Drug-Induced Urinary Incontinence

Urinary incontinence — the involuntary leakage of urine from the bladder — is a very common problem, particularly in older adults and women. It is estimated that up to one-third of men older than 65 years and more than half of women older than 59 years have some degree of urinary incontinence.[1],[2]

Urinary incontinence often causes people to limit their activities and adversely affects quality of life.[3] The condition is associated with depression and anxiety, work impairment and social isolation.[4]

Urinary incontinence develops for many reasons, often involving structural problems with the muscles and nerves that control bladder function. Importantly, numerous prescription and over-the-counter drugs can cause or exacerbate urinary incontinence. Knowing which medications prescribed or recommended by your doctor cause urinary incontinence will allow you to take steps to prevent or minimize this common, troubling adverse drug effect.

Types of urinary incontinence

There are three major types of urinary incontinence:

• urge urinary incontinence;
• stress urinary incontinence; and
• overflow urinary incontinence.

Urge urinary incontinence happens when a person has a sudden, uncontrollable urge to void and has difficulty making it to the bathroom before urine accidentally leaks out of the bladder.[5],[6] It is the most common type of urinary incontinence in men.[7] Many patients with urge urinary incontinence have overactive bladder syndrome,[8] which is caused by involuntary contractions of the bladder muscles, even when the amount of urine in the bladder is low.[9]

Stress urinary incontinence occurs in the absence of bladder contractions when increased external pressure is placed on the bladder, such as during exercising, coughing, sneezing or lifting heavy objects.[10].[11] It is due to, among other things, inadequate function of the muscle of the urethra that normally holds the bladder closed and relaxes during voiding.

Overflow urinary incontinence, which is less common than the first two types of urinary incontinence, occurs when urine is retained in the bladder due to incomplete voiding.[12] It can be caused by partial blockage of urine outflow from the bladder due to prostate enlargement or narrowing of the urethra and by inadequate contraction of the bladder wall muscles due to neurologic conditions such as peripheral neuropathy from diabetes or spinal cord injury.[13]

Medications

Medications can cause or exacerbate urinary incontinence through their effects on the nerves or muscles that control bladder function.[14] Specifically, certain medications may do one or more of the following:

• Relax the muscles in the urethrathat normally keep the bladderclosed
• Increase contractions of the bladder muscles
• Cause urine retention (incomplete emptying of the bladder)by decreasing contractions of thebladder muscles or increasingcontractions of the muscles inthe urethra

Other drugs can cause urinary incontinence by impairing cognitive function, which can lead to confusion or drowsiness, or by increasing urine output by the kidneys.[15]

The list of drugs that have been linked to urinary incontinence is lengthy (see the Table, below, for examples) and includes the following:

• certain medications for treating abnormal heart rhythms
• alpha blockers used to treat hypertension (high blood pressure)and/or benign prostatic hypertrophy (enlargement)
• angiotensin-converting enzyme(ACE) inhibitors used to treat hypertension and heart failure
• first-generation antihistamines for treating allergic conditions
• antipsychotics
• benzodiazepine sedatives
• decongestants
• diuretics (water pills) for treatingheart failure and other conditions that lead to fluid overloadand swelling
• muscle relaxants
• opioid analgesics
• drugs for treating overactive bladder
• anticholinergic medications used to treat Parkinson’s disease
• tricyclic antidepressants
• [16]

Examples of Drugs That Can Cause or Exacerbate Urinary Incontinence

†Combination brand-name drug that contains one or more other active ingredients
*Designated as Limited Use by Worst Pills, Best Pills News
**Designated as Do Not Use by Worst Pills, Best Pills News

What You Can Do

If you experience urinary incontinence, review all of your medications with your doctor to determine whether any of them may be contributing to your problem. If you are taking a drug that can cause or exacerbate urinary incontinence, your doctor may recommend reducing the dosage of the drug or switching to a different medication. Do not stop taking any prescription medication without first talking to your doctor. Be aware that other drugs not listed in this article, as well as alcohol and caffeine, can exacerbate or cause urinary incontinence.
 

References

[1] Clemens JQ. Urinary incontinence in men. UpToDate. Updated January 3, 2022.

[2] Lukacz ES. Female urinary incontinence: Evaluation. UpToDate. Updated April 6, 2022.

[3] Clemens JQ. Urinary incontinence in men. UpToDate. Updated January 3, 2022.

[4] Lukacz ES. Female urinary incontinence: Evaluation. UpToDate. Updated April 6, 2022.

[5] Clemens JQ. Urinary incontinence in men. UpToDate. Updated January 3, 2022.

[6] Lukacz ES. Female urinary incontinence: Evaluation. UpToDate. Updated April 6, 2022.

[7] Clemens JQ. Urinary incontinence in men. UpToDate. Updated January 3, 2022.

[8] Ibid.

[9] Mayo Clinic. Overactive bladder. May 3, 2022. http://www.mayoclinic.org/diseases-conditions/overactive-bladder/symptoms-causes/dxc-20311824. Accessed June 22, 2022.

[10] Clemens JQ. Urinary incontinence in men. UpToDate. Updated January 3, 2022.

[11] Lukacz ES. Female urinary incontinence: Evaluation. UpToDate. Updated April 6, 2022.

[12] Clemens JQ. Urinary incontinence in men. UpToDate. Updated January 3, 2022.

[13] Ibid.

[14] Drug-induced urinary incontinence. Prescrire International. July 2015;24(162):181-183.

[15] Ibid.

[16] Lukacz ES. Female urinary incontinence: Evaluation. UpToDate. Updated April 6, 2022.