Incontinence – Don’t seek a pill, find the cause

There are several different types of incontinence, the unintentional loss of urine. Stress incontinence occurs when there’s an increase in the pressure in the abdomen, such as with coughing, sneezing, or bending over, when there’s a lack of support in the lower urinary tract.  It isn’t from psychological stress, as the name may suggest. Stress incontinence is common after giving birth as well as from a lack of estrogen. Urge incontinence is more aptly named because those that have it have periodic, sudden, intense urges to void. It is often caused by or made worse by components of foods and fluids that are irritating to the lining of the bladder. While women are more prone to stress incontinence, both sexes can be affected by urge incontinence. Overflow incontinence is caused by several things, such as a weakening of the bladder muscle. Disorders and some drugs, such as strong pain medications can cause this.

There have been many drugs developed for urge incontinence and they can help some people avoid involuntary urine loss. Like most medications, they have some significant side effects. One large group of incontinence medicine is anticholinergics. They block aspects of the “rest and digest” part of the autonomic (involuntary) part of the nervous system. This maintenance nerve network has functions that are the opposite of the “flight or fight” involuntary response that helps the body survive threats to health and survival. So, blocking this “rest and digest” has the effect of mimicking the flight or fight response such as inhibiting urine flow, making urination less likely. That produces the intended affect but can cause urine retention, especially if prostate problems are also present. Because they decrease bladder muscle contraction, they can make it harder to empty the bladder completely and even lead to overflow incontinence.1

Drugs in this class also slow normal peristalsis that moves food and wastes through the GI tract, thus potentially causing constipation. They also increase the heart rate, decrease the flow of saliva and prevent pupil constriction. Thus heart pounding, dry mouth and blurred vision.2 This happens because blocking the rest and digest system allows more input from the flight or fight response. Those stress response effects are unpleasant, to say the least. They are more likely to cause problems for those with glaucoma, prostate enlargement, or thyroid disease.

Anticholinergics can also cause confusion and short-term memory problems. This can be an especially serious problem for the elderly.3 Unfortunately, that is the population most likely to experience incontinence. It is estimated that 30% of elderly women and 15% of elderly men experience incontinence. Due to the nature of incontinence, that is probably a grossly underestimated.

But even more important is the lack of need for such medications. For stress incontinence, Kegel exercises can sometimes help. Although it may not sound like an acceptable treatment for some, pessaries can help support the tissues. These fitted devices fit in the vagina and can be a big help to many women.

There are various foods, drinks, and medications that can cause urge incontinence. Some, like tea, coffee, alcohol, and orange juice, are common causes. But what causes urge incontinence in one person doesn’t have that effect in another. It’s easy to do an Internet search and find lists of possible triggers and then keep a diary of foods and drinks that seem to cause it. It isn’t necessary to avoid those things if a bathroom is going to be readily available. Usually they only need to be avoided before trips, errands or any situation where it isn’t easy to get to a bathroom. For elderly individuals with urge incontinence, permanent avoidance may be necessary since rushing to a bathroom carries a fall risk. But is avoiding a particular food or drink really such a sacrifice? And isn’t it better to do an exercise or avoid something that to take another pill that can potentially cause so much harm? Considering some of the side effects, avoiding such drugs could, for some individuals, be a life-saver.

This article is not intended to replace your health care provider. The intent is to inform people about this problem and possible solutions that affected individuals can discuss with their health care provider.


 1   The Merck Manual of Diagnosis and Therapy, 19th Edition, Merck, Sharp & Dohme, Corp, Whitehouse Station, NJ, 2011.

2 Neel, Armon and Hogan, Bill, Are Your Prescriptions Killing You?  Atria Books, New York, NY, 2012.

3   Neel and Hogan, Are Your Prescriptions Killing You?

     4  The Merck Manual of Diagnosis and Therapy.


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