CBD and Urinary Incontinence: No Evidence of Increased Risk
There is no evidence that medical-grade CBD increases urinary incontinence; in fact, preclinical research suggests CBD may reduce bladder contractility and potentially improve incontinence symptoms, though clinical data in humans remains limited. 1
Evidence from Research Studies
Preclinical Findings Suggest Potential Benefit
- Laboratory studies demonstrate that CBD-enriched cannabis extracts significantly reduce acetylcholine-induced bladder contractions in both rat and human bladder tissue, suggesting a potential therapeutic rather than harmful effect on bladder control 1
- The inhibitory effect of CBD on bladder contractility could theoretically provide benefit for overactive bladder symptoms rather than worsening incontinence 1
- Cannabis-based medicines containing CBD have been shown to reduce urinary urgency, incontinence episodes, frequency, and nocturia in patients with multiple sclerosis, though these products typically contain multiple cannabinoids 1
Absence of Clinical Reports Linking CBD to Incontinence
- Current clinical guidelines on urinary incontinence management do not identify CBD or cannabinoids as causative agents for incontinence 2, 3
- Comprehensive reviews of drug-induced urinary incontinence do not list CBD among medications known to cause or worsen incontinence 4
- The American College of Physicians position paper on cannabis (2024) does not mention urinary incontinence as an adverse effect of CBD, despite detailing numerous other potential harms including sedation, cardiovascular effects, and hepatotoxicity 2
Known Adverse Effects of CBD (Not Including Incontinence)
Common Side Effects
- The most frequently reported adverse effects of CBD include dizziness, confusion, dry mouth, and fatigue—but not urinary symptoms 2
- CBD presents dose-dependent risks for hepatotoxicity, with elevated liver enzymes occurring primarily at doses exceeding 300 mg/day 2
Serious But Rare Effects
- More serious adverse effects include tachycardia, orthostatic hypotension, severe confusion, and paranoia, particularly with excessive dosing 2
- In elderly patients, sedation and obtundation may occur, potentially increasing fall risk 2
Clinical Context and Caveats
Distinguishing CBD from THC-Containing Products
- Pure CBD products (such as FDA-approved Epidiolex) should be distinguished from cannabis products containing THC, which have different pharmacological profiles 2
- Products labeled as "CBD" may contain trace amounts of THC, which could theoretically have different effects on bladder function 5
Populations at Higher Risk for Incontinence (Unrelated to CBD)
- Women with diabetes have 30-100% increased risk of urinary incontinence, particularly urge incontinence, due to polyuria, neurogenic bladder, and autonomic insufficiency 2
- Older adults are at baseline higher risk for incontinence due to multiple factors including medications, functional impairment, and comorbid conditions 2
Medications That Actually Cause Incontinence
- Alpha-1 adrenoceptor antagonists, antipsychotics, benzodiazepines, and certain antidepressants are established causes of drug-induced urinary incontinence 4
- Diuretics can worsen incontinence through increased urine production, though this is a functional rather than direct bladder effect 4
Important Clinical Considerations
If Incontinence Develops During CBD Use
- Evaluate for other causative factors including new medications, urinary tract infection, constipation, metabolic disorders, or worsening of underlying neurological conditions 2
- Consider that correlation does not equal causation—incontinence developing during CBD use is more likely due to other factors given the absence of mechanistic or clinical evidence linking CBD to incontinence 1
Monitoring Recommendations
- While urinary incontinence monitoring is not specifically required for CBD use, patients should be asked about urinary symptoms as part of routine care, particularly in high-risk populations 2
- Focus monitoring efforts on established CBD adverse effects: liver function tests for hepatotoxicity (especially at doses >300 mg/day), cardiovascular parameters in elderly patients, and mental status changes 2