as published in Central Florida Medicine.com August 7, 2011

The media has done a great job convincing the public that the more water you drink the better. The reality is, however, there is no need to carry a gallon of water jug with you all the time – unless you are planning to ascend a steep hill in the bright tropical sun.

The daily intake of fluid for the average woman should be approximately 2700 ml (91 ounces), which is about 11 and a half cups from all beverages and foods.

This includes fluid from fruits and vegetables and all other foods. The truth is that unless it is really warm and we evaporate a substantial amount, or we are really physically active, fluids do not have to be pushed.

According to the Institute of Medicine, the vast majority of healthy people adequately meet their daily hydration needs by letting thirst be their guide. About 80 percent of people’s total water intake comes from drinking water and beverages, and the other 20 percent is derived from food.

Meaning, if we drink eight cups of fluid per day, we are close to the amount truly recommended, since we will get more than 2 cups from our food. If you choose to only drink water then that means that you should drink up to eight glasses. However most of us will add fluid with the intake of some coffee or tea.

Prolonged physical activity and heat exposure will increase water losses and therefore may raise daily fluid needs. However, it is important to note that excessive amounts can be life-threatening.

The eight glasses of water rule was made popular by Weight Watchers and makes some sense if drinking water replaces a higher calorie choice. However, in the popular press it has changed into, “you need to drink at least 8 glasses of water,” not counting all the other fluid sources – and the more the better.

Patients who arrive in my office with their gallon water jug, wondering why they have to go to the bathroom hourly and get up three times at night is an easy solution. It may sound obvious why this occurs, however more problems can be encountered.

Stress Incontinence?

A 46 year-old patient came into my office complaining of leakage during coughing and sneezing. She also complained of two “accidents” that she had experienced in which her entire bladder had emptied out without feeling an urge. This was actually my second patient in the same day with a similar story.

Is this stress incontinence? Yes, however when presented with 500-600 ml (over 2 cups) in the bladder, which is close to twice what women hold normally, leakage with sudden moves or increase in pressure is difficult to prevent.

There is a bigger problem though, as the patient who has been forcing herself to drink large amounts of water, has actually trained herself to ignore the urge to go to the bathroom. At a certain point the bladder becomes so full it automatically eliminates, without any warning and often at unmanageable times such as in the middle of a store.

When patients are asked to keep a 24 hour output diary, it typically shows a large volume and bathroom visits only for two cups and up, as well as some night time bathroom visits.

During a cystometrogram, which is a functional test of the bladder, a late sensation of fullness and a large capacity is noted, as well as some high volume stress incontinence (leakage with coughing, jumping).

Despite all the signs of the obvious, I have found it very difficult to convince some women that it will be better for their health to stop their excessive water intake. Remember, the eight cups includes coffee, tea and other beverages. If you are always thirsty, some lemon can be added to the water to make it less palatable or Perrier® water may be used, which is carbonated and makes it more difficult to drink in large quantities.

Obviously there are diseases that make you want to drink more, such as diabetes mellitus (problems with insulin and sugar metabolism) and diabetes insipidus (lack of fluid concentrating ability). It is always important to make certain that none of these diseases are the reason for the desire to take in an excessive amount of fluid.

When I explain to the patient who is otherwise healthy that she has to curb her water input the reply is typically, “Doctor, I thought that drinking a lot of water is healthy and everybody says that it is good to drink lots of water.”

There is no study to date that proves that you live longer and healthier if you push your water intake to the limit. If you drink water instead of a soda, that is definitely a healthier choice. Otherwise stick to the recommendation of the Institute of Medicine and let thirst be your guide.

ABOUT THE AUTHOR

Dr. Marja Sprock practices in Rockledge, Florida and is a fellowship trained UroGynecologist and specializes in helping women with urinary and fecal frequency; urgency and incontinence; and pelvic organ prolapse. A Dutch native, she moved to the United States to do an OB/GYN residency at Henry Ford Hospital in Detroit. Dr. Sprock also trained in Urogynecology at Henry Ford Hospital. After spending more than 10 years at Henry Ford, she served as the assistant program director of the OB/GYN residency program for five years as the director of the Urogynecology. Dr. Sprock has been honored with numerous awards during her career, from excellence in laparoscopic surgery, to excellence in patient care. For more information call 321-806-3929. send us a note or log on to CentralFloridaUroGynecology.com.