Login
Subscribe
Urinary incontinence, or loss of bladder control, is a common and often embarrassing problem that can have a huge impact on quality of life. The condition is increasingly common as people age, and women are especially likely to be affected, with some studies showing that as many as half of all women report some form of urinary incontinence.[1]
The condition develops for many reasons, often involving structural problems with the muscles and nerves that control the bladder.[2] Certain...
Urinary incontinence, or loss of bladder control, is a common and often embarrassing problem that can have a huge impact on quality of life. The condition is increasingly common as people age, and women are especially likely to be affected, with some studies showing that as many as half of all women report some form of urinary incontinence.[1]
The condition develops for many reasons, often involving structural problems with the muscles and nerves that control the bladder.[2] Certain drugs also can influence these nerves and muscles, increasing the risk of incontinence.[3]
Often, drugs known to cause urinary incontinence are prescribed to elderly patients already at risk for the condition due to age, dementia and other factors. For example, donepezil (ARICEPT, NAMZARIC), a drug prescribed to treat Alzheimer’s disease, can cause urinary incontinence by affecting the nervous system.[4],[5] When loss of bladder control occurs in patients taking donepezil, it is easy for doctors to mistakenly believe the bladder issues are caused by dementia and not the drug being used to treat it.[6]
The French medical journal Prescrire recently published an article summarizing the drugs that cause urinary incontinence, some of which are listed in the table below.
Examples of Drugs That May Cause Urinary Incontinence
| Drug names | Effects that may lead to incontinence |
|---|---|
Benzodiazepines
|
Relaxes the urethra and has sedative effects that can lead to lack of concern or desire to use the toilet.[7],[8] |
Atypical antipsychotics
|
Reduces muscle tone, relaxing the muscle that holds the bladder closed.[9] Also increases the amount of urine retained in the bladder, leading to overflow accidents. This may lead to involuntary bed-wetting at night.[10] |
Cholinesterase inhibitors
|
Modifies the part of the nervous system that controls the urge to urinate. |
Alpha blockers
|
Reduces muscle tone, relaxing the muscle that holds the bladder closed.[11] |
Menopausal hormone replacement therapy (HRT)
|
Reduces the quantity and strength of collagen, a protein often found in connective tissue that helps support the bladder.[12] |
Muscle-paralyzing agents
|
Temporarily paralyzes the muscles controlling the bladder. |
* Do Not Use except for panic disorder
** Do Not Use
*** Limited Use
Risk of other side effects
Many drugs that cause loss of bladder control also can cause more dangerous and even deadly side effects for elderly patients. For example, atypical antipsychotics clozapine (CLOZARIL, FAZACLO ODT, VERSACLOZ), olanzapine (ZYPREXA), quetiapine (SEROQUEL) and risperidone (RISPERDAL) carry a black-box warning, the strongest FDA warning, stating that use of these drugs by elderly patients with dementia-related psychosis increases the risk of death. These drugs are not approved by the Food and Drug Administration (FDA) for treating elderly patients with dementia, and Public Citizen’s Health Research Group lists them as Limited Use drugs because they should not be used by these patients.
Benzodiazepines such as diazepam (DIASTAT, VALIUM) also can cause loss of bladder control. They are listed as Do Not Use drugs because they can be addictive, can increase the risk of falls and hip fractures by 50 percent, and can cause memory loss and other dangerous side effects, particularly in older people.[13]
Drugs used for hormone replacement therapy (HRT), which can cause incontinence, are sometimes prescribed to treat urinary incontinence and other bladder-related conditions.[14] This use has not been approved by the FDA and is supported by only weak evidence. While a few studies testing HRT drugs for their effect on bladder control have suggested benefits for certain types of incontinence, others have shown no benefit or even negative effects with treatment.[15] Most importantly, the largest and best study to date, the Women’s Health Initiative, showed that taking HRT pills increases the risk of urinary incontinence.[16] Current evidence suggests that HRT pills actually do more harm than good in terms of incontinence.[17] (It is possible that vaginal estrogen creams could produce different results, although these have been tested in only a small number of studies.)[18]
What You Can Do
Elderly people, particularly elderly women, should be aware that taking any of the drugs listed in the table above can cause or worsen urinary incontinence.
If you are experiencing distressing symptoms of urinary incontinence and are taking one of the drugs in the table — or another drug that may affect muscles, nerves or fluid in the body — talk with your doctor about whether it may be possible to improve or eliminate this problem by reducing the dosage, switching to a different drug or stopping treatment entirely.[19]
It is very important that you do not stop taking any of these drugs without first talking to a doctor. Some of the drugs in the table, including antipsychotics and treatments for hypertension, treat serious and even life-threatening conditions. Stopping treatment without supervision from a doctor could be very dangerous. By talking with your doctor, you may be able to find a safe and effective alternative treatment that does not cause urinary incontinence.
References
[1] Drug-induced urinary incontinence. Prescrire Int. 2015;24(162):180, 182.
[2] Ibid.
[3] Ibid.
[4] Ibid.
[5] Gill SS, Mamdani M, Naglie G, et al. A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Arch Intern Med. 2005 Apr 11;165(7):808-13.
[6] Ibid.
[7] Drug-induced urinary incontinence. Prescrire Int. 2015;24(162):180, 182.
[8] Harvard Health Publications. Medications that can cause urinary incontinence. http://www.health.harvard.edu/bladder-and-bowel/medications-that-can-cause-urinary-incontinence. Accessed November 25, 2015.
[9] Drug-induced urinary incontinence. Prescrire Int. 2015;24(162):180, 182.
[10] Ibid.
[11] Ibid.
[12] Robinson D1, Toozs-Hobson P, Cardozo L. The effect of hormones on the lower urinary tract. Menopause Int. 2013;19(4):155-62.
[13] Drug profile: alprazolam (NIRAVAM, XANAX, XANAX XR); chlordiazepoxide (H-TRAN, LIBRITABS, LIBRIUM, MITRAN, POXI); clorazepate (GEN-XENE, TRANXENE); diazepam (DIASTAT, DIAZEPAM INTENSOL, VALIUM); estazolam (PROSOM); flurazepam (DALMANE); halazepam (PAXIPAM); lorazepam (ATIVAN, LORAZEPAM INTENSOL); oxazepam (SERAX); prazepam (CENTRAX); quazepam (DORAL); temazepam (RESTORIL); triazolam (HALCION). WorstPills.org Last reviewed July 31, 2015. /monographs/view/83. Accessed November 16, 2015.
[14] Robinson D1, Toozs-Hobson P, Cardozo L. The effect of hormones on the lower urinary tract. Menopause Int. 2013 Dec;19(4):155-162.
[15] Ibid.
[16] Ibid.
[17] Cody JD, Jacobs ML, Richardson K, Moehrer B, Hextall A. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database of Systematic Reviews. 2012, (10): CD001405.
[18] Ibid.
[19] Drug-induced urinary incontinence. Prescrire Int. 2015 Jul;24(162):180, 182.
