When you look in your medicine cabinet, chances are you're searching for help with incontinence, not worrying about making it worse. But some of the drugs you take every day may be doing just that: triggering incontinence or making a sensitive bladder overactive. Here are seven possible culprits:
1. Blood pressure-lowering drugs
Which ones: Alpha-blockers; brand names Cardura, Minipress, Hytrin; generic names doxazosin mesylate, prazosin hydrochloride, terazosin hydrochloride
Why they may be culprits: Alpha-blockers work to lower blood pressure by relaxing blood vessel walls. The trouble is, they also relax the bladder along with the blood vessels. And alpha-blockers can relax the urethra, the tube leading from the bladder to outside and the muscle at the neck of the bladder. This leaves you prone to stress incontinence, which is leakage when you sneeze, cough, laugh, run, or jump.
What to do: You can start by doing Kegel exercises to increase your ability to control the muscles of the bladder. Good muscle control might be able to overcome the relaxing effects of the alpha-blockers. But if leakage is really a problem, level with your doctor (despite the embarrassment -- he or she has heard it all) and ask to switch meds. Luckily, there are many options for controlling blood pressure, so your doctor can try using a calcium channel blocker or another class of medication that doesn't have this unfortunate effect on your bladder.
2. Hormone therapy
Which ones: Oral estrogen-only or combination estrogen and progesterone pills
Why they may be culprits: This came as a surprise discovery a few years ago, and experts don't know what exactly is going on. Until recently, hormone therapy was actually thought to help with incontinence, but it's now known to trigger or worsen both stress and urge incontinence.
What to do: Talk to your doctor about using topical hormones, such as estrogen and progesterone in cream form, or estrogen patches, which seem to have far fewer incidences of this side effect than oral hormone pills. In fact, for some women topical estrogen applied as a cream or patch helps prevent or lessen incontinence. You can also try progesterone-only therapy, either oral or cream, which hasn't been found to be associated with incontinence. Like so many hormone-related side effects, this one is very individual; it's important to experiment and see what works for you.
More medications that can cause incontinence
3. Antidepressants and other mental health drugs
Which ones: Drugs with anticholinergic effects, which means drugs that block the neurotransmitter acetylcholine; brand names Norpramin, Cogentin, Haldol, Risperdal; generic names nortriptylene, amitriptyline, desipramine, benztropine, haloperidol, risperidone
Why they may be culprits: These medications affect the elasticity of the bladder, preventing it from contracting all the way, so it doesn't fully empty. But urine continues to enter the bladder, leading to overflow incontinence, which happens when the bladder overfills and leaks without giving the signal to go.
What to do: If you think your antidepressant or another anticholinergic drug is affecting your bladder, talk to your doctor about switching to an alternative medication. Interestingly, some tricyclic antidepressants have been found to help with incontinence, so you may need to work with your prescribing doctor and try different ones until you find the one that works for you without unwanted side effects.
Which ones: Any medication prescribed as a diuretic; brand names Bumex, Lasix, Aldactone; generic names bumetanide, spironolactone, furosemide, theophylline, and all the "thalazides" (such as hydrochlorothiazide), which are among the most common first-line medications for hypertension
Why they may be culprits: Diuretics stimulate the kidneys to flush excess water and salt out of the body, making you have to go to the bathroom more frequently. Because your body's producing more urine, it puts increased pressure on the bladder.
What to do: If you need a diuretic to prevent hypertension, you're going to have to find work-around solutions to this problem. Though it's tempting, don't quit taking the diuretic, as you'll lose the protective effect on your heart and cardiac system. Instead, talk to your doctor about experimenting with different diuretics until you find one that doesn't stress your bladder. It may also help to take your diuretic early in the day, rather than at night when you don't want to be running to the bathroom.
More medications that can cause incontinence
5. Decongestants and antihistamines
Which ones: Brand names Sudafed, Contac, Benadryl; generic names pseudoephedrine, diphenhydramine
Why they may be culprits: Decongestants that contain pseudoephedrine tighten the urinary sphincter, causing urine retention, which in women is frequently followed by sudden overflow incontinence. However, in men who have leakage after prostate surgery, Sudafed can temporarily clamp down the bladder muscles, preventing leakage. Some antihistamines relax the bladder and also make you sleepy, which can cause incontinence in the elderly especially.
What to do: Try taking a different decongestant, such as loratadine (brand name Claritin), that doesn't cause bladder-related side effects.
6. Sedatives and sleeping pills
Which ones: Any sedative or sleeping aid that relaxes muscles and makes you sleep deeply; brand names Ativan, Valium, Dalmane, Lunesta, Ambien; generic names diazepam, flurazepam, lorazepam, eszopiclone, zolpidem
Why they may be culprits: Sedatives slow your reflexes, so you don't recognize the signal that it's time to go. Sleeping pills compound the problem by putting you into such a deep sleep that you miss the alert from your bladder to get up. Bed-wetting affects about 10 percent of incontinence sufferers, and experts estimate sleeping pills contribute to the problem in many cases.
What to do: Instead of sedatives and sedative-based sleeping pills, try natural remedies for anxiety and sleep. Melatonin taken an hour before bedtime can be an effective sleep remedy, since it's the natural hormone that tells your brain it's time to sleep. The herbs valerian and hops are sleep aids that haven't been associated with incontinence or bed-wetting. The amino acids 5-HTP or tryptophan and L-Theanine are natural sedatives that don't have muscle-relaxing properties. You might also talk to your doctor about prescription sedatives and sleeping pills that don't cause muscle relaxation.
7. Narcotic painkillers
Which ones: Any opium-based painkiller; brand names OxyContin, MS-Contin, Oramorph; generic names codeine, morphine, oxycodone
Why they may be culprits: Drugs made from opium interfere with the bladder's ability to contract fully. This can lead to urine retention and overflow incontinence. Opioid painkillers also lead to constipation, and studies show that constipation desensitizes the bladder and worsens urge incontinence (the kind when you suddenly have to go).
What to do: Avoid opioid painkillers if you can. If you need pain medication after an injury or surgery, ask your doctor to try nonopioid medications first.