Intake of Bladder Irritants in Women with and Without Urgency Incontinence

Objectives: To compare consumption of purported bladder irritants between women with urgency incontinence versus those without, using data from the National Health and Nutrition Examination Survey (NHANES) database.

Methods: We performed a case control study, utilizing NHANES data from 2007-2020. We included all female participants aged ≥20 years who completed the NHANES mobile examination, computer-assisted personal interview, “Kidney Conditions” questionnaire, and a 24-hour dietary recall. Women with stress urinary incontinence (“yes” to “During the past 12 months, have you leaked or lost control of even a small amount of urine with an activity like coughing?”) were excluded. Cases with urgency incontinence were women who: (1) responded “yes” to the question “During the past 12 months have you leaked or lost control of even a small amount of urine with an urge or pressure to urinate and you could not get to the toilet fast enough?” and (2) reported moderate, severe or very severe incontinence, measured with the Sandvik Incontinence Severity Index (ISI) score of 3-6 = moderate, 8-9 = severe, 12 = very severe. We compared cases with urgency incontinence to controls, defined as women who either denied any urgency incontinence or who reported urgency incontinence with an ISI score of 1-2 (none or slight). The exposures of interest were the six categories of purported bladder irritants listed on the NIDDK website, including alcohol; spicy foods; chocolate; artificial sweeteners; caffeinated, carbonated, and citrus beverages; and high-acid foods such as citrus and tomatoes. Dietary exposures were identified on each participant’s 24-hr dietary recall. We categorized each food or beverage as “yes” or “no” for each of the six purported bladder irritant categories. Multivariate logistic regression analysis was used to determine independent associations between bladder irritants and urgency incontinence. All analyses incorporated NHANES sample weights and design effects following CDC recommendations.

Results: Overall, 10,198 women were included in our analysis: 651 cases (6.4%) reporting moderate/severe/very severe urgency incontinence and 9,547 controls (93.6%). More cases than controls reported consuming caffeinated, carbonated, and citrus beverages (53.8% vs 47.8%, p=0.016) and high-acid foods (50.3% vs 44.8%, p=0.02). Urgency incontinence was not associated with the 4 other categories of purported bladder irritants (alcohol, spicy foods, chocolate, or artificial sweeteners). In multivariate analysis, the odds of moderate/severe/very severe urgency incontinence were increased significantly with intake of caffeinated, carbonated, and citrus beverages (OR 1.31, 95% CI 1.05-1.64) and high-acid foods (OR 1.26, 95% CI 1.01-1.57), after controlling for age, race, education, body mass index, diabetes, and hysterectomy status.

Conclusions: In this large, national study of community-dwelling adult women, urgency incontinence was associated with consumption of caffeinated, carbonated, and citrus beverages and high-acid foods. There was no association between urgency incontinence and other purported bladder irritants.