Cannabis and the Bladder
An “apple a day keeps the doctor away” is part of the American culture. But is it possible that smoking a “joint” everyday may also become an acceptable part of daily life to help bladder function? Much has been written about the medicinal effects of marijuana, however until recent, little attention has been placed on its effects on the bladder.
Those in favor of widespread legalization are touting the medical effects of marijuana. It’s currently possible to obtain prescription marijuana for chronic pain, glaucoma, AIDS, and cancer. Various studies have also shown other purported benefits of marijuana, including treating migraines, slowing the progression of Alzheimer’s, suppressing a gene that allows some cancer cells to multiply, helping to control seizures, treating depression, helping with inflammatory bowel disease, decreasing insulin levels in diabetics, and pain control pain in Multiple Sclerosis.
A recent study from Kaiser Permanente has shown a slightly lower incidence of bladder cancer amongst smokers of marijuana compared to non-smokers. The mechanism for this association has yet to be identified. This study does not establish causality for a protective mechanism to the bladder, and clearly Urologists are not going to advocate its usage to prevent bladder cancer.
However, smoking marijuana has become very common amongst Americans, and a recent Gallup survey has shown that nearly half of Americans have smoked pot at least once. It will be interesting to see if more widespread use of this substance results in the identification of bladder effects.
Overactive bladder is also a very prevalent problem in the US. Presently, numerous treatments are available to patients for treatment. These options include, behavioral modification, oral pills, gels, biofeedback, BOTOX, and spinal cord stimulation. So could it be on the horizon that perhaps marijuana is added to the treatment armamentarium??
Cannabinoids are the active ingredients of cannabis, marijuana. Receptors for cannabinoids have been identified in the bladder, thus resulting in new interest in the effects that these substances may have on the bladder. Researchers in Italy have identified non-psychotropic cannabinoids that effect decrease bladder contractility. In a mouse model, these substances decreased bladder contractions.
It has been speculated that these receptors are involved in a pathway that regulates bladder relaxation. Perhaps, this helps to explain the reason that patients with multiple sclerosis exhibit fewer episodes of urinary incontinence while using cannabis.
Smoking marijuana has also received great scrutiny regarding potential deleterious effects. The impairment of short-term memory, ability to impair one’s driving, and their effects on pregnancy have been well documented. Its adverse effects on the lung have also been published, and some have found increased toxicity due to people inhaling this for longer periods of time than cigarette smoke. But so far, only the link between cigarette smoking and the subsequent development of bladder cancer has been well established, and a similar link with marijuana remains unclear. There are many Urologists who can say that they have never taken out a bladder for advanced bladder cancer in a non-smoker.
Just remember…buyer beware. Case reports in the literature exist without solid epidemiological evidence that associate cannabis usage with lower testosterone levels, causing erectile dysfunction, and testicular cancer
Jay Motola, MD, is a board-certified urologist and attending physician, Department of Urology, Mount Sinai West, and Assistant Professor of Urology, Icahn School of Medicine at Mount Sinai. Dr. Motola is a summa cum laude, Phi Beta Kappa graduate of Boston University, and earned his medical degree at the State University of New York at Stony Brook.