- OAB Foods to Avoid
- The Dos and Don’ts for Managing an Overactive Bladder Through Diet
- Foods to Avoid if You Have OAB
- Foods to Eat and Drink for Optimal Health
- Foods for bladder health
- Incontinence Diet Part I: Foods to Avoid
- Foods to Avoid
- Irritating Foods
- Less Irritating Foods
- What to Eat When You Have Overactive Bladder
- Watch Your Weight
- Choose Your Foods
- Manage fluid intake
- Focus on fiber
- Adjusting Your Diet Might Help Manage Overactive Bladder
OAB Foods to Avoid
Some people find that certain foods or beverages seem to make their OAB symptoms worse.
If you feel that any of these potential problem foods make your urge incontinence symptoms worse, see if eliminating or cutting them back helps:
- Acidic foods. Citrus fruits (lemons, limes, oranges, and grapefruit), tomatoes, and tomato products (like tomato sauce or salsa) are among the chief reported offenders.
Solution: Eat more fruits that are less acidic, such as pears or blueberries. They’re also high in disease-fighting antioxidants. If you like lemon in your water, try adding a twist or thin slice. You’ll get the hint of the fresh fruit flavor without the acid.
- Highly spiced foods. Some people say chilies or wasabi wreaks havoc on their bladder.
Solution: Cut back on the spices little by little and see if your symptoms get better.
- Artificial sweeteners. Aspartame, saccharin, and other artificial sweeteners aren’t just in beverages — they are also added to foods.
Solution: Read the labels of pre-packaged foods and eat those with artificial sweeteners in moderation.
- Chocolate. Sorry, chocolate lovers — there’s caffeine in this sweet confection.
Solution: Skip the jumbo candy bar. Stick with one chocolate kiss. (It’s better for your waistline, too.)
- Salty foods. Potato chips, salted nuts, and other salty foods can cause the body to retain water, which eventually goes to the bladder. They also make you thirstier, so you’re likely to drink more liquids.
Solution: Switch to low- or no-salt snacks.
If you feel that something in your diet is hampering your attempts to manage your urge incontinence, but you don’t know what it is, try keeping a bladder diary. This is basically a daily record of what and when you eat and drink, and your urination patterns.
Another option is trying an elimination diet. Remove one item — tomatoes, for example — from your meals for a week. If your symptoms get better, make a note of it. Gradually add back small amounts of that food until you notice your symptoms come back. You may be able to enjoy the food in modest amounts while avoiding irritating side effects.
The Dos and Don’ts for Managing an Overactive Bladder Through Diet
People living with an overactive bladder often can find relief by changing their diet.
“We forget that some of the things we eat are causing our problems,” said the late Jean Fourcroy, MD, a urologist who was based in Washington, DC, in a 2011 interview.
Avoiding things that irritate the bladder, regulating your amount of fluid intake, and increasing your dietary fiber are just a few of the ways you can eat better to improve the symptoms of overactive bladder.
Find out more about the dos and don’ts of managing this condition through diet.
Foods to Avoid if You Have OAB
Doctors have identified a number of foods and drinks that can worsen overactive bladders, including:
- Caffeinated beverages and foods
- Spicy foods
- Citrus fruits and juices
- Carbonated beverages
- Milk and milk products
- Sugar or honey
- Artificial sweeteners
When these foods and drinks collect in the bladder, it can cause irritation resulting in bladder muscle spasms. Those spasms can create the sudden urge to urinate and increase your frequency of urination. Because each person will react differently to trigger foods — coffee might bother one person, while dairy can be problematic for someone else — doctors suggest keep a food journal so you can see which foods affect you the most.
But there are certain beverages that are known to cause repeat trips to the bathroom. Even a moderate amount of alcohol, coffee, tea, or soda will increase the amount of urine your bladder must manage. Research published in September 2016 in the journal Current Urology showed nearly one-half of people over the age of 60 who drink more than 300 mg coffee a day (a little over a cup) suffer from overactive bladder symptoms, which is significantly higher than peers who do not consume large amounts of caffeine.
Also, chemicals in cigarettes have been shown to irritate the bladder and increase the risk of bladder cancer. Smoking can cause coughing spasms that increase problems with stress incontinence. The American Cancer Society offers extensive resources on quitting, noting smokers are at least 3 times more likely to get bladder cancer compared with nonsmokers.
Foods to Eat and Drink for Optimal Health
Dr. Fourcroy recommended tackling incontinence by making your diet as simple as possible.
“Very often, I have my patients start off with Cream of Wheat and baby food and then add back little by little to see what causes problems,” she said.
Since constipation can cause or exacerbate urinary incontinence, you should make sure you’re getting enough fiber by filling your daily diet with the following foods:
- Noncitrus fruits
“For most of these things you can do a little trial and error — try certain elimination diets or eliminate certain fluids to see if there’s a positive impact,” says Benjamin M. Brucker, MD, a urologist at NYU Langone adding that it’s best to start with bland foods and slowly add things back.
There are a number of juices that are less irritating to your bladder than others, including apple, grape, cherry, and cranberry. These juices also help by making urine more acidic, preventing the spread of bacteria and controlling urine odor. But beware of additives in these drinks. A study published in March 2016 in the journal Research and Reports in Urology noted that artificial sweeteners can increase the likelihood of OAB. And remember to drink plenty of water, which is the best way to hydrate your body.
Overall, you should drink six to eight 8-ounce glasses of fluid every day. If you drink less, your urine might become concentrated and irritate your bladder. If you drink more, you might overtax your bladder and make matters worse.
“If you’re complaining of peeing too frequently or having leakage episodes, 40 to 60 ounces a day is reasonable,” says Dr. Brucker.
To further ease your overactive bladder, avoid drinking a lot of fluid at one time. Sip 2 or 3 ounces every 20 to 30 minutes between meals. Cutting off fluid intake a few hours prior to bedtime also will help.
“We know that surgeries and medication can be very effective, but we also know that lifestyle modifications can be very effective,” says Brucker. “Medication can work, lifestyle can work, but if you’re doing both, even better.”
Additional reporting by Kalah Siegel.
Foods for bladder health
Share on PinterestIt is recommended to drink 6 to 8 glasses of water each day.
Making alterations to diet and lifestyle can have an impact on an overactive bladder. The recommended dietary changes include:
For people with an OAB, there is a fine line between drinking too much and not drinking enough.
People should try to stick to the recommended 6 to 8 glasses of fluid each day. The body can regulate liquid in the body, excreting unwanted fluid via the urine. Therefore, exceeding the recommended amounts is likely to lead to more time in the bathroom.
However, it is important not to get dehydrated as this will result in more concentrated urine, which may further irritate the bladder lining. It is possible to monitor hydration levels by checking the color of the urine. Dark yellow urine could be a sign of dehydration.
It is best not to drink a lot at any one time, but to spread drinks across the course of the day. It is a good idea to stop drinking a couple of hours before bedtime to minimize the likelihood of getting up in the night.
Caffeinated drinks include tea, coffee, and carbonated drinks such as cola. Caffeine is a diuretic, which encourages the release of water in the urine. This can make the symptoms of an OAB worse.
The evidence suggesting that people with OAB should avoid caffeine is varied and mainly anecdotal. However, some people may find it helpful to avoid or limit caffeinated drinks and opt for water, diluted juice, and herbal teas instead. This may improve symptoms of urgency and frequency but not incontinence.
Alcohol acts as a diuretic and increases urine production, so it is likely to make symptoms worse for people with an OAB. It may be a good idea to cut back on alcohol or avoid it completely for a while to see if symptoms improve.
Certain foods, including spicy ones, might irritate the bladder. For some people with an OAB, it is best to avoid them.
Citrus fruits are also believed to irritate the bladder, which might cause painful urination.
High fiber foods
Studies have shown an association between constipation and an OAB. Adults with urge incontinence who also suffer from constipation should seek dietary advice on how to encourage regular bowel movements. Foods high in soluble fiber, which include oats, bran, vegetables, and legumes, may help with constipation.
Incontinence Diet Part I: Foods to Avoid
Although some people who suffer from incontinence or bed wetting may be able to improve or even eliminate their bladder issues through medical treatment, there are many people for whom this isn’t an option. It is for such people that long-term incontinence products and incontinence lifestyle changes are indicated – and at AvaCare Medical, we aim to serve our customers by offering guidance in both of these areas.
One important lifestyle change for anyone who is suffering from an overactive bladder is dietary changes. There are many foods and eating habits that significantly affect bladder movement. The following are some important things to know if you’d like to take an active part in dealing with incontinence, whether it is for yourself or for a loved one.
Foods to Avoid
As with most diet changes, it is a good idea to start by eliminating these products completely from your diet. Then, if desired, you can slowly re-introduce these foods to learn how much your body can handle. One great way to make your diet changes more effective is to keep a bladder diet which helps you keep track of the foods and drinks you consume so you can track which are good for you and which aren’t.
- Alcohol. Alcohol is often related to health-related issues, and bladder problems are no exception. When an individual consumes alcohol, they are both more likely to have a need to urinate and less likely to know when they need to do so. This is because alcohol reduces the control over the natural signals that let you know when your bladder is full and needs to be emptied. (For those who also experience fecal incontinence, alcohol is a double whammy, since it is a natural laxative.)
- Caffeine. Caffeinated food and drinks cause a stronger urge to urinate and also prompt the body to get rid of fluids. Caffeine is also a bowel stimulant, which can be a problem for anyone also suffering from bowel incontinence. If you can, try to eliminate caffeine from your diet, or at least aim for less than 100mg/day – but whatever you do, be sure to avoid all caffeinated foods and drinks after 7 PM. Caffeinated foods and drinks to avoid include – but are not limited to – the following list:
- Carbonated drinks
- Energy drinks
- Spicy foods. Avoid super spicy foods like horseradish, chili, hot peppers and Mexican and Chinese dishes, because like caffeine, these foods can irritate the lining of the bladder and cause increased urinary incontinence problems. For those with bowel issues, spicy foods can also affect stool, speeding up the time it takes for it to move through the bowel.
- Acid. Citrus fruits and drinks, as well as tropical fruits (like pineapple) and tomatoes are acidic and are bladder irritants, causing you to feel a stronger urge to urinate. Other places you’ll find acid: coffee, dark chocolate and condiments like soy sauce, vinegar, ketchup (as well as any other tomato-based products) and mayonnaise.
- Carbonated Drinks. Even caffeine-free fizzy beverages can aggravate a sensitive bladder, due to the carbon dioxide present in the drink, so it may be a good idea to avoid these.
- Sweeteners. Things like sugar, honey, corn syrup and artificial sweeteners can also prove to be a bladder pitfall for some, so be sure to consume in moderation.
- Dairy products. Milk and other dairy products are often found to be a bladder irritant. In addition, lactose may cause looser stool, leading to bowel incontinence, and other parts of milk such as the whey and casein can aggravate the colon. Rich, creamy cheeses, especially sour cream and aged cheese, may be too much for your bladder to handle – if it is, try processed, non-aged cheese or imitation sour cream.
- Processed foods. Additives, preservatives and artificial flavors are often bladder irritants, so be careful to read nutrition labels before indulging.
- Apples, bananas and grapes. For some people, these fruits can trigger the urge to go, so these are best avoided until you know your body is okay with them.
- Cranberry juice. Because cranberries help avoid bladder infections and UTIs, many people incorrectly assume that it can help with incontinence. The truth is, though, that because of its acidic pH, it’s not good for overactive bladder and should generally be avoided.
- Prunes. Urinary incontinence can often come along with, or be exacerbated by, constipation. Before you go running for the fix-it-all prunes, keep in mind that prunes aren’t easy on the bladder, so you’d be better off tackling constipation by introducing more fiber into your diet.
- Raw onions. Raw onions are rough on the system, so make a point of eating only cooked onions, or try substituting your yellow and red onions for the milder shallot.
- Medications. As always, be sure to discuss your incontinence symptoms with your doctor before beginning (or, if the incontinence issues are new, continuing) and medications. Certain medications including some blood pressure reducers, muscle relaxants, heart medications, sedatives and more can exacerbate incontinence issues by causing an overload of fluid in the bladder. Also look out for caffeinated medicines, since these can affect your bladder just like coffee does.
In addition to these foods, smoking is a habit that should be avoided by anyone experiencing bladder sensitivities. This is because cigarettes aggravate the bladder and increase the risk of developing bladder cancer. Another issue caused by smoking: it can cause coughing spasms that negatively affect those with stress incontinence.
If you’ve read this far, you’re likely feeling very overwhelmed by the list of foods that aren’t all that easy on the bladder. The good news is twofold, though: (A) With trial and error, you may find that many of the above foods, in limited quantities, may not be a problem for you, and (B) there are many other foods which are not only okay for incontinence, but may actually improve your bladder function.
To learn more about these foods, continue on to Part II of this series: Foods to Help with Incontinence >>
All the fluids we drink affect our urinary cycles, but some fluids (such as coffee and beer) have a greater impact, since they are diuretic bladder irritants. Even fruit juices can increase the sudden urge to urinate, as their acidic content irritates our bladders.
If frequent urination at night is an issue, controlling the timing and quantity of your fluid intake during the day can alleviate it. Try to drink more fluids in the morning and early afternoon, rather than in the evening or at night.
Moderation is the key to improving bladder function— the more we drink and the more quickly we drink, the more frequently we will have to urinate. So slowly drink small amounts of fluids during the day. Try to avoid beverages containing caffeine and alcohol, and stick with drinking enough water as often as possible.
Having said that, it is important to drink enough fluids to avoid waste build up in our bladders that can irritate them. We should monitor urine color and smell to ensure we are drinking enough. Dark yellow, strong-smelling urine is an indication that the fluid consumption is too low.
Note that our bodies absorb water from food as well. So foods with high water content, like soups, can also result in higher bladder action. Again, it is helpful to avoid these foods in the evening and at night.
If you have urinary incontinence, you may feel strong, sudden urges to pee, especially during the night. Eating or drinking certain things can make symptoms worse, mainly because your bladder is sensitive to irritants that can trigger the urge to go.
Paying attention to these triggers—and avoiding them if possible—can go a long way toward cutting down on sudden bathroom trips. Here are 10 types of food and drink that can worsen your need to go.
- You may want to reconsider reaching for hot pepper sauce at every meal or always eating sushi with wasabi. For pretty much the same reason that hot, spicy foods can make your mouth burn, it is thought they can irritate the bladder lining and worsen symptoms.
- Cranberry juice helps fight off bladder infections, but it can be a culprit in worsening overactive bladder symptoms. The berries’ acidity can irritate the bladder, and although its diuretic action helps flush out the bladder and urethra, it will also make you go more frequently.
- It makes sense that if too much caffeine can make you jittery, it also can make your overactive bladder jumpy. So if you’re a coffee or tea lover, stick to one cup—and be prepared for the consequences. And be aware that cocoa and chocolate also pack a caffeine punch.
- Like caffeine, alcohol is a diuretic and a bladder irritant. So drinking a beer is a triple whammy, because you’re consuming liquid, accelerating the rate at which your kidneys are gathering water, and forcing the bladder to empty more often. If you do drink stick to a single glass of wine or liquor per day.
- Bubbly drinks can tickle your bladder as well as your nose. What’s more, soda often contains caffeine, sugar, or artificial sweeteners—all of which are overactive-bladder triggers in their own right.
- Acidic foods and drinks, such as grapefruits and orange juice, can also irritate your bladder, Dr. Winkler says. But don’t let citrus scare you away from other fruits, such as apples, blueberries, and pears, which provide key nutrients as well as a healthy dose of fiber. Eating fruit also helps stave off constipation, which can sometimes plague people with overactive bladder.
- Tomatoes, like citrus fruits, are quite acidic. If you can’t bear the thought of life without tomato sauce, some chefs swear adding a little sugar can make your ragu or Bolognese less acidic, although others argue that the sugar just masks the acid taste.
- Real sugar—and artificial versions such as Splenda—can worsen the symptoms of overactive bladder for some people. Even honey can cause problems. If you find that sweeteners give you bladder trouble, try to cut them out of your diet, or use as little as possible.
- Monosodium glutamate, or MSG, most famous as a flavor enhancer used liberally in some Chinese restaurants, lurks in other foods as well. And for some people, MSG is a trigger of overactive bladder symptoms. Luckily, plenty of Chinese restaurants are now MSG-free. If you are MSG-sensitive, carefully read the labels of soups, stocks, salad dressings, canned vegetables, frozen entrées, and foods containing whey or soy protein to make sure they are free of the additive.
- The adage that drinking eight to 10 glasses of water per day is good for you turns out not always to be true. So there’s no reason for you to overload on liquids, which for obvious reasons can aggravate an overactive bladder. Drinking too little liquid can be a problem, too, because it can lead to overly concentrated urine, which is also a bladder irritant.
If you suffer from Overactive Bladder (OAB), Bladder Pain Syndrome, or Interstitial Cystitis (IC), you’re probably familiar with the feeling of discomfort and urgency that accompanies normal, everyday activities. One way to soothe bladder pain and control these symptoms is through your diet. Eliminating irritating foods and eating soothing foods should dull some of your bladder pain.
According to the IC Network, there are several foods that can affect your bladder symptoms and soothe bladder pain.
Understandably, acidic or spicy foods irritate your bladder. To avoid that uncomfortable feeling of pain or urgency, avoid the following foods:
- Coffee (caffeinated and decaffeinated)
- Caffeinated tea
- Carbonated beverages
- Fruits such as grapefruit, lemon, orange, and pineapple
- Fruit juices such as cranberry, grapefruit, orange, and pineapple
- Tomato products
- Hot peppers
- Spicy foods (including cuisines like Mexican, Thai, and Indian)
- Artificial sweeteners such as NutraSweet, Sweet ‘N Low, Equal, and Saccharin
Less Irritating Foods
Certain foods won’t irritate your bladder as long as they aren’t combined with acidic or spicy foods. Diet alone won’t cure the symptoms of OAB, but these foods won’t intensify your discomfort.
- Low-fat or whole milk
- Fruits such as honeydew melon, pears, raisins, watermelon, and cucumber
- Vegetables such as broccoli, Brussels sprouts, cabbage, carrots, cauliflower, celery, mushrooms, peas, radishes, squash, and zucchini
- White potatoes and sweet potatoes/yams
- Meat such as chicken, turkey, beef, pork, and lamb
- Seafood such as shrimp, tuna fish, and salmon
While the above foods won’t completely eliminate discomfort, certain foods actively soothe bladder pain during flares.
- Homemade zucchini bread
- Homemade white or yellow cake
- Ricotta and string cheeses
- Oatmeal or sugar cookies
- Vanilla ice cream
- Dried marjoram
- Green peas
- Vanilla or rice pudding
- Chamomile and peppermint teas
In addition to these bladder-friendly foods, several foods are worth trying but might irritate more sensitive bladders. Learn more about how your diet can soothe your bladder pain.
What to Eat When You Have Overactive Bladder
Linda Wasmer Andrews Was this helpful? (364)
Imagine a heaping plate of pasta with marinara sauce and a glass of wine, followed by a slice of chocolate cake and a cup of coffee. For many people, that would be a big night at their favorite Italian restaurant. But if you have overactive bladder (OAB), it could be the prelude to many hurried bathroom visits.
Several common foods—such as tomatoes, wine, chocolate, and coffee—contain substances that can aggravate OAB. Plus, overindulging in high-calorie foods could lead to weight gain, which can worsen OAB symptoms as well.
Fortunately, with a little planning, you can still treat your inner gourmet. You just need to keep OAB in mind when deciding what to eat—and what to skip. The guidelines below can help.
Watch Your Weight
Whether you’re dining out or eating in, smart food choices help keep your weight in check. The key is choosing foods that pack a lot of nutrition into a relatively small number of calories. Such foods include vegetables, fruits, whole grains, fish, lean meats and poultry, and fat-free or low-fat milk and dairy products.
If you’re overweight, losing weight may lessen OAB symptoms. One study included 338 overweight women with bladder control problems, including OAB. The women were randomly assigned to either an intensive weight loss program or a control group. After six months, those in the weight loss group had lost an average of 8% of their body weight, compared to about 2% for the control group. The weight loss group also had a greater decrease in their frequency of urinary accidents.
Choose Your Foods
Certain foods and drinks have a more direct effect on OAB. Watching what’s on your menu helps keep your symptoms in check.
Avoid troublemakers. Some foods and drinks can irritate the bladder, contributing to urine leaks. Sensitivity varies from person to person, but these are common culprits:
Artificially sweetened drinks
Coffee (even decaf)
Tomatoes and tomato products
Citrus fruits and juices
Highly spiced foods
Manage fluid intake
Drinking too much fluid makes you urinate more often. On the other hand, drinking too little leads to very concentrated, dark yellow, strong-smelling urine. Such concentrated urine irritates the bladder, and it also promotes the growth of bacteria. Aim for a healthy balance—about six glasses a day. Water is the ideal choice. Cranberry, grape, cherry, and apple juices are also gentle on your bladder.
Focus on fiber
Constipation can worsen OAB symptoms. The fiber found in many fruits, veggies, and whole grains helps prevent this problem. To minimize gas and bloating, add fiber to your diet a little at a time. Talk with your doctor if constipation continues.
Adjusting Your Diet Might Help Manage Overactive Bladder
Women’s Health Update Jul 25, 2017
Overactive bladder syndrome (OAB) is an issue faced by many people, but there are some adjustments you can make to your diet that you can take to help manage the condition.
OAB is when your bladder is more sensitive than it should be, says William Rush, MD, an OB/Gyn physician with Lifestages Centers for Women’s Health, a Premier Physician Network practice. With OAB, the bladder starts to have more spasms as it fills up.
“The spasms can send messages to the brain saying ‘I have to go. I have to go now,’ and they can be very persistent and urgent and cause spasms strong enough that they can cause urine to come out,” Dr. Rush, who specializes in urogynecology, says.
The condition affects about 33 million Americans – about 40 percent of which are women, according to the American Urological Association (AUA).
OAB isn’t a disease, but rather a name given to a group of urinary symptoms, including the overwhelming urge to urinate more frequently than normal.
A normal amount of urination within 24 hours is seven times, including once at night, Dr. Rush says. However, he adds that frequency is subjective. Even if someone’s amount of urination is in the normal range, they might feel it is too frequent, and it can be a real bother to them.
Symptoms of OAB, according to the National Institutes of Health (NIH), include:
- Feeling a sudden urge to urinate and having difficulty controlling it
- Having urge incontinence, which is having an urgent need to urinate followed by involuntary urination
- Frequent urination, which means more than eight times in a 24-hour period
- Waking two or more times a night to urinate
There are a variety of issues that can cause bladder control problems, such as OAB. According to the NIH, those issues include:
- Alcohol and caffeine consumption
- Excess weight
- Nerve damage
- Weak bladder muscles
OAB can affect anyone, but it is most common among women in their 40s, 50s, and 60s, Dr. Rush says.
Dr. Rush also wants women to understand the connection between their diet and OAB. By making some adjustment to what they eat or drink, he says women can help improve their OAB symptoms.
Drinking too many fluids is one problems Dr. Rush says he sees.
“Sometimes people are coming in, and they are drinking 80 oz. to 100 oz. a day,” he says. “There are myths out there that say a person needs 64 oz. in a day, but there is not a lot of scientific evidence toward that. You really only need 40 oz. to 50 oz. total fluid in a day – and there is fluid in a lot of things, like soup.”
Though Dr. Rush says it’s OK to drink a lot of water, he reminds women to be prepared to urinate more if they are going to drink a lot.
Many women, however, aren’t using water to get in more fluid ounces for the day, he says.
“A lot of people are drinking diet drinks, and anything with artificial sweetener is harmful to your stomach lining and very tough on your bladder lining,” Dr. Rush says. “Your body doesn’t really know how to process artificial sweeteners. On top of irritating the bladder, when they get there, they are telling the kidneys to make more urine, and you have even more than usual.”
Dr. Rush recommends not cutting out your favorite drinks completely, but having them in moderation to help manage OAB symptoms.
“An 8 oz. cup, or even 12 oz. of caffeinated drink that has no calories, by itself, is probably good for you. It is when people are having three or four or five cups a day that it can be a problem,” he said. “But a cup or a cup and a half of coffee, for example, is probably good for you.”
When women have a concern about how much they urinate, Dr. Rush says he first talks to them about their diet. He recommends limiting fluid intake if someone is drinking much more than necessary, and also recommends adding sources of fiber, which can help keep the digestive and urinary tract running correctly.
Women should eat between 21 and 25 grams of fiber daily, Dr. Rush says, and he recommends some of the following foods to help reach that goal:
If diet changes don’t work well enough to manage a woman’s OAB, Dr. Rush says he recommends physical therapy to help teach the woman how to suppress the overwhelming urge to urinate.
Medication to help decrease the spasms is also an option, he says.
If all the non-invasive options don’t help, Dr. Rush said there is a minor procedure that can help with OAB. But he reserves that as a last resort.
For more information about overactive bladder, talk with your doctor or find a physician.