CBD for Urinary Incontinence: Not Recommended
There is no evidence supporting CBD use for urinary incontinence, and emerging data suggests regular cannabis use may actually worsen bladder symptoms. The established, evidence-based treatments for urinary incontinence should be used instead.
Why CBD Should Not Be Used
Lack of Evidence for CBD Specifically
- While one small open-label pilot study (n=15) in advanced multiple sclerosis patients showed that a combined THC+CBD extract reduced urgency and incontinence episodes, this was not CBD alone, and the study lacked a control group 1
- Laboratory studies show that CBD-enriched cannabis extracts reduce bladder contractility in vitro, but these are mechanistic studies that do not translate to clinical recommendations for incontinence treatment 2
- No clinical guidelines recommend CBD or cannabis products for urinary incontinence management 3, 4, 5, 6
Evidence of Potential Harm
- A large cross-sectional study (NHANES 2005-2018) found that regular marijuana use is an independent risk factor for overactive bladder (OR 1.39,95% CI 1.16-1.66) and is associated with increased severity of overactive bladder symptoms (OR 1.45,95% CI 1.30-1.60) 7
- Approximately 24% of the US population reports regular marijuana use, making this a significant public health concern 7
- The authors explicitly state their data "do not support the evidence for the use of cannabinoids in the medical treatment of patients with overactive bladder" 7
Evidence-Based Treatment Algorithm Instead
For Stress Urinary Incontinence
- Pelvic floor muscle training (PFMT) is the first-line treatment with strong evidence 4
- Pharmacologic therapy is not recommended for stress incontinence 4
- For obese women, weight loss and exercise effectively reduce symptoms 4
For Urgency Urinary Incontinence
- Bladder training is the mandatory first-line treatment before any medication 4, 6
- Implement weight loss and exercise for obese patients concurrently 6
- Reduce caffeine and manage fluid intake 6
- If bladder training fails after 4-8 weeks, pharmacologic options include:
- Tolterodine or darifenacin as first-line medications (discontinuation rates similar to placebo) 4, 5, 6
- Solifenacin has the lowest risk for discontinuation due to adverse effects (NNTB 9 for achieving continence) 4, 6
- Mirabegron offers lower anticholinergic side effects, particularly important in patients over 60 5, 6
- Avoid oxybutynin due to highest discontinuation rates and cognitive impairment risk in elderly patients 4, 5, 6
For Mixed Urinary Incontinence
- Combined pelvic floor muscle training with bladder training is first-line treatment 4
Clinical Bottom Line
The question about CBD reflects growing public interest in cannabis-based treatments, but the evidence does not support this approach for incontinence. In fact, regular cannabis use may worsen bladder symptoms 7. Direct patients toward proven non-pharmacologic interventions (bladder training, PFMT, weight loss) as first-line therapy, with antimuscarinic medications or mirabegron reserved for urgency incontinence that fails conservative management 4, 5, 6.