Question:

I want to stay hydrated, but when I drink fluids I seem to have more accidents. What’s the right amount to be drinking during the day? 

Answer:

Let me begin by saying that proper hydration is more important than just about anything else, including leaks. Remember: There are solutions for accidents, but hydration is essential to staying and feeling healthy.

The human body has an intricate system that keeps fluids and electrolytes balanced, but you have to take in enough water for that to happen. If this system is not functioning properly, you become susceptible to the dangerous consequences of dehydration. In the elderly, this is even more important to be aware of, because as you get older, the regulation system may no longer function properly on its own. In fact, dehydration is surprisingly common among seniors – between 17% and 28% of older adults in the United States experience it, (1) and it’s a frequent cause of hospital admission.

What Happens When You’re Body Isn’t Well-Hydrated?

Being dehydrated is not just a matter of being thirsty. Dehydration at the cellular level means that the body is not functioning properly. It can affect organs, cognitive function, mood, and energy. With increasing age, body water content decreases, the risk for dehydration increases, and the consequences become more serious.

Between the ages of 20 and 80, the amount of body fluid decreases by about 15% or around 1-1/2 gallons – that’s a lot of water! (2) With this decrease, the body becomes more susceptible to dehydration from the loss of even a small amount of fluid. (3) Aging can also reduce your kidneys’ ability to concentrate urine and retain water when you’re not properly hydrated, (4) and aging kidneys are also less able to conserve or excrete sodium. (5) Incontinence only complicates matters because it can cause additional water loss.

Many people who have bladder leakage think if they drink less, they’ll urinate less. Unfortunately, things aren’t quite as simple as that. It may seem counterintuitive, but cutting back on fluids can actually lead to more severe incontinence. That’s because the lack of fluid can lead to constipation, and constipation promotes urinary incontinence.

When you drink less, you also produce more concentrated urine, and that can irritate your bladder and make you go more often. Concentrated urine also encourages the growth of bacteria, which can lead to bladder infections and UTIs. (6)  It’s even worse if you’ve been under-hydrated for an extended time: When exposed to a virus or bacteria, you become more likely to develop an infection, including not only UTIs but also pneumonia and other respiratory diseases. (6)

So just how much you should be consuming for optimal health? While water needs can vary from day to day and from person to person, the general recommendation for fluids is at least 6 to 8 cups, or 48 to 64 fluid ounces daily. This may be increased if you’re losing excess water through sweat or urine. As a rule of thumb, try to drink 4 ounces of water every 15 to 20 minutes during periods of excess loss. (3)

Along with the amount that you’re consuming, you should also be paying attention to what you’re consuming. Many everyday foods and beverages are bladder irritants, including carbonated sodas, sugar, artificial sweeteners, honey, milk products, citrus fruits or juices, highly spiced foods, chocolate, and even tomato-based products. Caffeine is a big offender, too, because it’s a natural diuretic (which explains why you often have to pee so bad after you’ve had a couple of cups of coffee!). If you want to do all you can to address your symptoms, all of these must be controlled.

If you find yourself craving something like juice or soda, you don’t have to necessarily go cold turkey. Try mixing juice 50-50 with water to cut down on the sugar and calorie content, and make soda an occasional treat instead of a staple. And don’t forget that about one-fifth of the fluid you take in comes from the foods you eat, including soups, fresh fruits, vegetables, and ice pops.

Finally, remember to watch the time of day you take in fluids. Drinking later in the evening often turns into trips to the bathroom in the middle of the night – and that’s more than just an inconvenience. Along with a disturbed sleep schedule, late-night bathroom breaks are a leading cause of slips and falls.

References:

1. Taylor, K., & Jones, E. B. (2020). Adult dehydration. In StatPearls [Internet]. StatPearls Publishing.

2. Silver AJ. Aging and risks for dehydration. Cleve Clin J Med. 1990:574:341-4.

3. Morrow, K. (2017). Proper Hydration in the Elderly. Livestrong.com 

4. Bennett JA. Dehydration: Hazards and Benefits. Geriatric Nursing 2000;21:84-8.

5. Zhao, L., Li, W., and Tian, P. (2013). Reconciling mediating and slaving roles of water in protein conformational dynamics. PLoS ONE 8:e60553. doi: 10.1371/journal.pone.0060553

6. Byrd, A. L., Belkaid, Y., & Segre, J. A. (2018). The human skin microbiome. Nature Reviews Microbiology, 16(3), 143-155.

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