MANAGEMENT OF URINARY FREQUENCY, ENURESIS & INCONTINENCE IN PREGNANCY

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(Date of issue: August 2017, Version: 1)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

Summary

Urinary incontinence, defined as the involuntary leakage of urine, has multiple causes which may require different interventions. Urinary stress incontinence is common during pregnancy and after childbirth. Pelvic floor exercises during and after pregnancy are therefore advised for all pregnant women, both in the treatment and prevention of urinary stress incontinence. Pharmacological treatment of pregnancy-associated stress incontinence is not routinely indicated.

If pharmacological treatment of urinary incontinence during pregnancy is being considered, for example for woman with complex neurological conditions, specialist input should be sought. A wide range of drugs are currently used, including off-license, to reduce symptoms of urinary frequency, enuresis, and incontinence. These include: darifenacin, fesoterodine, flavoxate, mirabegron, oxybutynin, propantheline, propiverine, solifenacin, tolterodine and trospium. Fetal risk with use in pregnancy is, however, unknown for the majority, with no published human pregnancy safety data available for darifenacin, fesoterodine, flavoxate, mirabegron, propantheline, propiverine, solifenacin, tolterodine and trospium. Pregnancy outcome data is available from UKTIS for a small number of pregnancy exposures to oxybutynin, solifenacin, tolterodine and trospium. Data from a single prospective cohort study of pregnant women are available for oxybutynin but are too limited to enable an evidence-based assessment of risk. 

Adverse fetal effects have been observed in preclinical reproductive toxicity studies of darifenacin, fesoterodine, mirabegron, oxybutynin, propiverine, and tolterodine, however exposure was often at maternally toxic doses. A careful risk-benefit analysis in discussion with the patient is therefore required if use in pregnancy of any of these drugs is being considered.

 
Exposure to drugs used to reduce symptoms of urinary frequency, enuresis and incontinence at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy, however, due to the lack of data, additional fetal monitoring may be warranted. Other risk factors may also be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

                      
This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.