title: Does Instruction to Eliminate Coffee, Tea, Alcohol, Carbonated, and Artificially Sweetened Beverages Improve Lower Urinary Tract Symptoms?: A Prospective Trial.
abstract: OBJECTIVE
  Common advice for lower urinary tract symptoms (LUTS) such as 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 whether symptoms worsened with partial reintroduction.
  
  
  METHODS
  The 3-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 nonpotentially irritating beverages (primarily water).
  
  
  METHODS
  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 protocol demands, total beverage intake was not stable; mean (± standard deviation) daily total intake volume dropped by 6.2 ± 14.9 oz (P = .03) during Phase 2. In Phase 3, the volume of total beverage intake returned to baseline, but the 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 ≤ .01). The number of voids per day decreased on average by 1.3 and 0.9 voids during Phases 2 and 3, respectively (P = .002 and P = .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 whether 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.
authors.affiliation: Janis M. Miller, PhD, RN, APRN, School of Nursing, University of Michigan, Ann Arbor, Michigan. Caroline E. Garcia, BA, School of Nursing, University of Michigan, Ann Arbor, Michigan. Sarah Becker Hortsch, MSW, RN, School of Nursing, University of Michigan, Ann Arbor, Michigan. Ying Guo, MS, School of Nursing, University of Michigan, Ann Arbor, Michigan. Megan O. Schimpf, MD, Department of Obstetrics and Gynecology, Division of Urogynecology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Janis M
authors.initials: JM
authors.lastname: Miller
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Garcia
authors.forename: Sarah Becker
authors.initials: SB
authors.lastname: Hortsch
authors.forename: Ying
authors.initials: Y
authors.lastname: Guo
authors.forename: Megan O
authors.initials: MO
authors.lastname: Schimpf
mesh_terms: D000368:Aged; D001628:Beverages; D003069:Coffee; D015930:Diet Records; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000178:diet therapy* / Q000517:prevention & control*; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013549:Sweetening Agents; D013662:Tea
chemical_list: D003069:Coffee; D013549:Sweetening Agents; D013662:Tea