An adequate urinary volume is absolutely essential for the prevention of kidney stones and recurrent urinary tract infections. The average 24 hours urinary volume in normal people is about 1300 cc's per day. Patients with kidney stones or recurrent urinary infections should produce about 2000 cc's or a little more that 2 quarts each day. A low urinary volume will significantly increase the concentration of calcium, salt and other minerals predisposing to kidney stone formation and bladder irritation. A high enough urinary volume can reduce the bacterial count of the urine and actually cure mild bladder infections by getting rid of the bacteria faster that they can multiple. The obvious way to achieve this is to increase oral fluid intake but this is often difficult for many patients. We therefore suggest the "IRS Plan" for increasing fluid intake and urinary output.

At least half of any increased oral fluid intake should be water. This is what the body was designed for. As a general rule, the urine should appear no darker than a pale yellow. To keep track of he urinary output, collect all he urine for 24 hours in a half-gallon milk container. If you can fill the container in just one day, then the urinary output is probably adequate.

The IRS plan (internal renal stones) may be he easiest way to significantly change your fluid intake. The IRS plan consists of a "Kitchen tax, meal tax, nighttime bathroom use tax, penalty tax, restaurant tax, snack tax, summertime tax, time tax, work tax and water fountain tax!" You should add as many "taxes" as necessary to reach and maintain he desired level of urinary volume

The "tax" in the plan consists of a glass of water or other suitable liquid. The size of this additional glass will need to be adjusted between 4 and 12 ounces to maintain the urinary output at the desired level. We suggest that you start at just 4 ounces and let your body adapt to the increased fluid. Depending on your individual tolerance and metabolism, your system will gradually adjust to the increased fluid and you will become thirsty if you fail to keep your fluid intake up. This usually takes about a month of regular increased fluid intake. Until your internal fluid "barometer" is reset, it may be difficult to maintain the increased fluid intake, but your system will start to adjust in just a few weeks.

"Kitchen Tax"= one glass whenever you’ve entered the kitchen and wish to leave (this is more of a "toll" than a "tax"

"Meal tax" = one extra glass with each meal except if you eat out at a restaurant where you will need two extra glasses

"Nighttime Bathroom use Tax" = one glass whenever you get out of bed to go to the bathroom at night. (We don’t usually drink very much at night when we’re asleep. With this tax, if you’re already up anyway, you might as well add that extra drink of water).

"Penalty Tax" = if you eat or drink a food item you’ve been instructed to avoid or limit, you must drink at least two extra glasses.

"Restaurant Tax" = When you eat out at a restaurant you need to double the meal tax to two glasses. (This is because restaurant food is high in salt, which causes you to retain water).

"Snack Tax" = at least one extra glass if you have a snack between meals or at bedtime.

"Summertime Tax" = during the summer months or whenever the outside temperature is over 75 degrees, you must double all the other taxes.

"Time Tax" = One glass if you’ve managed to avoid all the other taxes for at least two hours.

"Water fountain Tax" = whenever you pass a water fountain, you are required to take a drink consisting of at least 10 swallows.

"Work Tax" = One glass whenever you leave your designated work area or desk.

A Few Other Suggestions to Help Increase Urinary Volume

Substitute high fluid content desserts in place of pastries, cookies and cakes. Frozen ices, sherbet, melons and fruit are recommended.

Maintain the humidity level in the home and workplace between 40 and 45 percent to minimize fluid loss through the skin and from just breathing.

Limit your salt or sodium intake. Salt in your food can cause you to retain fluid and make your urine more concentrated. Avoid heavily seasoned and processed foods and do not add any additional salt to your meals.

If these suggestions fail to adequately increase the urinary output, a diuretic can be used as a last resort. This will force a mandatory increase in urinary volume but can cause mineral and salt imbalance in the blood and a number of other complications. Failure to increase fluid intake while taking a diuretic could lead to dehydration.

It is rarely necessary to resort to all of these measures to increase the urinary output adequately. Check your progress by measuring the urinary volume and add as many "taxes" as necessary to achieve an optimal total volume. This will reduce your risk of recurrent infections and particularly of kidney stones. Good luck!