Can depression cause urge incontinence?

Depression and Urge Incontinence: The Connection and Management

Depression can contribute to urge incontinence through altered serotonin pathways that normally inhibit bladder contractions, creating a bidirectional relationship between these conditions. 1

The Relationship Between Depression and Urinary Incontinence

• Depression is a recognized risk factor for urinary incontinence, particularly urge incontinence, with serotonergic neuronal systems implicated in both conditions 1
• Studies show that 60% of patients with idiopathic urge incontinence have depression or an abnormal Beck Depression Inventory score, compared to only 17% of continent controls 1
• Depression is listed among potentially modifiable risk factors for urinary incontinence, alongside smoking, caffeine consumption, diabetes, vaginal atrophy, and constipation 2

Physiological Mechanism

• Descending serotonin pathways from the brain stem normally inhibit bladder contractions; depression with altered serotonin function may reduce this inhibition, predisposing to urge incontinence 1
• This serotonergic connection helps explain why serotonergic antidepressants can be effective in treating urge incontinence 1
• The relationship appears strongest for idiopathic urge incontinence rather than stress incontinence or urge incontinence due to neuropathology or obstruction 1

Evidence for Bidirectional Relationship

• Research demonstrates that changes in depression significantly predict changes in bladder symptoms for women with urinary incontinence undergoing pelvic floor muscle training 3
• Treatment of urge urinary incontinence has been shown to improve depressive symptoms, regardless of treatment type (physical therapy or medication) 4
• A large Norwegian study found that moderate/severe anxiety or depression increased UI prevalence from approximately 28% to 38-44%, with strongest associations for mixed UI 5

Clinical Implications and Management

• Screen for depression in patients with urge incontinence, as treating the depression may improve incontinence symptoms 1, 4
• Consider antidepressants with serotonergic properties for patients with both depression and urge incontinence 1, 6
• For patients with urge incontinence and depression:
  • Begin with behavioral interventions including bladder training and pelvic floor muscle exercises 7, 8
  • Consider weight loss for obese patients 7
  • Address potentially modifiable factors like caffeine consumption and constipation 7, 8
  • For persistent symptoms, antimuscarinic medications or beta-3 adrenergic agonists may be beneficial 7
  • Serotonergic antidepressants may provide dual benefit for both depression and urge incontinence 1, 6

Important Considerations

• High-dose antidepressant use is independently associated with urinary incontinence (OR 1.36), even after adjusting for depression 5
• Anxiolytics were associated with less UI (OR 0.64) after adjustments for anxiety 5
• Case reports suggest that successful treatment of depression can resolve incontinence in some patients without identifiable organic causes 6
• Annual screening for urinary incontinence is recommended for women, with assessment of impact on activities and quality of life 2

Pitfalls to Avoid

• Don't assume all incontinence in depressed patients is purely psychological; proper urological evaluation is still necessary 7
• Don't overlook the possibility that medications used to treat depression may themselves affect urinary symptoms 5
• Don't miss the opportunity to address both conditions simultaneously, as improvements in one condition often lead to improvements in the other 3, 4