People with urinary incontinence are often told to give up caffeine but for those who derive great pleasure from their cuppa, this can be difficult to do and also add more stress to the already stressful symptoms of incontinence. Today, let’s look at the facts around this advice.
I want to acknowledge that I am sharing largely from an educational piece by Taryn Hallam, an awesome Australian pelvic floor physiotherapist educator.
General Information about Bladder Health and Incontinence
- The bladder incorporates a muscle called the detrusor.
- Detrusor overactivity (DO)/instability is when the bladder muscle contracts more often than it should or randomly spasms. This can cause urge incontinence. The bladder should only contract when it’s full, or when you tell it to empty with your brain.
- There are 2 types of urinary incontinence- stress incontinence and urge incontinence or a mix of the 2.
- Stress incontinence is the loss of urine when the abdominal pressure increases (jumping, laughing, coughing etc) and pushes on the bladder and the bladder neck pressure isn’t high enough to close off against the bladder pressure so wee leaks out. The bladder neck is supported by the sphincters +/- the pelvic floor muscles.
- Urge incontinence is that sudden eye-watering desire to pee which can strike at any time. It may hit randomly or be associated with an activity like turning on the shower or putting the key in the door.
- There are different causes of urge incontinence (UI) for men and women. UI is more strongly associated with detrusor instability/overactivity in men than in women. For women, there are more varied causes of urge incontinence.
- Keep in mind that the actual caffeine content of a cup of coffee or tea can vary considerably because of factors such as origin, processing and preparation method, including brewing time. So use these numbers from Mayo Clinic April 2017 https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/caffeine/art-20049372 as a guide.
The charts below show typical caffeine content in popular beverages. Drink sizes are in milliliters (mL). Caffeine is shown in milligrams (mg). 237mL is the drink size as this first table uses US data and is based on their 8oz cups.
|Coffee drinks||Size in (mL)||Caffeine (mg)|
|Brewed, decaf 237 2-5||237||2-5|
|Espresso 30 47-64||30||47-64|
|Espresso, decaf 30 0||30||0|
|Instant 237 63||237||63|
|Instant, decaf 237 2||237||2|
|Latte or mocha 237 63-126||237||63-126|
|Teas||Size in (mL)||Caffeine (mg)|
|Brewed black, decaf||237||2-5|
|Ready-to-drink, bottled||237 5-40||5-40|
Gleason et al 2012 estimate that average caffeine levels in beverages are
|Coffee||95 – 206 mg per 250ml (average – 150mg)|
|Tea||14 – 120 mg per 250mls (average – 65mg)|
|Carbonated drinks||20 – 90 mg per 375ml can (average – 55mg)|
|High Energy drinks||50 – 505 mg/serve (average – 275mg)|
Here’s the overview from 10 research articles and I’m happy to share the reference list with anyone interested.
Urge incontinence in men has a stronger relationship to bladder overactivity. In women, there are more factors involved than bladder overactivity. There appears to be fairly consistent research showing an association between caffeine and detrusor overactivity but does it make the urinary symptoms worse?
Whilst there is no evidence that caffeine causes detrusor overactivity it may worsen detrusor overactivity (DO) in those already affected. Research shows DO has a stronger relationship to male urge incontinence than to all other lower urinary tract symptoms, and there was one study that showed higher caffeine intakes (? 2 cups coffee) in men worsened their symptoms.
If there is an association between urge incontinence and caffeine in women it only appears to be at very high levels of caffeine consumption (over 450 mg). There appears to be no increased risk at moderate intake vs low intake. A woman presenting with a caffeine intake of 1-2 cups per day really has no increased risk compared to no caffeine intake.
There does not appear to be any link between caffeine intake and stress incontinence.
Will prolonged Caffeine Intake affect bladder symptoms?
There was a study to see whether caffeine intake would make urinary incontinence worse over time. 21% of people in both the lowest and the highest caffeine intake groups had an increase in urinary incontinence over the same time frame. So again, caffeine doesn’t seem the culprit.
So to Summarize…
In some people, there is a link between caffeine and symptoms. It is definitely worthwhile to trial a reduction in caffeine and see if there is an improvement in symptoms. (If you do try this, make sure you drink the same amount of fluid as you usually would- just with no caffeine. We do know that drinking less fluid reduces leaking or urinary incontinence. If your symptoms improve, you don’t want to blame coffee for the leaking when it’s really just that you drank less.)
Caffeine may not be your nemesis which is good news for the coffee addicts out there 🙂