Potential Bladder Irritants and Overactive Bladder Symptoms: A Systematic Review

ImportanceInitial management for overactive bladder includes behavioral modification with avoidance of bladder irritants. However, in 2017, the International Consultation on Incontinence concluded that more research is needed to determine the precise role of these irritants in the treatment of overactive bladder.ObjectivesThe objectives were to identify, evaluate, and summarize peer-reviewed literature examining associations between 6 potential bladder irritants as proposed by the National Institute of Diabetes and Digestive and Kidney Diseases (alcohol; spicy foods; chocolate; artificial sweeteners; caffeinated, carbonated, and citrus beverages; and high-acid foods such as citrus and tomatoes) and OAB symptoms.Study DesignWe performed a systematic literature search on MEDLINE, EMBASE, and SCOPUS. An adapted version of the patient-intervention-comparison-outcome framework was applied. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies-of Exposures assessment tool. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023466251).ResultsWe reviewed 51 unique articles exploring the effect of alcohol (n = 34); spicy foods (n = 1); chocolate (n = 3); artificial sweeteners (n = 5); caffeinated, carbonated, and citrus beverages (n = 27); and high-acid foods (n = 2). The considered outcomes included overactive bladder (n = 16), urgency incontinence (n = 19), urinary urgency (n = 15), frequency (n = 17), and nocturia (n = 17). Overall, observed associations were mixed and inconsistent. The risk of bias was moderate in 23 publications and low for the remaining publications.ConclusionsThis systematic review failed to identify consistent evidence of an association between any of these 6 potential bladder irritants and overactive bladder symptoms.