Understanding Eliquis (Apixaban)
Eliquis, with the generic name apixaban, is a prescription blood thinner classified as a direct-acting oral anticoagulant (DOAC) [1.8.1]. It is primarily prescribed to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AFib), a type of irregular heartbeat not caused by a heart valve problem [1.8.2]. Additionally, Eliquis is used to treat deep vein thrombosis (DVT), which are blood clots in the legs, and pulmonary embolism (PE), which are blood clots in the lungs [1.8.6]. It is also approved for preventing DVT in patients who have undergone hip or knee replacement surgery [1.8.3].
Eliquis works by selectively inhibiting Factor Xa, a crucial enzyme in the blood coagulation cascade [1.8.4]. By blocking this factor, apixaban disrupts the process of clot formation, making the blood less likely to clot. This mechanism is highly effective, but like all anticoagulants, its primary side effect and risk is bleeding [1.3.4, 1.5.6].
What is Urinary Incontinence?
Urinary incontinence is the involuntary loss of urine. It's a common issue that can range from a minor leak when you cough or sneeze to a sudden, intense urge to urinate followed by an involuntary loss of urine. There are several types, including:
- Stress Incontinence: Urine leaks under pressure from coughing, sneezing, laughing, or exercising.
- Urge Incontinence: A sudden, intense urge to urinate followed by involuntary leakage.
- Overflow Incontinence: Frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
- Functional Incontinence: A physical or mental impairment prevents you from making it to the toilet in time.
Understanding these types is key when evaluating symptoms that appear while taking a new medication.
Investigating the Link: Does Eliquis Cause Incontinence?
There is limited scientific evidence to suggest that Eliquis directly causes urinary incontinence or increased urinary frequency (polyuria) [1.2.1, 1.4.1]. Official prescribing information and drug safety databases do not list incontinence as a common or direct side effect of the medication itself [1.3.5, 1.3.6]. Changes in urinary patterns experienced by individuals taking Eliquis are often considered multifactorial, meaning they are likely influenced by other factors such as underlying medical conditions, lifestyle, or other concurrent medications [1.2.1].
The Critical Warning: Spinal Hematoma and Incontinence
While Eliquis may not cause incontinence directly, loss of bladder or bowel control (incontinence) is listed as a critical symptom of a rare but very serious side effect: a spinal or epidural hematoma (blood clot) [1.2.2, 1.4.5]. This risk is highest for patients taking Eliquis who undergo a spinal puncture or receive spinal/epidural anesthesia [1.8.3].
A spinal hematoma can compress the spinal cord, leading to severe neurological damage, including long-term or permanent paralysis [1.5.3]. The symptoms include:
- Back pain
- Tingling or numbness, especially in the legs and feet
- Muscle weakness, particularly in the lower body
- Loss of control over the bladder or bowels [1.2.2, 1.8.3]
Therefore, if a person taking Eliquis suddenly develops incontinence, especially alongside these other symptoms, it should be treated as a medical emergency.
Other Urinary and Bladder-Related Side Effects
The most commonly reported urinary side effect of Eliquis is hematuria, which is the presence of blood in the urine [1.3.7, 1.5.3]. This is a direct consequence of the drug's blood-thinning properties. Signs of hematuria include urine that appears red, pink, or brown [1.3.1]. Any sign of blood in the urine should be reported to a healthcare provider immediately, as it indicates bleeding [1.5.5].
Factors That Can Influence Urinary Health
Many patients prescribed Eliquis have other health conditions or factors that can independently cause or worsen urinary incontinence. It's important to consider these confounding variables:
- Age: The risk of incontinence increases with age, and many Eliquis users are older adults.
- Other Medications: Many drugs can affect urinary function. For example, diuretics ('water pills') increase urine production, while other blood pressure medications like alpha-blockers, ACE inhibitors, and calcium channel blockers can sometimes worsen incontinence [1.2.4, 1.2.6].
- Underlying Conditions: Conditions like an enlarged prostate, pelvic floor weakness, diabetes, and neurological disorders are common causes of incontinence.
- Hydration Status: While staying hydrated is important, changes in fluid intake can affect urinary frequency [1.2.1].
Comparison of Anticoagulants and Urinary Side Effects
Patients often wonder how different blood thinners compare. Here is a brief overview:
| Feature | Eliquis (Apixaban) | Xarelto (Rivaroxaban) | Warfarin (Coumadin) |
|---|---|---|---|
| Mechanism | Direct Factor Xa Inhibitor [1.8.4] | Direct Factor Xa Inhibitor | Vitamin K Antagonist |
| Common Side Effects | Bleeding, bruising, nausea [1.5.5, 1.6.3] | Bleeding, back/abdominal pain, dizziness [1.6.1] | Bleeding, bruising, gas, altered taste |
| Reported Urinary Issues | Hematuria (blood in urine); Incontinence as a symptom of rare spinal hematoma [1.3.7, 1.2.2] | Hematuria (blood in urine) [1.6.1, 1.6.3] | Hematuria (blood in urine) |
Studies suggest that Eliquis may have a lower risk of major bleeding events, including gastrointestinal bleeding, compared to Xarelto [1.6.2, 1.6.6]. However, all anticoagulants carry a risk of bleeding, and hematuria is a possibility with any of them.
What to Do If You Experience Urinary Changes on Eliquis
If you develop urinary incontinence or other urinary symptoms while taking Eliquis, it's crucial to act appropriately:
- Do Not Stop Taking Eliquis: Abruptly stopping this medication significantly increases your risk of having a stroke or forming a dangerous blood clot [1.8.2]. Always speak to your doctor before making any changes to your dosage.
- Contact Your Doctor Promptly: Inform your healthcare provider about any new or worsening urinary symptoms. They can help determine the underlying cause, which may be unrelated to Eliquis [1.2.1].
- Seek Emergency Medical Help Immediately: If you experience incontinence along with back pain, numbness, tingling, or weakness in your legs, go to the nearest emergency room. These are warning signs of a potential spinal hematoma [1.4.5, 1.5.3].
- Report Any Signs of Bleeding: If you notice pink, red, or brown urine, contact your doctor right away as this is a sign of bleeding [1.4.6].
Conclusion
To answer the central question: No, current clinical data does not show that Eliquis directly causes urinary incontinence as a standard side effect. The belief that it does is a common misconception [1.2.1]. The most documented urinary issue related to Eliquis is hematuria (blood in the urine), which is a symptom of the drug's primary risk—bleeding [1.3.7].
However, it is critically important for patients to know that the sudden onset of incontinence, especially when paired with back pain or leg weakness, can be a symptom of a rare but potentially devastating spinal blood clot [1.2.2]. Any urinary changes experienced while on Eliquis warrant a conversation with a healthcare provider to rule out serious complications and identify the true cause.
Authoritative Resource
For more detailed information, you can review the manufacturer's patient information and Medication Guide, available through the FDA website or from your pharmacist [1.8.3].
