4 Medications That Can Cause or Worsen Incontinence

Ask your doctor if you think medicines may cause your incontinence.

From the WebMD Archives

If you are showing signs of urinary incontinence or if your incontinence problem seems to be getting worse, take stock of your medicine cabinet. Not for a new remedy, but to find overlooked causes of incontinence, or the explanation for your worsening symptoms.

Commonly recommended medications could be the cause of your incontinence, or at least contributing to them.

Medications affect people differently, so one person with incontinence may not notice worsening symptoms, while another person does.

If you suspect medications may be worsening or the cause of your urinary incontinence, describe your incontinence symptoms to your doctor and let him or her know about all the medicines you take, both prescription and over-the-counter. That way, your doctor can help determine whether these medicines should be adjusted or stopped, or if a treatment should be modified.

Here are the most common medicines that can worsen or cause urinary incontinence:

1. High Blood Pressure Medicine as a Cause of Urinary Incontinence

Also called alpha-adrenergic antagonists, these medicines -- including Cardura, Minipress, and Hytrin -- work by dilating blood vessels to reduce your blood pressure.

In women, alpha blockers can relax the bladder. "So, if they cough or sneeze, they might lose urine," says Rodney Appell, MD, director of the Baylor Continence Center at the Baylor College of Medicine, Houston.

If you are a woman on an alpha blocker and you are experiencing urinary incontinence, Appell has this advice: "Go back to the internist who prescribed the alpha blocker and ask if there is something else you can be treated with."

In men, these medications actually are prescribed to help with urination problems. In men with an enlarged prostate, a condition called benign prostatic hyperplasia, or BPH, alpha blockers can help relax the muscles in the bladder neck, letting urine flow more easily and improving symptoms of BPH.

2. Antidepressants as a Cause of Urinary Incontinence

While a few antidepressants actually help urinary incontinence (Tofranil and Elavil), most can worsen symptoms of urinary incontinence, at least in some people, Appell tells WebMD.

Antidepressants can impair the contractility of the bladder, and that can worsen symptoms of overflow incontinence, in which the bladder can't empty completely. Other antidepressants may decrease your awareness of the need to void.

If you think your antidepressant is worsening your incontinence, talk to your doctor about switching to another medication.

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3. Diuretics as a Cause of Urinary Incontinence

Commonly called "water pills," diuretics work in the kidney to reduce blood pressure by flushing excess water and salt out of the body.

"If you take your diuretic, you are making more urine," says David Ginsberg, MD, a urologist and associate professor of clinical urology at the Keck School of Medicine, University of Southern California, Los Angeles.

That translates to more bathroom visits and a worsening of incontinence symptoms, he says.

"If you need the diuretic, you need it," says Ginsberg. But he recommends you pay more attention to the recommended incontinence treatments, following your doctor's instructions to the letter.

That may mean paying more attention to doing your Kegel exercises, designed to strengthen the pelvic floor muscles. Weakened pelvic floor muscles are often the cause of a common type of urinary incontinence called stress incontinence, in which small amounts of urine are leaked, especially when you cough, sneeze, or laugh.

Once you learn how to do Kegel exercises correctly (ask your gynecologist or internist for help), you can do them nearly anytime -- even while driving a car or watching TV or sitting at your desk.

If nighttime incontinence is a problem, you might ask your doctor if you could take the diuretic in the morning, suggests Jennifer Anger, MD, MPH, a urologist at Santa Monica -- UCLA Medical Center, Santa Monica, Calif., and an assistant professor of urology at the University of California Los Angeles' David Geffen School of Medicine.

That way, the volume of urine would be greater in the morning and hopefully taper off as the day goes on.

4. Sleeping Pills as a Cause of Urinary Incontinence

Only a small percent of people with incontinence have a problem with bed-wetting, according to Anger, who estimates about 10% of patients with incontinence wet the bed. However, sleeping pills may pose a problem for those with incontinence at night.

"Sleeping pills can make things worse because people don't wake up [when their bladder is full]," she says.

As an alternative, cut down on caffeine so you sleep better on your own, Anger suggests.

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"Sleeping pills are overprescribed," Appell tells WebMD. And if you already have incontinence, it can worsen the situation. "You wake up in a puddle," he says.

He encourages patients to look for alternatives to help them sleep. "If someone needs a little something to help them go to sleep, an antihistamine, like Benadryl, can be helpful," Appell says.

Paying attention to lifestyle can help, too. "Exercise so you will be tired," Appell suggests.

Sleep will come more easily if you keep a regular bedtime and wake-up schedule, according to the National Sleep Foundation. You can also develop a relaxing bedtime ritual, such as reading a book or listening to soothing music.

How to Talk About Urinary Incontinence

Bringing up the topic of urinary problems with your doctor or your spouse is never easy; most people are at least a bit embarrassed. But open communication can help you find out about the causes of incontinence and whether your medications may be contributing.

One good opener might be something like this: "I have been having bladder troubles."

If you will be visiting a new doctor, and have not yet selected him or her, you might seek out a doctor of the same sex, if you think that would help you feel more comfortable. Or, you might bring up the topic first with your doctor's nurse.

Preparing for the conversation about urinary incontinence may help you feel more in control. That means being able to answer the questions your doctor is likely to ask, including:

  • When did your urinary incontinence symptoms begin?
  • Have you had urinary incontinence symptoms before?
  • What medications are you on, and when did you start each of them?

You may find it easier to talk about incontinence if you acknowledge it as a medical condition that needs treatment, just as high blood pressure, arthritis, or high cholesterol does. Treatment options are plentiful, and nearly everyone can be helped so that symptoms, if they don't abate, improve.

WebMD Feature Reviewed by Louise Chang, MD on January 17, 2007

Sources

SOURCES: Jennifer Anger, MD, MPH, urologist, assistant professor of urology, David Geffen School of Medicine, UCLA; attending physician at Santa Monica -- UCLA Medical Center, Santa Monica, Calif. Rodney Appell, MD, director, Baylor Continence Center, Baylor College of Medicine, Houston. David Ginsberg, MD, urologist and associate professor of clinical urology, Keck School of Medicine, University of Southern California, Los Angeles. Merck Manual: "Urinary Incontinence." The American Geriatric Society Foundation for Healthy Aging: "Incontinence." National Heart Lung and Blood Institute: "Your Guide to Lowering High Blood Pressure." National Institutes of Health: "Your Body's Design for Bladder Control." The National Sleep Foundation: "Healthy Sleep Tips."

© 2007 WebMD, Inc. All rights reserved.

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