Eliminate excess fluids to bring incontinenece under control

Q. I have mild urinary incontinence. I’ve heard that something called “fluid management” can help.

A. It can, and it’s a simple concept. The less water in your bladder, the less pressure your bladder feels to urinate. For some people, eliminating excess fluid intake is all it takes to bring urinary incontinence under control.

Start by following these guidelines to see if they help:

Ÿ Drink only when you feel thirsty.

Ÿ Don’t exceed six to eight 8-ounce cups of fluid per day from all sources (unless you have a medical condition that requires more). Fluid sources include soup and even milk in your cereal.

Ÿ Don’t drink more than 8 ounces at a time.

Ÿ Don’t guzzle. The faster your bladder fills, the more likely you are to feel urgency.

Ÿ Minimize caffeinated and carbonated drinks.

Ÿ Decrease or eliminate alcohol consumption.

Ÿ Fill your glass only two-thirds as full as you usually do. One study showed that this technique alone helped reduce episodes of incontinence.

Ÿ If you tend to urinate a lot at night, making for poor sleep, be especially careful to limit the amount of fluid you drink at dinner and in the evening.

One exception: If you are thirsty because it’s hot or you have exercised, don’t hesitate to drink water.

I’m sure I’ll get mail asking about the standard advice to drink at least eight, 8-ounce glasses of water per day. But this advice was likely based on a misunderstanding.

The advice has been traced to the 1940s, when the National Academy of Sciences recommended one milliliter of fluid for each calorie burned. That’s a little more than eight cups for a typical 2,000-calorie diet. However, the statement then explained that most of this fluid could be obtained from the liquid contained in foods.

Regardless, the eight-glasses-a-day dictum caught on. Indeed, today people often drink much more. Large amounts of water are claimed to promote weight loss as well as purify and detoxify the liver and other organs. But these claims are not based on fact. Drinking water won’t help you lose weight unless it replaces high-calorie drinks such as soda and fruit juice. And a person with normal liver and kidney function does not have to worry about toxins.

On the other hand, cutting down on fluids might prevent embarrassing leaks and urgent trips to the bathroom.

So despite what you might have heard about drinking at least eight glasses of water a day for good health, if you have incontinence, drink no more than that. And remember that the “eight-glass” rule refers to all types of liquids, not just water.

Ÿ Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com.