– Is More Really Better?
Marja Sprock, M.D.
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
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.
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
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
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
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
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
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.
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.
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 or
send us a