Treatment of urinary incontinence

(Date: August 2017. Version: 1a)

This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.

What is urinary incontinence?

Urinary incontinence is involuntary leakage of urine. It is common during pregnancy due to hormonal changes and pressure exerted on the bladder by the developing baby, and is frequently experienced by women after childbirth. Urinary incontinence can also occur as a result of problems with the nerves that control the bladder or other abnormalities of the urinary system that are not related to being pregnant.  

How can urinary incontinence be treated during pregnancy?

Urinary incontinence that occurs due to pregnancy (‘stress incontinence’) is generally not treated with medication. Pelvic floor exercises are recommended for all women during pregnancy and immediately after birth to reduce the risk of urinary incontinence in the future.

Urinary incontinence due to problems with the nerves that control the bladder or due to an abnormality of their bladder structure may be treated with medicines such as darifenacin, fesoterodine, flavoxate, mirabegron, oxybutynin, propantheline, propiverine, solifenacin, tolterodine or trospium, often in combination with pelvic floor exercises and bladder training. Use of such medicines may therefore need to be considered during pregnancy in a woman who has one of these underlying conditions.

Are medicines for urinary incontinence safe to use during pregnancy?

The only urinary incontinence medicine for which information on use in human pregnancy is available is oxybutynin. A single small study has reported pregnancy outcomes in 53 women who took oxybutynin in pregnancy. There was no indication of any increased risk of miscarriage or birth defects in the babies of these women. Although this study does not flag up any concerns, it involves only a very small number of women and other possible effects on their pregnancies were not investigated. Information therefore needs to continue to be collected and studied before an assessment of the safety of oxybutynin use in pregnancy can be made.

As no studies of use in pregnancy of other medicines to treat urinary incontinence have been carried out, the effects of these medicines on a developing baby are unknown.

When deciding whether to use a urinary incontinence medicine in pregnancy it is necessary for women and their doctors to weigh up the risks and benefits to both mother and baby of not taking a specific treatment against those of taking the treatment. The outcome of this assessment will vary from person to person and will depend on various factors including the severity of the mother’s condition and the complications that could arise if her treatment is altered.

What if I have already used a medicine to treat urinary incontinence during pregnancy?

If you are taking any medicines it is always a good idea to let your doctor know that you are pregnant so that you can decide together whether you still need the medicines that you are on or whether you might need to switch to a different medicine.

Will my baby need extra monitoring during pregnancy?

As part of their routine antenatal care most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects and to check the baby’s growth.

Because the potential fetal effects of urinary incontinence medication use in pregnancy are largely unknown your doctor may suggest extra monitoring of your baby, including more detailed or earlier scans to detect birth defects, and more frequent reviews of the amniotic fluid levels and your baby’s growth in the womb.

Are there any risks to my baby if the father has taken a urinary incontinence medicine?

There are no scientific reports of babies born to men who used a urinary incontinence medicine around the time of conception. Most experts agree that the majority of medicines used by the father are unlikely to harm the baby through effects on the sperm. However, more research on the effects of urinary incontinence medicines specifically and medicine use in men around the time of conception generally is needed.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.

General information 

Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks.  They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.

Medicines use in pregnancy

Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby.  There are, however, some medicines that can harm a baby’s normal development.  How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.

If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.

When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.   

Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.

   

www.medicinesinpregnancy.org

Disclaimer: This information is not intended to replace the individual care and advice of your health care provider. New information is continually becoming available. Whilst every effort will be made to ensure that this information is accurate and up to date at the time of publication, we cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes following decisions made on the basis of this information. We strongly advise that printouts should NOT be kept for any length of time, or for “future reference” as they can rapidly become out of date.

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