD)
p-value Mean
(SD)
p-
value
Mean
(SD)
p-
value
Average total daily intake per 24 hours over 3 days (oz) 30 74.7
(26.1)
30 68.6
(28.7)
30 74.8
(30.3)
−6.16
(14.88)
0.031 +0.08
(10.03)
0.965 +6.24
(13.67)
0.018
Average “Potentially Irritating Beverage” intake per 24 hours over 3 days (oz) 30 63.3
(39.3)
30 38.0
(37.0)
30 52.8
(27.6)
−25.3
(53.4)
0.015 −10.5
(37.1)
0.132 +14.8 0.04
Average number of voids per 24 hours over 3 days 30 10.5
(2.64)
30 9.2
(2.71)
30 9.6
(2.86)
−1.27
(2.05)
0.002 −0.9
(2.29)
0.040 +0.37
(1.54)
0.202
Average total daily voided volume per 24 hours over 3 days (oz) 30 77.72
(22.66)
30 70.99
(27.98)
30 72.07
(24.69)
−6.74
(20.73)
0.086 −5.66
(14.0)
0.035 +1.08
(14.28)
0.681
Average self-reported urge symptoms* reflecting on past 24 hours on each day of 3 days (ranging from 1–5 points with higher scores indicating worse urge) 29 3.21
(0.63)
30 2.80
(0.57)
30 2.91
(0.71)
−0.43
(0.55)
0.000 −0.339
(0.67)
0.011 +0.11
(0.64)
0.377
Self-report ability to delay reflecting on past 3 days (ranging from 0–4 points, with higher scores indicating worse ability to delay) 29 2.91
(0.67)
30 2.25
(0.91)
30 2.37
(0.78)
−0.66
(0.64)
<0.000 −0.53
(0.64)
0.000 +0.12
(0.73)
0.387
Self-report of bother reflecting on past 3 days (ranging from 8 –48 points, with higher scores indicating more bother) 29 29.77
(15.49)
30 18.95
(13.4)
30 22.05
(14.78)
−10.46
(14.82)
0.001 −7.65
(12.14)
0.002 +3.09
(8.03)
0.044

Although women were instructed to entirely eliminate PIBs during Phase 2, PIB intake was still on average 38.0 ounces per day, which was a reduction of 25.3 ounces per day from baseline (). Eight participants reported increasing their intake, one participant did not change her intake volume, five complied with 100% elimination of PIBs, and the remaining 17 women decreased PIB intake to varying degrees (). There was no relationship between reducing PIBs during Phase 2 and original PIB intake volume, as shown in a plot of individual data in .

Participants were individually instructed on how to add back 50% of their personal baseline PIBs intake during Phase 3. Nevertheless, they experienced difficulty achieving this goal, and 11 women (37%) did not reduce the amount of PIBs from baseline at all. Overall, women reported a mean 15% reduction in PIB consumption rather than the requested 50% (, ).

Despite incomplete adherence to the protocol, the greatest reduction in LUTS was achieved during Phase 2, when PIB consumption was lowest (). When compared to their baseline (Phase 1) self-reported urinary urgency (p=0.0003), ability to delay voiding (p<0.0001) and bother scores (p=0.0007) improved significantly during Phase 2. In addition, the mean daily voided volume was reduced by 6.7±20.8 ounces; this change was consistent with a decrease in total beverage intake. Nevertheless, this difference was not statistically significant compared to baseline, (p=0.09). The number of voids per day in Phase 2 was significantly reduced compared to Phase 1 (10.5 voids vs. 9.2 voids, p=0.002), but it was not different from Phase 3.

When participants were asked to add back some PIBs during Phase 3, there was still a significant reduction in LUTS compared to baseline (). During this phase, total beverage intake volume was similar to baseline (p=0.1), while the improvements in bladder function demonstrated at Phase 2 were maintained. The number of voids/day continued to be significantly lower than baseline (10.5 voids compared to 9.6 voids; p=0.04). Total voided volume was also significantly reduced by 5.6 ounces (p=0.04) relative to baseline. Symptom scores for urgency, ability to delay voiding and degree of bother were all significantly improved compared to baseline ().

Comparing Phases 2 and 3, women consumed more total beverages and more PIBs in Phase 3 than Phase 2. Voided volume and number of voids per day were similar in the two phases (). Bother scores did show a significant worsening from Phase 2 to Phase 3 (p=0.04), although both phases were improved compared to baseline.

Discussion

This feasibility study evaluated the effects on LUTS of two different intake volumes of PIBs, none or half of baseline consumption, while holding total beverage intake constant by swapping in primarily plain water. While we noted LUTS improvement with PIB reduction, truly eliminating PIBs proved difficult for a majority of study participants. As a result, we cannot yet conclude if the improvement we noted was from fewer PIBs, reduced total intake of beverages, the effect of self-monitoring bladder habits, or some combination of these.

Complete elimination of PIBs was not achieved by many women in this study. We therefore recommend that clinicians carefully consider the difficulty of achieving and adhering to PIB elimination as a treatment strategy. We did not specifically analyze reasons for lack of adherence to PIB and overall fluid intake, so we can only speculate about the numerous possible reasons women were unable to eliminate PIBs. Many PIBs are habit-forming11, 12, and many social events are tied to PIB intake. As a result, persons may find it difficult to avoid consuming a cup of coffee at a meeting or an alcoholic beverage as when participating in an after-work social gathering. Based on these considerations, we believe that partial elimination of PIBs may be a more feasible goal. Women still improved in our study when average PIBs intake was reduced to almost half of their initial intake, making this still a reasonable treatment option. The cultural, societal, familial, biological and other influence on PIB intake are an important future area of future investigation.

We observed wide variability in daily fluid intake across the study phases, despite instructions to try to maintain the same cumulative volume of beverage intake. Multiple reasons may account for this variability, including physical activity levels, weather conditions, and their effects on thirst.

While women’s LUTS improved based on group averages at both study phases, variability in the concentration of certain ingredients or in total amount of irritating substances in these beverages renders it impossible to draw conclusions about the relationship of LUTS to each specific substances or the cumulative amount consumed. All we can determine from this 3-phase study design is that following instruction to reduce total amount of PIBs while swapping in non-PIB alternatives, while recording intake, output and LUTS women achieved reductions in LUTS. [0]Our findings were confounded by inconsistent protocol compliance across the women and wide variability in concentration or total amount of potentially irritating substances in these commonly consumed beverages.

While the effect of various PIBs on LUTS is clinically relevant, we cannot draw conclusions based on specific ingredients of each PIB. For example, we did not assess the type and strength of coffees consumed. Similarly, findings from this study cannot differentiate which of the multiple ingredients in a diet cola that may act as a bladder irritant, considering it is carbonated, caffeinated, artificially sweetened, and acidic. We hope to study this interesting question in future work.

There are pros and cons to the various study designs and protocols available. A laboratory study that rigorously controls participants’ intake would offer more precise determination of ingredients and control for overall intake volume. However, since LUTS are driven by the social environment, evaluation of these environmentally triggered symptoms (e.g. urgency on arrival home) poses a validity issue. A community-based study that limits ingredients by providing pre-packaged standardized amounts of an ingredient of interest is a feasible and likely worthwhile design, but does not reflect the reality of our complex beverage-choice environment and is unlikely to provide real-world clinical treatment guidance. A randomized controlled trial asking participants in the intervention group to eliminate all PIBs is a logical next step and has the advantage of a control group who is equally exposed to the simple learnings that can occur from self-monitoring, such as awareness of how much one is actually drinking. However, since we do not yet fully understand the reasons for lack of compliance to PIB reduction, it seems logical to initiate investigation with real-life, qualitative work to learn more about this phenomenon. Clearly, the data from our study show that reliance on simple instruction to “eliminate coffee, tea, alcohol, and carbonated beverages” is not adequate motivation for women to do so. This area is also worthy of further investigation.

A relationship between PIBs such as the ones measured in our study and LUTS has been demonstrated in prior studies, but many of these studies have focused only on caffeine. In one study, mean dietary caffeine intake of women with detrusor overactivity on cystometry was significantly higher than that of women without detrusor overactivity.13 Total beverage intake and bladder capacity were not reported. Other studies link a decrease in caffeine consumption to reduction in LUTS. A recent pilot study of 11 women demonstrated a reduction in urgency and frequency, quality of life and bladder symptoms in general while drinking decaffeinated drinks compared to when they drank caffeinated beverages14. In a study by Bryant and colleagues, 26 adult participants who routinely consumed at least 100 mg of caffeine per day were randomly assigned to an intervention or control group.15 All participants received education about bladder training, but participants in the control group continued caffeine intake, while the intervention group received additional education on caffeine reduction. The intervention group achieved a significant reduction in daily episodes of leakage. It is unclear if other beverages were substituted for caffeine, so symptom reduction could have resulted from a decrease in total volume intake.

The biochemical mechanism of how caffeine contributes to LUTS is unclear, but does not appear to be the same in all women. This was supported by a study in which a standardized drink of caffeine was associated with a rise in bladder pressure only in a group of women with detrusor overactivity compared to asymptomatic women.16 It can be hypothesized that caffeine is perhaps metabolized differently in symptomatic women, or that some other factor predisposes symptomatic women to bladder symptoms when exposed to caffeine. Nevertheless, our knowledge of these mechanisms are not entirely understood, as another study showed. In that cohort, decreasing overall beverage intake significantly improved LUTS, but decreasing caffeine intake did not result in significant improvement when replacing caffeinated beverages with non-caffeinated drinks.17

The question of different PIBs affecting LUTS differently is a fascinating one that additionally merits further work. If different PIBs have different effects on symptoms, this would be welcome and germane information to patients. This is suggested in a recent study that showed that women who increased consumption of coffee or soda, especially diet soda, experienced an increase in LUTS.18

We also included as PIBs those containing alcohol and artificial sweeteners. Data concerning sugar substitutes in humans are limited, but laboratory studies have shown that ascorbic acid and citric acid augment bladder muscle contraction via a hypothesized enhanced calcium ion influx.19 Three artificial sweeteners, acesulfame K, aspartame, and sodium saccharin have been evaluated using isolated animal detrusor specimens and found to stimulate the contractile response of bladder muscle and significantly enhance contractions.

The strengths of our study, which is one of the only of its kind studying this important clinical recommendation, include enrolling community-dwelling women who may be amenable to modification of PIBs versus treatment with drugs or other interventions with a higher likelihood of side effects. We used diaries to minimize recall bias, and we had good compliance with diary recording throughout the 3 phases of the study. We believe this was partially due to the provided detailed instruction and “tips and tricks” on easing the burden of the diary recording in the standardized educational slideshow. Diary recording is a burden for patients, and hence we abided by recommendations of only three days at a time, followed by four days of non-recording.20 While this likely did ease the burden on study participants, it raises other interesting potential implications as the “wash-out period” most likely included increased PIB intake compared to the study phases, likely skewing results of the first diary day of each study period. This supported using an average value of the three study periods for our data interpretations. The trade-off of preventing recording fatigue was important to preserve subject completion of the study.

Limitations

Our three phase study design limited our ability to make causal inferences. Whether a DVD-based slide show delivery of information is the best method of study instruction is unknown, as are the many social factors discussed above regarding societal encouragement of PIB consumption. While our diary permitted the collection of a large amount of discrete data, the intensive self-monitoring that occurs with use of intake-output diaries acted as intervention. Translating this into clinical practice is always complex, and we tried to mitigate the artificial environment of a study versus real-world clinical care by keeping the study period short, providing tips on PIBs substitution and allowing subjects the washout period. All of these factors, however, are also limitations. We do not know from this study whether the length of the intervention influenced the outcomes, nor in what direction. We also do not know how the washout period influenced the outcomes. It is one thing to commit to a 3-day period of limiting PIBs, but quite another to do so for the duration.

We recommend that future studies better document specific PIBs and sweetener intake to improve counseling about specific PIBs. Compliance on counselling women about giving up sweeteners versus caffeine, for example, may increase if women are allowed to keep one or the other. Additionally, PIBs are not only found in beverages. We did not measure the presence of sweeteners in food, such as yogurt. We did not collect data on reasons why so many of our participants were unable to eliminate PIBs, and recommend future investigation into the barriers of changing this intake pattern in future studies.

Additionally, given the primarily Caucasian and well-educated demographics of our sample, our current results cannot be generalized to the broader public. Future studies will ideally include a wide range of demographic backgrounds.

Conclusions

Findings from this study supports instructing women to reduce PIBs to improve LUTS. Nevertheless, the reasons why reduction in PIB intake alleviates LUTS remain unclear. LUTS improvement observed in this study may result from changing the type of beverages consumed, changing overall volume of beverages consumed, or some combination of these factors. We believe that findings from this feasibility study set the stage for additional research. In addition, we believe that the data collection tool used in this study offers a level of precision previously not available to clinicians or researchers interested in the relationship between PIB consumption and LUTS.

Acknowledgments

Funding sources:

This project was funded by The Michigan Center for Health Intervention, University of Michigan School of Nursing, National Institutes of Health, National Institute of Nursing Research (P30 NR009000-01). Additional investigator support was provided through the Office for Research on Women’s Health (ORWH) Specialized Center of Research (SCOR) on Sex and Gender Factors Affecting Women’s Health and National Institute on Child and Human Development (NICHD) (Grant #P50 HD044406)).

Appendix 1

Three-day diary (last page shown)


Time Arise: _______________ Trial: 1 2 3

Time to Bed: _______________ Today I should: Maintain usual habits Drink no “irritating” beverages Drink____oz. of “irritating” beverages

Beverage Intake Urine Output
Beverage
Type
Caffeinated Artificially
Sweetened
Beverage
Amount
(ounces)
Volume of Urine Output Episodes
of
Leakage
Yes
No
Yes
No
Urine
Amount
(oz)
Measured
Close
estimate
Wild
Guess
✓✓✓
Morning (6am-noon)
Afternoon (noon-6pm)
Evening (6pm-midnight)
Night (midnight-6am)

Appendix 2

Over the past 3 days, when you urinated, what was your usual perception of your bladder fullness? (Adapted with permission from De Wachter & Wyndaele)8

0 No bladder sensation
1 Urinating could easily be delayed for more than 30–60 minutes
2 Urinating could only be delayed for 30 minutes
3 Urinating could only be delayed for 5 minutes
4 Immediate urinating was mandatory and/or fear of leakage

Footnotes

Conflict of Interest: None of the authors have a conflict of interest.

References

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5 Things to Avoid When You Have a UTI

Urinary tract infections (UTIs) must be treated promptly by your doctor. Left untreated, a UTI can be painful and may spread. There are several things you should avoid while you have a UTI in order to prevent worsening of symptoms.

Urinary tract infection (UTI) is one of the most common infections affecting older adults, especially women. If you have a UTI without complications, and you are otherwise in good health, your doctor might prescribe a shorter urinary tract infection treatment, such as a 3-day course of antibiotics. However, treatment type and length will depend on your medical profile and specific symptoms. Additionally, your physician may prescribe pain medication that relieves burning during urination, but pain is usually relieved shortly after beginning the antibiotic treatment. Below is some information to help you know what to do if you have a UTI infection in order to prevent exacerbating your UTI symptoms.

The following things can further irritate your bladder and increase the frequency of sensing an urgent need to urinate. Until your UTI has cleared up, you should:

1. Avoid Foods and Beverages that Can Worsen UTI Symptoms

Avoid consuming foods and beverages that can irritate your bladder or worsen your symptoms, such as:

  • Caffeinated coffee
  • Caffeinated sodas
  • Alcohol
  • Spicy foods
  • Acidic fruits
  • Artificial sweeteners

2. Avoid Delay in Going to the Doctor When you Have a UTI

At the first sign of symptoms of a UTI, call your doctor. Attempting to treat a UTI yourself just allows the infection additional time to spread. Putting off getting medical attention for a UTI puts you at risk of serious health complications. Over-the-counter medications can mask pain, but do not kill the bacteria; antibiotics are necessary to eliminate a UTI infection.

3. Avoid Thinking You Can Quit the Prescribed Antibiotics Early

The particular antibiotic prescribed for your type of infection must be in your system for the full length of the period prescribed by your doctor in order to entirely eliminate the threat. Although you will probably start to feel better after just one or two days from the start of the antibiotic treatment, that does not indicate that the antibiotics have completely eliminated the infection.

Avoid Insufficient Water Intake

Depleting your body of water leads to dehydration. When the body is dehydrated, bacteria can grow in the bladder. Additionally, not drinking sufficient amounts of water can keep your medication from penetrating into your kidneys and bladder. Drinking abundant amounts of water flushes the kidneys and bladder, helps deliver the antibiotic to the urinary tract, prevents dehydration, and, additionally, reduces risk of developing kidney stones.

Avoid Delays in Urinating

Do not allow yourself to hold your urine because you think you are too busy to urinate. When you sense the urge to urinate and hold in the urine instead, you can put yourself at risk for major urinary tract issues. Retaining the urine also allows germs that are floating in your bladder to remain there. Emptying the bladder promptly flushes out bacteria.

For more information about UTI symptoms and treatments, or to make an appointment to see an OB/GYN in Little Rock AR, contact us by calling the Woman’s Clinic at (501) 664-4131.

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 A yu lov mi, I ask again and again and,
There is cold coffee on the table.
You're like morphine to me, you're just a profile
And this is love, do not care.

And yu catch mi, I ask again and again and,
There is cold coffee on the table.
You're like morphine to me, you're just a profile
And this is love, do not care.

And yu catch mi, I ask again and again and,
There is cold coffee on the table.
You're like morphine to me, you're just a profile
And this is love, do not care.

Your nails are sometimes square, sometimes sharper,
In bed you love but slowly, then quickly.I love to call and hear an unusual "hello",
I love it, and so does the color of your hair.
In a pink scarf, dark purple leggings,
You eat traffic on the Internet and go shopping.
She took my netbook again, even if I asked
You asked, I said yes, you said thank you.
I don’t remember Che, okay, wait, kitty, a fan is calling me.
I have fun with you, too,
You smoke again, oh, you're only thin with [bad word]
Well I'm sorry, then bring me a drink from the kitchen
And then I'll spank on the pope, and come on there, don't be stupid.Come on, wow, wow, my joy,
Although, if you take the truth with you, sometimes it is necessary.

And yu catch mi, I ask again and again and,
There is cold coffee on the table.
You're like morphine to me, you're just a profile
And this is love, do not care.

And yu catch mi, I ask again and again and,
There is cold coffee on the table.
You're like morphine to me, you're just a profile
And this is love, do not care.

You can dine with a light salad
And find romance in the lousy scenario.
Do you like tulips from this tipan,
Who writes about you now, but you do not know about his plans.What's next? At least, maximum sex
You can ask the tubes from the battle of psychics.
They are all kind of fierce and everything seems to be in fluff,
I'm so shocked for this nonsense.
You are always a lot, but you are always not enough,
Probably, to my misfortune, I always pamper you.
When you see me, you jump to the ceiling
I love it when you wear a skirt and stockings.
If I have tequila, then you - wine chocolate,
And if they give me whiskey and cola, they give you Long Island by pull.
It makes us happy, just as it made us happy
It means that everything is as it should be, it means that everything is as it should have been.And yu catch mi, I ask again and again and,
There is cold coffee on the table.
You're like morphine to me, you're just a profile
And this is love, do not care.

And yu catch mi, I ask again and again and,
There is cold coffee on the table.
You're like morphine to me, you're just a profile
And this is love, do not care.

And yu catch mi, I ask again and again and,
There is cold coffee on the table.
You're like morphine to me, you're just a profile
And this is love, do not care. 

Franke Coffee Systems in St. Petersburg

A representative office of the Franco company was opened in St. Petersburg.The company is the official distributor of Franke Coffee Systems, supplying Franke and Bremer super-automatic coffee machines to the Russian market.

On September 18, at the Pribaltiyskaya Park Inn hotel, Korablestroiteley, house 14, in the Kronstadt hall, a presentation was held on the opening of the St. Petersburg branch of the Franco company.

The company “Franco” is the official distributor of the Swiss company Franke – one of the world’s largest manufacturers of super-automatic coffee machines.

At the beginning of the presentation, a brief excursion into the history of the creation and work of the Franke manufacturing company was made. In particular, it was mentioned that since 1972 Franke began to closely cooperate with such giants as McDonald’s and delivered equipment to a new restaurant in Munich. And at the moment, the experience of production and the use of the latest technologies of the Swiss concern Franke, which has about 70 companies in 40 countries of the world, allow us to constantly increase the number of its customers.Among them are such as McDonald’s, IKEA, BurgerKing, Yam Group, Sheraton, La Meridian.

General Director Anna Ambarova, President of VENDOR (Franke’s distributor in the Scandinavian countries and the Baltic states) Eric Viljanen and Director of the new St. Petersburg office Svetlana Lyashedko took the floor at the presentation. Svetlana said that now in the new office, located on Kartashikhina street, building 6, lit. And, there is an opportunity to get acquainted with the coffee machines in detail.A showroom is specially equipped for this.

In addition to the announcement of the start of the official dealership, three models of coffee machines were presented at the presentation: these are Franke Flair, Evolution Basic and the new Franke Spectra model. The latest high-tech, fully automatic coffee machine, a new addition to the Franke range of equipment. The design of this machine has been awarded the IF Design Award. The list of options for choosing the configuration of this super-automatic coffee machine includes: colored light frame of the control panel (3 RGB colors), the choice of the display type (Basic, Touch, Vetro) and the choice of the color of the coffee machine body (silver, anthracite, champagne).It is important to provide a selection of brewing units, which are made according to the patented technologies ENB © (espresso, needle filter or high-output brewing system):

ENB © 43 E Espresso brewing system – the solution for classic espresso and milk and coffee-based beverage options;

Espresso ENB © 50 – potential for high performance;

ENB® 50 N needle filter brewing system – espresso coffee under pressure and classic filter coffee without pressure – in the same machine;

ENB © 50 B brewing system for greater productivity, which is capable of brewing large quantities of coffee (Spectra X only).

Additional modules were presented: cup warmer and milk cooler.

LLC “Franco”, following the high traditions of quality of the Swiss manufacturer, relying on their proven technical support system, provides a full range of services for the supply of coffee equipment, installation, warranty service and subsequent service.

New office in St. Petersburg: Kartashikhina street, building 6, letter A.

Wax Museum “At Baba Ooty”, St.Odessa

Rating: +39 / 9 participants / 5 recommendations / (+0) (-0) quality

Odessa Wax Museum was founded by the famous businessman Alexander Pavlovsky in 1998. In the period from 2008 to 2009, the museum underwent a large-scale reconstruction, and it again opened its doors to its guests, but in a new format – now it is not just a museum, but a museum-cafe – “At Baba Uti’s”.

The new name of the museum was chosen for a long time, finally settling on “Baba Uta”.The lady mentioned was the legendary woman who was the first to open a catering center in Odessa, located in the premises now occupied by the museum. Her famous cafe was visited by such famous personalities as Mikhail Zhvanetsky, Roman Kartsev and others. According to various rumors, during perestroika she moved to Batumi, and her further fate is unknown.

All the characters that can be seen in the museum are made of wax. Thanks to its unique consistency, you can look at celebrities and historical figures who have long gone from this world.

Today, five halls of the museum showcase cartoon characters and films for children – Batman, Shrek, Harry Potter, famous historical figures such as Empress Catherine the Great, Odessa mayors Joseph de Ribas, Duke de Richelieu, great writers Alexander Pushkin and Nikolai Gogol , heroes of famous films D’Artagnan and the Three Musketeers, Gleb Zheglov, Ostap Bender and many others.

In a separate room there is a thematic exposition dedicated to Deribasovskaya street.It consists of models of all buildings of the main and most famous street in the city.

In the cafe you can drink not only tea or coffee, but also taste unique chocolate figurines of famous cartoon characters and a variety of desserts.

A visit to the Odessa Museum of Wax Figures “At Baba Uti” will be interesting for all age generations and everyone will have a unique opportunity to get acquainted with the most famous personalities of the past and present.

Address: st.Rishelievskaya, 4
tel .: +38 (048) 722 34 36
Working hours: from 9:00 to 21:00
Day off – no

Museum website source

Russian translation, synonyms, antonyms, pronunciation, example sentences, transcription, meaning, phrases

The proprietor came over with another cup of coffee. The owner came up and put a cup of coffee in front of John Grady.
Then could you get me another cup of coffee? Could you get me another cup of coffee?
Resigning himself to which condition with a perfectly satisfied manner, Phil begs the favor of another cup of coffee. Nevertheless, Phil resigns himself to his bitter fate and, quite pleased, asks for permission to pour himself another cup of coffee.
‘Would you like another cup of coffee, ma petite?’ Would you like another cup of coffee, ma petite?
Other results
Tennyson put another log on the fire and walked back to the couch, sitting down beside Ecuyer and hoisting his bare feet up on the coffee table. He sat down next to Ekayer, put his bare feet on the coffee table.
We will sit here and enjoy another coffee in peace and quiet. We will sit here and enjoy our coffee in peace and quiet.
Mitch sipped his coffee and searched for another question. Mitchell sipped his coffee and wondered what else to ask.
Or you could just have another pint of coffee and we’ll wait for the bodies to float down the canal. Or you can just have another pint of coffee, And wait for the corpses to float down the canal.
Another one had poured the coffee from that same silver coffee pot, had placed the cup to her lips, had bent down to the dog, even as I was doing. Someone else was pouring coffee from this silver coffee pot, bringing the cup to his mouth, bending over to the dog, as I do now.
Another time he showed us how to make coffee-according to the Arabian method. Another time McShaughnessy showed us how to prepare coffee in Arabic.
Good, I said and went back to the house and drank another bowl of coffee at the mess table. Great, – I said, went back into the house and had another cup of coffee in the officers’ mess.
I don’t want another splashy-splashy coffee from the teeny-tiny coffee man. I don’t need another splash-splash from the barista of the uchi-way.
Probably just brewing another pot of coffee. Probably brewing coffee again.
Or you could just have another pint of coffee and we’ll wait for the bodies to float down the canal. Or you can just have another pint of coffee, And wait for the corpses to float down the canal.
Now I recollect, said the afflicted old father; my poor boy told me yesterday he had got a small case of coffee, and another of tobacco for me! Oh! Now I remember, – whispered the unfortunate father, clinging to the last hope.“He told me yesterday that he brought me a box of coffee and a box of tobacco.
In that case our friend, the image-breaker, has begun operations in another quarter of London. There’s coffee on the table, Watson, and I have a cab at the door. If I’m not mistaken, it follows that our friend, a maniac, moved his activities to another part of London … Coffee on the table, Watson, and a cab at the door.
‘Mr de Winter is having coffee with us, go and ask the waiter for another cup,’ she said, her tone just casual enough to warn him of my footing. Mister de Winter will have coffee with us, go get the waiter to bring another cup, ”she said casually so that he could guess my humble situation.
I’ll go put on another pot of coffee. I’ll get some more coffee.
Could you send up another pot of coffee, please? Could you replace the coffee pot please?
There was tea, in a great silver urn, and coffee too, and on the heater, piping hot, dishes of scrambled eggs, of bacon, and another of fish. There was a large silver electric samovar and a coffee pot, dishes of scrambled eggs, ham and fish on an electric stove.
She put a carrot in one, an egg in another, and ground coffee beans in the last one. She put carrots in one, an egg in the second, and ground coffee beans in a third.
Come and let’s have another drop of coffee. Let’s go have another sip of coffee.
Soon after five p.m. we had another meal, consisting of a small mug of coffee, and half-a-slice of brown bread. After five hours we were fed again – each got a small mug of coffee and a slice of gray bread.
You wanna have another coffee? Maybe another cup of coffee?
I wan ‘another cuppa coffee. I want another cup of coffee.
Yeah. I, uh, just really wanted to thank you for yesterday and, um, save you from another evil vending-machine coffee. Yeah, I just wanted to thank you for yesterday, and uh, save you from the evil coffee machine.
Mycena citricolor is another threat to coffee plants, primarily in Latin America. Mycena citricolor is another threat to coffee plants, primarily in Latin America.
Another issue concerning coffee is its use of water. Another question regarding coffee is its water use.
Although coffee is another important cash crop of this woreda, less than 20 square kilometers are planted with this crop. Although coffee is another important cash crop of this pest, less than 20 square kilometers are planted with this crop.
Next, the beans are transferred to another container and immersed in coffee oils that were obtained from spent coffee grounds and left to soak. Next, the beans are transferred to another container and immersed in coffee oils, which were obtained from the used coffee grounds and left to soak.
Another legend attributes the discovery of coffee to a Sheikh Omar. Another legend attributes the discovery of coffee to Sheikh Omar.
The Coffee Tree restaurant across the I-80 freeway, another part of the original Nut Tree holdings, was demolished in late 2005. Coffee Tree Restaurant opposite I-80, another part of the original Walnut Tree complex, was demolished at the end of 2005.
Another option is to use an automatic espresso or drip coffee maker which grinds the coffee beans and dispenses the coffee into a cup. Another option is to use an automatic espresso or drip coffee maker that grinds the coffee beans and pours the coffee into the cup.
Over coffee, the deCODE team confirmed that the Finnish variant did not exist in Iceland, but that another did. Over a cup of coffee, the decoder team confirmed that the Finnish version does not exist in Iceland, but there is another option.
Coffee is another popular beverage, but more popular in South India. Coffee is another popular beverage, but more popular in South India.
In another study of popular brands of decaf coffees, the caffeine content varied from 3 mg to 32 mg. In another study of popular brands of decaffeinated coffee, the caffeine content ranged from 3 mg to 32 mg.

27 Saint Anna, an open festival of student and debut films, summed up the results

On October 16, in the White Hall of the Central House of Cinematographers, the St. Anna festival turned the last page of its calendar.His every day was full of views, meetings, discussions, a meaningful educational program. The screenings were held at various venues in Moscow and have always enjoyed constant interest, since the thoughts, feelings, and creative experiments of the young generation entering the territory of cinema today were read in the festival films.

This year was special, and the organizers faced special difficulties, which they successfully coped with, bringing the festival to the final chord, this is the program director of the festival Viktor Prokofiev, the director of the festival is Elena Tsukanova and their wonderful young team.

The final evening was opened by the closing film “P.S. Uchi-Uchi-Uti “, created by the master, a wonderful director Sergei Solovyov, together with his today’s students. He himself called it in his video greeting “a cinematic sketch”, but in it, too, he managed to hide the depth of meaning behind the external simplicity. The lake, on the shore of which the events take place, refers us to the water element, which has always been the basis of human life. Here are modern mermaids, performed by Stasya Venkova and Nastya Teplinskaya, and, either a fisherman sitting on the shore, Sergei Soloviev himself, or a waterman who wrapped himself in him, controlling everything that happens around.Perhaps this is a sketch for a future masterpiece.

Having moved from the screen to the stage, Stasya Venkova held the closing ceremony, where prizes and awards were presented to the laureates and winners of the festival.

Based on the results of the views and discussion of the jury consisting of: Sergey Mokritsky (Chairman), Sergey Zemlyanukhin, Elena Laskari, Egor Moskvitin, Anna Slyu, Alexey Fedorov, Leonid Shmelkov and Elena Yatsura, the winners were distributed in the following nominations:

BEST FEATURE FILM

– 1st prize
“RIO”.Director Zhenya Kazankina
VGIK, workshop of V.I. Khotinenko

– II Prize
“CONQUERING DREAMS”. Director Pavel Palekhin
VGIK, workshop of V.S. Kalinin, V.I. Romanov

– III Prize
“IZ KHOVRINO”. Director Daria Elena Dashunina
Nerpa-Film Studio

BEST DOCUMENTARY FILM

– I Prize
“ADVANCED AGE”. Directed by Elena Kondratyeva
MShK, workshop of A.P. Popogrebsky

– II Prize
“Troubled Nasty”.Director Sofya Meledina
VGIK, workshop of A.E. Teacher

– III Prize
“AGAINST THE CURRENT”. Director Grigory Kurdyaev
Studio “Classic-Film”

BEST ANIMATION FILM
DRILL, ROPE AND ACORN. Director Alina Titorenko
“Animation workshop”, workshop of V.S. Chirkova

BEST OPERATOR’S WORK
For cameraman Anastasia Chernova (VGIK, workshop of I. Klebanov)
For the film “Escape”

BEST SCENARIO
Script writer Dmitry Grigoriev (VGIK, workshop of V.I. Khotinenko)
For the film “EKOLAV”. Director Dmitry Grigoriev

BEST ACTOR ENSEMBLE
For director Anna Fradkina For the film “HAPPY HOURS”

BEST SOUND SOLUTION (with the support of Cinelab)
SNOWROCHKA. Director Asaad Abbud (VGIK, workshop of N.V. Skuibin, A.V. Malkin)

Sound engineers Marina Shamaeva, Stas Ignatiev

CINEMA CONCERN “MOSFILM”
“For the courage of working with the master and a daring result” to Stasa Venkova, scriptwriter and actress of the film “P.S. Ooty-uti-uti “, director S. A. Soloviev

Special prizes and diplomas

Prize of the Chairman of the Organizing Committee of the festival “Saint Anna” NS Mikhalkova: “For the support, trust and strengthening of the talents of young filmmakers” to actress Veronika Timofeeva for her work in “WINDOW” and “MY MOTHER (NOT) THE BEST)”

“HAS BEEN COFFEE”. Directed by Yana Sariadi. “For the brevity of the narrative”

“CLUB KNITTING FOR MEN OVER 40”. Directed by Yegor Gavrilin. “For the thin thread of narration”

“ORTINO UROCHISHCHE”.Director Anton Ermolin “For artistic documentary”

“MY FRIEND IS A BOILO.” Director Sofya Fedorova “For the male ensemble”

“RIO”. Operator Luda Kuropyatnikova. “With faith in future success”

WHITE ON BLACK. Directed by Anton Mamykin. “For adherence to tradition”

“ULYANA”. Directed by Evgeny Sangadzhiev. “For genuine romanticism”

“ANNA. CATS-MOUSE “. Directed by Varya Yakovleva. “For a talentedly invented portrait, eroticism and taming”

To the actress VERONIKA TIMOFEEVA “For acting” in the films “WINDOW” and “MY MOTHER (NOT) THE BEST)”

The members of the jury, summing up the final line of the festival, wished the young filmmakers good luck and new creative searches and good luck.

We are grateful to the students of GITR for the provided photos!

Photo: Denis Filippenkov

Comment on the news of the Union of Cinematographers in social networks: VKONTAKTE, Instagram and Facebook!

Bar Ooty-Booty Protein Colombian Cola – calories, useful properties, benefits and harms, description

Calories, kcal:

278

Carbohydrates, g:

6.3

Columbia Cola protein bar is a novelty from TM Ooty-Booty. The bar, as the name implies, has a bright cola taste, characteristic sourness. If you are on a diet and strive to give up sweets and carbonated drinks, the Ooty-Booty bar will come in handy. It has few calories and no sugar at all. A great option for a complete protein snack without excess fats and carbohydrates. The consistency of the bar is very plastic, inside there are jelly pieces with cola flavor.

Ooty-Booty Protein Bar Calories Columbia Cola

The calorie content of Ooty-Booty Columbia Cola Protein Bar is 278 kcal per 100 grams of product. One bar contains 167 kcal.

Ooty-Booty Bar Composition Colombian Cola

Ooty-Booty Columbia Cola Protein Bar contains the following ingredients: protein blend (whey protein concentrate, milk protein concentrate, whey protein hydrolyzate), soluble corn fiber (fiber, prebiotic), isomaltooligosaccharide (humectant, fiber), purified water, coconut butter (vegetable), alkalized cocoa powder, jelly pieces identical to taste (no added sugar), water-retaining agent (sorbitol), insoluble wheat fiber, sweetener (erythritol), flavor.

Benefits and Harms of Ooty-Booty Bar Colombian Cola

Ooty-Booty Columbia Cola Protein Bar is designed for sports and diet nutrition. It will also appeal to vegetarians who find it difficult to get the right amount of protein throughout the day. Looking at the composition of the bar, we can safely say that if the daily protein intake is observed, it will not bring harm.

Museum of wax figures “At Baba Ooty” in Odessa on Rishelievskaya ⚓️

Tsarsky will introduce you to historical figures who have become significant in the life of Odessa.These are Catherine the Great, and the Comte de Richelieu, and Emelyan Pugachev. An excellent opportunity to get acquainted with the history of the city if the format of long excursions is not for you.

Children’s will delight our little guests with wonderful copies of their favorite cartoon characters. It features wax figures of Pirates of the Caribbean, Shrek heroes, super heroes and many more. We guarantee that this room will not leave indifferent both kids and adults.

Hollywood will be especially interesting for cinema fans.Here you will meet copies of such famous Hollywood stars as Johnny Depp, Arnold Schwarzenegger, Angelina Jolie and other Hollywood stars.

At Hall of Musketeers you will be greeted in person by the figures of Artos, Partos, Aramis and D’Artanyan.

At the exhibition you will meet other equally interesting and impressive figures. Besides the fact that they look exactly like the real ones, the figures convey the mood of the era or movie from which they came.

Also in the museum there is a cafe “At Baba Uti”, where you can find out the answer to the name of the museum. Baba Utya is a legendary character. She was the first to open public catering in Odessa and met the most interesting and outstanding guests. And you have the opportunity to have a cup of coffee and taste desserts together with the first famous guests of Baba Uti – Grigory Kotovsky, Anna Akhmatova and Leonid Utesov.

And also, you can walk along a small copy of the famous Deribasovskaya street and enjoy the paintings in the gallery.

Visiting the museum is a great opportunity for residents of Odessa and guests to learn the history of the city, get acquainted with the historical figures of Odessa, enjoy incredibly beautiful and realistic characters. And just have a good time 🙂

As a souvenir, you can take unique photographs with the hero of the famous film “Avatar” or Empress Catherine – photographing in the museum is allowed.

Guided tours

.