When talking about incontinence, some of the more common causes are things such as a weakened pelvic floor, BPH, or the cumulative effects of aging. One of the less talked-about causes or contributors to incontinence is medications. While there are four groups or types of medications directly linked to incontinence symptoms, other medications can contribute to or worsen symptoms for someone already experiencing incontinence.
Knowing which medications cause incontinence and how to discuss them with your provider can help you make the best plan going forward. As a nurse, I help patients understand their medical conditions and advocate for them to ensure they receive care that meets their personal goals and needs.
How Medications Can Impact Bladder Control
The exact mechanism by which each drug causes or worsens incontinence has not been well studied. There is some consensus that medications affect the lower urinary tract because the body excretes them through urine. This means any medications you take pass through your bladder and lower urinary tract.
The bladder has receptors that communicate back to your brain. These bladder receptors are sensitive to medications; depending on the signals they send to the brain, they can change your bladder storage capacity. This means your bladder may hold less urine before signaling it needs to empty, or it may hold too much urine and not signal at all. Both of these can lead to urinary incontinence that is directly related to medications you may be taking.
Which Medications Can Cause Incontinence?
These are four types of medications that can cause incontinence. Not every medication causes the same side effects, so discuss any potential side effects or symptoms with your medical provider.
Diuretics: Diuretics are used for several reasons, but most commonly to help manage high blood pressure and congestive heart failure (CHF). Diuretics work by drawing more salt and water out of your body and into your urine. By removing excess fluid, they can lower blood pressure and make it easier for your heart to work.
While managing blood pressure and CHF is essential, a common diuretic side effect is increased urine production. This can cause urgency (the need to go right away with little to no warning) and incontinence (defined as any involuntary leakage of urine).
Antidepressants and Antipsychotics: Medications called antidepressants are most commonly used to treat depression and/or anxiety. However, they can also be used off-label (a term used to describe when a medication is given for a condition it was not created for) to treat other conditions. Antipsychotics are a medication type commonly used to treat conditions such as schizophrenia, mood disorders, ADHD, obsessive-compulsive disorder(OCD), and other conditions such as acute psychosis. Studies have shown that anywhere from 1-42% of people taking these medications experience incontinence as a side effect.
As discussed above, the exact mechanism behind how these medications cause incontinence is not fully understood.
Estrogen: The use of estrogen and other hormone replacement therapy is commonly used for women during perimenopause and menopause to treat symptoms. The use of oral estrogen has been linked to causing incontinence, especially after menopause in women. However, it is important to note that the use of topical estrogen does not have the same effect and can actually be used to treat incontinence.
Oral estrogen can change the body’s natural hormone balance, which can lead to tissue changes in the bladder and pelvic floor. These changes can lead to incontinence for some people.
Sedatives/sleeping pills: Unlike other medications that can cause incontinence, the effect of sedatives and sleeping pills is more indirect. When taking these medications, most people become lethargic, have a decreased reaction time, and can become sedated. As a result, they are less likely to respond promptly to the urge to urinate. This can result in incontinence episodes only while under the influence of the medication. This effect can be more prevalent with older adults who are more sensitive to these medications, and especially those who already are experiencing incontinence.
Since these medications are commonly taken at night (especially sleep aids), nighttime bedwetting can increase because it’s easy to sleep through the night without waking up, even if your bladder is full.
How to Manage Medications and Urinary Incontinence
It’s important to know that medications can cause or contribute to urinary incontinence. One study found that more than half of patients who reported urinary incontinence from a medication developed symptoms within one month of starting treatment. I recommend that whenever you start a new medication or change the dose of a current one, you write down any side effects you notice. This can include urinary incontinence and other symptoms. You can then provide your healthcare provider with a detailed timeline of any side effects you are noticing. This can help them determine if it is related to the medication or possibly something else.
Knowledge is power in healthcare and self-advocacy, so knowing what’s normal for your body helps you have meaningful discussions. In some cases, a medication’s benefits outweigh unwanted side effects like incontinence. But you should still discuss these with your provider. Developing incontinence due to a medication can be challenging and frustrating, but there are ways to help manage leaks and improve quality of life.
These are some tips for managing incontinence
Managing salt intake: If you take diuretics or other medications to lower blood pressure or manage CHF, your provider may have recommended limiting your salt intake. This prevents your body from holding onto excess water. Following your provider’s salt-intake recommendation can reduce the fluid your body needs to remove, which may lessen incontinence. Unless your provider specifies otherwise, reducing salt intake is good for most people, regardless of diagnosis. Salt makes the kidneys, heart, and other organs work harder. Current salt recommendations for adults are no more than 2300mg per day.
Pelvic floor therapy: Pelvic floor therapy helps to strengthen the muscles that control urine flow. Men and women can benefit from pelvic floor therapy. This is a great option for anyone experiencing incontinence or pelvic discomfort. If you are taking medications that cause or worsen incontinence, pelvic floor therapy may not eliminate your symptoms, but it can still help improve them.
Incontinence Products: Even with the methods above, many people still experience incontinence while taking certain medications. If the medication is more beneficial to your health, and after discussing it with your provider, you can choose to manage incontinence with incontinence products. These are designed to protect you from unwanted leaks while still letting you live your life. Incontinence products come in different sizes and styles, such as pull-up disposable underwear, briefs (like a tabbed diaper), and various pads and liners. It is a good idea to try different products to see what best meets your needs. Follow manufacturer sizing guides before ordering for the best fit.
Talk to Your Provider Before Blaming Your Bladder
Medications can come with numerous side effects, and we don’t always read the fine print. If you have started a new medication and begin to experience incontinence, or previous symptoms worsen, make sure to discuss them with your provider. Blaming our bladder can feel like the obvious choice, but many other factors can be contributing. Understanding how medications work and why they may affect bladder function can help you have more meaningful discussions with your provider and work toward a manageable solution.
