Drug-induced urinary incontinence

Nr 5|2017 (51)|Page 43-48|Main article|26-05-2017

Urinary incontinence occurs when one of the continence mechanisms fails. The incidence of urinary incontinence rises with increasing age, in both men and women. The exact cause of this has not yet been established. Urinary incontinence occurs in several forms, including stress incontinence, urge incontinence and overflow incontinence. Urinary incontinence can, however, also be caused by the use of certain medicines. The article presents the scientific evidence for drug-induced urinary incontinence. Randomised double-blind trials showing drug-induced urinary incontinence are only available for hormone replacement therapy with oestrogen. Observational studies have found an association between drugs affecting the autonomous nervous system, such as atypical antipsychotics and alpha-blockers, and urinary incontinence. No evidence for an association with urinary incontinence was found in observational studies of cholinesterase inhibitors, which also influence the autonomous nervous system. What is important is that a number of the studies have found that the symptoms disappeared when the use of these drugs was discontinued, which strengthens the evidence for an association between the drugs in question and this side-effect. There is also evidence for a possible association between SSRIs and the development of urinary incontinence. Other drugs which have been associated with urinary incontinence include gabapentin, gonadorelin antagonists and trastuzumab.

Research into urinary incontinence as an adverse effect has been limited, and the level of evidence is low. One favourable exception to this is hormone replacement therapy (HRT). Paradoxically, this is because it was once assumed that HRT would have a favourable effect on urinary incontinence, so its efficacy in this respect was examined in a large-scale randomised double-blind trial. There is usually not enough funding available for thorough research into urinary incontinence as a side-effect, because there is rarely any profit to be made from it.

Since urinary incontinence can negatively affect quality of life, it is useful to check the medication use of patients presenting with this disorder. If patients are already known to have problems of urinary incontinence, the doctor might look for alternatives to the abovementioned drugs before prescribing them. Obtaining evidence for a direct relation between a drug and a side-effect requires that doctors, pharmacists and patients report any suspected adverse effects, preferably stating full details of any temporal relationships, co-medication or other potential causes.

This article is a translation of the French article ‘Incontinence urinaire: des médicaments parfois en cause’ published in our French sister journal La Revue Prescrire 2015; 35: 271-274, adapted to the Dutch situation.

  1. Teunissen D, Dekker JH, Lagro-Janssen LAM, Berghmans LCM, Uijen JHJM, Mientjes GHC, et al. NHG-Standaard ’Incontinentie voor urine bij vrouwen’ (tweede herziening). Huisarts Wet 2015; 58: 368-375.
  2. Blanker MH, Breed SA, van der Heide WK, Norg RJC, de Vries A, Wolters RJ, et al. NHG-Standaard ’Mictieklachten bij mannen’. Huisarts Wet 2013: 56: 114-122.
  3. Bosch JLHR, Prins A. Urologie. Houten: Bohn Stafleu van Loghum, 2010.
  4. CBO-richtlijn ‘Urine-incontinentie bij vrouwen’. Utrecht: CBO & Landelijk Expertisecentrum Verpleging & Verzorging (LEVV, nu V&VN), 2012.
  5. Haylen BT, Ridder D de, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 2010; 21: 5–26.
  6. Boomsma LJ, Van Dijk PA, Dijkstra RH, Van der Laan JR, Van der Meulen P, Ubbink JTh, et al. NHG-Standaard ‘Enuresis nocturna’. Huisarts Wet 2006; 49: 663-671.
  7. Informatorium Medicamentorum. KNMP: ‘s Gravenhage, 2017.
  8. Passier JLM, Bemelmans BLH, Puijenbroek EP van. Antipsychotica soms oorzaak urine-incontinentie. Tijdschr Huisartsgeneesk 2004; 21: 92-93.
  9. Cop E, Oner P, Oner O. Risperidone and double incontinence in a child with autism. J Child Adolesc Psychopharmacol 2011; 21 : 647-648.
  10. Hergüner S, Mukaddes NM. Risperidone-induced double incontinence. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32: 1085-1086.
  11. Mendhekar DN, Duggal HS. Clozapine-induced double incontinence. Indian J Med Sci 2007; 61: 665-666.
  12. Sagar R, Varghese ST, Balhara YP. Olanzapine-induced double incontinence. Indian J Med Sci 2005; 59: 163-164.
  13. Warner JP, Harvey CA, Barnes TRE. Clozapine and urinary incontinence. Int Clin Psychopharmacol 1994; 9: 207-209.
  14. Lin CC, Bai YM, Chen JY, Lin CY, Lan TH. A retrospective study of clozapine and urinary incontinence in Chinese in-patients. Acta Psychiatr Scand 1999; 100: 158-161.
  15. Fuller MA, Borovicka MC, Jaskiw GE, Simon MR, Kwon K, Konicki PE. Clozapine-induced urinary incontinence: incidence and treatment with ephedrine. J Clin Psychiatry 1996; 57: 514-518.
  16. Kumazaki H, Watanabe K, Imasaka Y, Iwata K, Tomoda A, Mimura M.
    Risperidone-associated urinary incontinence in patients with autistic disorder with mental retardation. J Clin Psychopharmacol 2014; 34: 624-626.
  17. Quetiapine and micturation disorders. Nederlands Bijwerkingen Centrum Lareb Augustus 2005. Via: https://databankws.lareb.nl/Downloads/kwb_2005_3_queti.pdf.
  18. Informatie over aantal meldingen bij quetiapine. Kennisbank Lareb 2017. Via: www.lareb.nl.
  19. Productinformatie quetiapine (Seroquel®), via: www.ema.europa.eu, human medicine’s, EPAR’s.
  20. Marshall HJ, Beevers DG. Alpha-adrenoceptor blocking drugs and female urinary incontinence: prevalence and reversibility. Br J Clin Pharmacol 1996; 42: 507-509.
  21. Peron EP, Zheng Y, Perera, S, Newman AB, Resnick NM, Shorr RI, et al. Antihypertensive drug class use and differential risk of urinary incontinence in community-dwelling older women. J Gerontol A Biol Sci Med Sci 2012; 67: 1373-1378.
  22. Knol W, Verduijn MM, Lelie-van der Zande ACAM, van Marum RJ, Brouwers JRBJ, van der Cammen TJM, et al. Onjuist geneesmiddelgebruik bij ouderen opsporen. De herziene STOPP- en START-criteria. Ned Tijdschr Geneeskd. 2015;159:A8904.
  23. Hamilton H, Gallagher P, Ryan C, Byrne S, O’Mahony D. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med 2011; 171: 1013-1019.
  24. Kröger E, Van Marum R, Souverein P, Carmichael PH, Egberts T. Treatment with rivastigmine or galantamine and risk of urinary incontinence: results from a Dutch database study. Pharmacoepidemiol Drug Saf 2015; 24: 276-285.
  25. Steinauer JE, Waetjen LE, Vittinghoff E, Subak LL, Hulley SB, Grady D, et al. Postmenopausal hormone therapy: does it cause incontinence? Obstet Gynecol 2005; 106: 940-945.
  26. Hendrix SL, Cochrane BB, Nygaard IE, Handa VL, Barnabei VM, Iglesia C, et al. Effects of estrogen with and without progestin on urinary incontinence. JAMA 2005; 293: 935-948.
  27. Cody JD, Jacobs ML, Richardson K, Moehrer B, Hextall A. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev 2012; 10: CD001405.
  28. Votolato NA, Stern S, Caputo RM. Serotonergic antidepressants and urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2000; 11: 386-388.
  29. Polimeni G, Salvo F, Cutroneo P, Nati G, Russo A, Giustini ES, et al. Venlafaxine-induced urinary incontinence resolved after switching to sertraline. Clin Neuropharmacol 2005; 28: 247-248.
  30. Hansen LK. Venlafaxine-induced increase in urinary frequency in 3 women. J Clin Psychiatry 2004; 65: 877-878.
  31. Movig KL, Leufkens HG, Belitser SV, Lenderink AW, Egberts AC. Selective serotonin reuptake inhibitor-induced urinary incontinence. Pharmacoepidemiol Drug Saf 2002; 11: 271-279.
  32. Kibar S, Demir S, Sezer N, Köseo?lu BF, Dalyan Aras M, Kesikburun B. Gabapentin-induced urinary incontinence: a rare side effect in patients with neuropathic pain. Case Rep Neurol Med. 2015; 2015: 341573.
  33. Anoniem. Goséréline - Zoladex°. Cancer de la prostate localement avancé : un intérêt ? peser au cas par cas. Rev Prescrire 2000; 20: 101-102.
  34. Anoniem. Leuproréline - Eligard°, Enantone° LP, triptoréline - Décapeptyl° LP ou autre. Cancers de la prostate "localement avancés" : des "me too" évalués a minima. Rev Prescrire 2007; 27: 412.
  35. Hinkel A, Strumberg D, Noldus J, Pannek J. Observation of de novo bladder dysfunction under treatment with Her2-neu antibodies. Urol Int 2011; 86: 80-84.

*The literature refers to the Dutch text.