Olmesartan Does Not Cause Urinary Incontinence
Olmesartan does not cause urinary incontinence and may actually improve bladder dysfunction in hypertensive patients. The confusion likely arises from olmesartan's well-documented association with severe enteropathy (intestinal damage), not urinary symptoms 1.
Key Evidence Against Urinary Incontinence
Olmesartan improves bladder function in hypertensive patients by restoring bladder blood flow and reducing oxidative stress, leading to decreased urinary frequency and improved voiding volumes in animal models 2.
In human studies, olmesartan increases urinary ACE2 levels, which is associated with renoprotective effects rather than bladder dysfunction 3, 4.
The drug class (angiotensin II receptor blockers/ARBs) is not listed among medications that cause urinary incontinence in comprehensive reviews of drug-induced incontinence 5.
Important Distinction: Olmesartan Enteropathy
Olmesartan causes severe enteropathy (intestinal villous atrophy) that mimics celiac disease, presenting with diarrhea, weight loss, and malabsorption—not urinary symptoms 1.
This enteropathy responds rapidly to drug cessation and should not be confused with urinary tract effects 1.
Other ARBs have also been reported to cause similar enteropathy but are not associated with urinary incontinence 1.
Medications That Actually Cause Urinary Incontinence
For context, drugs that genuinely cause urinary incontinence include:
Alpha-blockers (e.g., doxazosin) cause stress incontinence by reducing urethral tone 6, 5.
ACE inhibitors (e.g., enalapril) cause persistent cough that can trigger stress incontinence episodes 6.
Antipsychotics, benzodiazepines, and certain antidepressants may induce incontinence through central nervous system effects 5.
Clinical Bottom Line
If a patient on olmesartan develops urinary symptoms, investigate alternative causes rather than attributing them to the medication. In diabetic patients taking olmesartan for nephropathy, urinary urgency is far more likely due to diabetic autonomic neuropathy (affecting 43-87% of type 1 diabetics and 25% of type 2 diabetics) than the medication itself 1, 7.