Be alert for possible urinary incontinence caused by antipsychotic drugs

Medical Letter consultants are drawing attention to the possibility of antipsychotic-induced urinary incontinence. Both first- and second-generation antipsychotics have been reported to cause urinary incontinence. Possible mechanisms include the anti-alpha-adrenergic, antidopaminergic and anticholinergic effects of these drugs, as well as sedation.1 A 2025 observational study examined the prevalence and types of urinary incontinence related to antipsychotic use. The study included 200 women 20–40 years of age who were mentally stable while under treatment with antipsychotics, and age-matched controls. Younger women were chosen for the study, before the age when the frequency of urinary incontinence rises.2Key results:Urinary incontinence was reported by 29% of those taking antipsychotic drugs and by 13% of age-matched controls (p < 0.001).Urge incontinence was observed in 24% of the women taking antipsychotics and 6% in the control group (p < 0.001).Stress urinary incontinence was twice as common in the treatment group compared to the control group (p = 0.04).Mixed incontinence occurred in 13% of patients in the antipsychotic group versus 2% in the control group (p = 0.003).Nocturia was seen in 15% of patients in the antipsychotic group compared with 3% in the control group (p < 0.003).Nocturnal enuresis was noted in 12% of those taking antipsychotic drugs and 2% of the control group (p < 0.006).Among women with nocturnal enuresis, five out of 12 patients were being treated with clozapine (p < 0.001).2In this study, urinary incontinence was more than twice as likely to occur in women treated with antipsychotics compared to controls. Urge urinary incontinence, mixed urinary incontinence, nocturia and nocturnal enuresis were four to six times more common, and stress urinary incontinence was two-fold higher in women treated with antipsychotics.2 Urinary incontinence symptoms, especially nocturnal enuresis, had a significant negative impact on quality of life, but only a third of these patients sought treatment for this problem.2 Overall, this study found that urinary incontinence affects approximately one-third of young women treated with antipsychotics. As many of the affected women did not seek treatment for urinary incontinence, healthcare providers should adopt a proactive approach and ask women about this potential adverse effect. In addition, due to lack of awareness about this potential adverse effect of antipsychotics, healthcare providers may overlook their urinary side effects. Healthcare providers need to be informed about this potential adverse effect and consider antipsychotics as a potential drug-induced cause of urinary incontinence.2References:Anon. Urinary incontinence with second-generation antipsychotic drugs. Med Lett Drugs Ther 2026;68(1749):40. doi:10.58347/tml.2026.1749c.Yosef L, Amital D, Nassar A, et al. Antipsychotic treatment influence on urinary incontinence in young women—types, severity and life quality. Eur J Obstet Gynecol Reprod Biol 2025;309:214. doi:10.1016/j.ejogrb.2025.03.020.

Be alert for possible urinary incontinence caused by antipsychotic drugs

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