Can diuretics (diuretic medications) affect urinary incontinence?

Diuretics and Urinary Incontinence

Diuretics can worsen urinary incontinence, particularly loop diuretics which cause rapid bladder filling that may trigger urgency and incontinence symptoms. 1

Relationship Between Diuretics and Urinary Incontinence

• Diuretics, especially short-acting loop diuretics like furosemide, can exacerbate urinary urgency, frequency, and incontinence by causing rapid bladder filling that triggers bladder contractions 1, 2
• Studies show that diuretic use is associated with a 3-fold increased risk of urinary frequency (adjusted OR=3.09) and 2.5-fold increased risk of urgency (adjusted OR=2.50) compared to non-diuretic users 2
• Loop diuretics have stronger associations with incontinence symptoms than non-loop diuretics 2
• In patients with chronic kidney disease using diuretics, urgency-related urinary incontinence was reported in 44.9% of patients, with 27.3% of these patients avoiding their diuretics due to urinary symptoms 3

Mechanism of Diuretic-Induced Incontinence

• The bladder contracts in response to rapid stretch, which occurs with short, rapid-acting loop diuretics 1
• Furosemide can cause acute urinary retention related to increased production and retention of urine in patients with bladder emptying disorders, prostatic hyperplasia, or urethral narrowing 4
• In patients with overactive bladder symptoms, the rapid diuresis from loop diuretics can overwhelm the bladder's capacity to store urine, leading to urgency and incontinence 1, 2

Clinical Implications and Management

• Diuretic avoidance due to urinary symptoms is common (15.3% overall), with higher rates among those with urgency incontinence (27.3%) and mixed incontinence (34.6%) 3
• Medication non-adherence due to fear of urinary incontinence may contribute to poorly controlled hypertension or heart failure 1
• For patients with bladder dysfunction who require diuretics, consider:
  • Using longer-acting diuretics like thiazides instead of short-acting loop diuretics 1
  • Extended-release formulations of loop diuretics if loop diuretics are necessary 1
  • Mineralocorticoid receptor antagonists, angiotensin receptor/neprilysin inhibitors, or SGLT2 inhibitors which may allow reduction in loop diuretic dosing 1

Special Populations

• Elderly patients are particularly susceptible to diuretic-induced incontinence, with 72% reporting urinary frequency, 68% reporting urgency, and 73% reporting urge incontinence in one study 2
• Patients with chronic kidney disease have high prevalence of incontinence when using diuretics, which may affect medication adherence 3
• In heart failure patients, the need for diuresis to manage volume overload must be balanced against the risk of worsening urinary symptoms 5, 1

Monitoring and Patient Education

• Patients receiving diuretics should be advised that they may experience symptoms from excessive fluid losses, including urinary frequency and urgency 4
• Patients with bladder emptying disorders require careful monitoring, especially during the initial stages of diuretic treatment 4
• Timing of diuretic administration (e.g., morning rather than evening dosing) may help minimize nighttime urinary frequency and incontinence 1

While diuretics are essential medications for managing conditions like heart failure and hypertension, their impact on urinary symptoms should be considered when selecting therapy, particularly in elderly patients or those with pre-existing bladder dysfunction.