Does Buspar Cause Urinary Incontinence?
Buspirone (Buspar) does not cause urinary incontinence; in fact, rare cases of urinary retention have been reported, which is the opposite problem. 1
Evidence from FDA Drug Label
According to the official FDA labeling for buspirone, urinary retention is listed as a rare adverse effect, not incontinence 1. The genitourinary side effects documented include:
- Infrequent: urinary frequency, urinary hesitancy, menstrual irregularity, dysuria
- Rare: amenorrhea, pelvic inflammatory disease, enuresis (bedwetting), nocturia, and urinary retention
Notably, urinary incontinence is not listed among the adverse effects in the comprehensive FDA safety database 1.
Mechanism and Bladder Effects
Buspirone's primary mechanism involves serotonin (5-HT1A) receptor agonism with no significant effects on GABA or benzodiazepine receptors 1. Research on buspirone's metabolite (1-PP) actually showed it decreased bladder contractions in animal models, suggesting if anything, a potential for urinary retention rather than incontinence 2.
Clinical Context
The confusion may arise because:
- Many medications can cause incontinence through various mechanisms (lowering bladder outlet resistance or increasing intravesical pressure) 3
- Buspirone is sometimes confused with other psychotropic medications that do affect continence
- The rare occurrence of enuresis (bedwetting) is documented with buspirone 1, but this is distinct from daytime urinary incontinence
Important Caveats
If a patient on buspirone develops urinary symptoms, consider:
- Drug interactions: Buspirone is metabolized by CYP3A4, and interactions with other medications could theoretically alter its effects 1
- Concurrent medications: Review other drugs the patient is taking, as antipsychotics, benzodiazepines, antidepressants, and alpha-blockers are more commonly associated with incontinence 3
- Underlying conditions: The anxiety disorder being treated may itself be associated with urinary symptoms
Bottom line: Buspirone should not be discontinued for urinary incontinence, as it is not a known cause. Look for other contributing medications or underlying bladder pathology instead.