Drugs That Worsen Urinary Incontinence

There are a few drugs that I remember when reviewing issues associated with urinary incontinence. Here’s my list of common drugs that worsen urinary incontinence.

First, we must discuss the term incontinence. In general, it is a pretty vague term and can be associated with different medical processes. Incontinence simply means any involuntary or accidental loss of urine. It also can be considered as the loss of control of the bladder.

Understanding this terminology, we can recognize that certain agents may allow for a relaxation of the bladder tissue and thus, increase the ease at which urine passes out of the body. Alpha-blockers are a commonly used agent in BPH which allows for easier passage of urine. This potentially beneficial effect can be a detriment in some patients. Patients with urge or stress incontinence may have symptoms worsened with the use of alpha-blockers. The most common indications I see in clinical practice with the use of alpha-blockers (besides BPH) is PTSD with nightmares (prazosin) and hypertension. We have much better agents for hypertension so the use of alpha-blockers for this indication is typically a last resort.

We use anticholinergic medications to help “retain” urine and manage symptoms of urge incontinence. On the flip side, cholinergic agonists and those medications with similar effects can allow easier passage of urine. Drugs like donepezil (for dementia) can increase cholinergic activity and may worsen urinary incontinence and symptoms of urge incontinence.

In clinical practice, there is one medication class that stands above the rest in its ability to exacerbate symptoms of urge incontinence and urinary frequency. Diuretics increase the amount of fluid to the bladder which is going to exacerbate the urinary sensation and increase the amount of frequency a patient has. In general, the more potent (or the higher the dose) the diuretic, the more likely you are to have patients report symptoms.

Be really careful with diuretics, heart failure, and urinary frequency. Patients generally understand that their “water pill” is responsible for them going to the bathroom frequently. Under certain circumstances, these patients may stop taking their diuretic (at least short-term) because urinary frequency is so bothersome. Be sure you ask about situational holding of diuretics because many patients who have an active social schedule may have certain days where they want to avoid going to the bathroom frequently.

I’m going to leave you with this case scenario from the past in regards to common drugs that can worsen BPH.

What else would you add to this list?

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Written By Eric Christianson

November 29, 2020

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