Evidence of the Impact of Diet, Fluid Intake, Caffeine, Alcohol and Tobacco on Lower Urinary Tract Symptoms: A Systematic Review

Abstract

Purpose Foods, fluid intake, caffeine, alcohol, and tobacco may influence lower urinary tract symptoms (LUTS). Changes in these potentially modifiable non-urologic factors (NUF) are often suggested to improve LUTS. To better understand the relationship of NUFs with LUTS, we performed a systematic literature review to examine, grade, and summarize reported associations between LUTS and diet, fluid intake, caffeine, tobacco and alcohol use. Materials and Methods We performed PubMed searches for eligible articles providing evidence on associations between one or more NUF and LUTS. A modified Oxford system was used to grade the evidence. Results We reviewed 110 articles covering diet (n=28), fluid intake (n=21), caffeine (n=20), alcohol (n=26) and tobacco use (n=44). The evidence grade was generally low (6% level 1, 24% level 2, 11% level 3; 59% level 4). Fluid intake was associated with urinary frequency and urgency in men and women. Modest alcohol use was associated with less likelihood of benign prostatic hyperplasia (BPH) diagnosis and fewer LUTS in men. LUTS associations with food, caffeine, and tobacco were inconsistent. Conclusions Evidence for associations between LUTS and diet, fluid intake, caffeine, alcohol and tobacco use is sparse and mostly observational. However, there is evidence of associations between increased fluid intake and urinary frequency/urgency, and between modest alcohol intake and decreased BPH diagnosis and LUTS. Given the importance of these NUF to daily life, and their perceived impact on LUTS, higher quality evidence is needed.

What do we really know about the role of caffeine on urinary tract symptoms? A scoping review on caffeine consumption and lower urinary tract symptoms in adults

“…They found no association with UI incidence, 10,11 or "unclear", "limited", "conflicting" or "mixed" results for various LUTS. 12,13 Yet, one review including studies on both human and animal models concluded that high caffeine doses may have a possible role in two LUTS, namely urinary frequency and urgency episodes-the latter being in line with our conclusions. 13 Caffeine is generally considered a mild diuretic, 55 with an increased water excreting action, especially for doses above 250 mg. 56 Consequently, while the diuretic effect is less certain for daily consumers due to habituation, caffeine intake could generally accelerate urine production.…”

Efficacy and Side Effects of Drugs Commonly Used for the Treatment of Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia

“…Interestingly, recent a meta-analysis found that the periodontal disease may be positively associated with an increased risk of BPH (Wu et al, 2019). In addition, research has shown that the long-term excessive consumption of alcohol, diuretics, dicyclomine, and caffeine may also contribute to LUTS, although moderate levels of alcohol intake have been shown to reduce the incidence of BPH (Bradley et al, 2017). At present, BPH can be treated by both non-pharmacological and pharmacological treatments.…”

A mobile telehealth program for behavioral treatment of urinary incontinence in women veterans: Development and pilot evaluation of MyHealtheBladder

“…Behavioral self‐management treatments, including pelvic floor muscle training, behavioral strategies, and fluid management, as first‐line treatment for UI, are supported by high levels of evidence from several systematic reviews and clinical practice guidelines . Behavioral interventions have proven efficacy for reducing UI and improving quality of life . Behavioral self‐management programs are multifaceted interventions that rely on patient education and active patient participation.…”