The question of whether steroids can cause incontinence or increased urination is complex, but they can be linked, often temporarily and indirectly. The primary agents associated with changes in bladder function are prescription corticosteroids, such as Prednisone. These powerful anti-inflammatory medications alter the body’s fluid balance and metabolism, leading to frequent or urgent urination. True incontinence, the involuntary loss of bladder control, is a less common but possible result, sometimes arising from the stress that increased urine volume places on the bladder. This article focuses on the effects of prescribed corticosteroids, as they are the source of most documented urinary side effects.
Differentiating Steroid Types and Risk
The term “steroids” covers two categories of drugs: corticosteroids and anabolic-androgenic steroids (AAS). It is important to distinguish between these, as they affect the urinary system through separate mechanisms. Corticosteroids, like Prednisone or Dexamethasone, are used medically to treat inflammation and autoimmune conditions. These drugs primarily pose a risk for increased urination by directly impacting fluid and electrolyte balance.
The risk of urinary changes is highest with high-dose or long-term systemic corticosteroid use. Anabolic-androgenic steroids (AAS) are synthetic versions of testosterone frequently misused to build muscle mass. While AAS do not cause the fluid-driven frequent urination seen with corticosteroids, they can affect the prostate gland in men. Prolonged use can contribute to the enlargement of the prostate, known as benign prostatic hyperplasia (BPH).
An enlarged prostate can physically obstruct the flow of urine, leading to symptoms like a weak stream, difficulty emptying the bladder, and an increased need to urinate, especially at night. While both steroid types can lead to urinary symptoms, corticosteroids cause increased urine volume and frequency, while anabolic steroids primarily cause obstruction and retention-related frequency.
Physiological Reasons for Increased Urination
The primary mechanism linking corticosteroids to frequent urination is their effect on the kidneys, which manage fluid balance. Corticosteroids possess mineralocorticoid activity, mimicking hormones that regulate sodium and water retention. This action initially causes the body to hold onto salt and water, which can lead to fluid retention.
As the body adjusts, this altered fluid balance often results in diuresis, the increased production of urine by the kidneys. The steroids affect the renal tubules, altering the reabsorption of sodium and water. This boosts the total volume of fluid that needs to be expelled. This large volume of urine fills the bladder quickly, leading to urgency and frequency, which may present as functional incontinence.
A secondary mechanism involves steroid-induced changes in blood sugar. Corticosteroids can raise blood glucose levels, potentially leading to a temporary increase in blood sugar. When levels are high, the kidneys filter out the excess glucose, pulling extra water along with it in a process known as osmotic diuresis. This further contributes to increased urine output, often noticeable as nocturia, or the need to wake up and urinate during the night.
Strategies for Managing Urinary Symptoms
Individuals experiencing frequent urination while on a prescribed corticosteroid must communicate openly with the prescribing physician. It is never appropriate to self-adjust the dosage or abruptly stop taking the medication, as this can lead to severe health complications. A doctor may be able to adjust the dosage or timing to better manage the side effects.
Adjusting the time of day the steroid is taken is a practical strategy. Taking the full dose earlier in the morning can shift the period of peak diuresis to the daytime, minimizing nighttime urgency and sleep interruption. Managing fluid intake is also helpful; ensure good hydration throughout the day but avoid large amounts of fluid, especially caffeine and alcohol, before bedtime. These substances are known diuretics and bladder irritants that compound the steroid’s effect.
Another technique involves engaging in pelvic floor exercises, also known as Kegels. Although the primary issue is excess fluid volume, strengthening these muscles provides better support and control for the bladder as it fills rapidly. These exercises can help manage urgency and prevent leakage when the bladder is stressed by increased fluid output. If symptoms are severe or persistent, a doctor may refer the patient to a urologist for specialized treatment.