Medications which cause urinary retention

A variety of drugs have been implicated in urinary incontinence, and attempts have been made to determine the mechanism responsible based upon current understanding of the processes involved in continence and the transmitters that play a role.

Each of the processes described previously can be manipulated by pharmacologic agents to cause one or more types of incontinence. The drugs commonly pinpointed in urinary incontinence include anticholinergics, alpha-adrenergic agonists, alpha-antagonists, diuretics, calcium channel blockers, sedative-hypnotics, ACE inhibitors, and antiparkinsonian medications. Depending upon the mode of action, the effect may be direct or indirect and can lead to any of the types of incontinence. On the other hand, a pharmacologic agent or any other factor that results in chronic urinary retention can lead to a rise in intravesical pressure and a resultant trickling loss of urine.

In this way, drugs that cause urinary retention can indirectly lead to overflow incontinence. Alpha-Adrenergic Antagonists: As described earlier, the stimulation of alpha 1 -adrenoceptors by norepinephrine leads to increased bladder outlet resistance.

It has been shown that alpha 1 -adrenoceptors influence lower urinary tract function not only through a direct effect on smooth muscle, but also at the level of the spinal cord ganglia and nerve terminals. In this way, they mediate sympathetic, parasympathetic, and somatic outflows to the bladder, bladder neck, prostate, and external urethral sphincter.

It is useful to note that many antidepressants and antipsychotics exhibit considerable alpha 1 -adrenoceptor antagonist activity. Alpha-Adrenergic Agonists: Alpha-adrenergic agonists such as clonidine and methyldopa mimic the action of norepinephrine at receptors. In this way they may contract the bladder neck, causing urinary retention and thus overflow urinary incontinence.

Antipsychotics: A number of antipsychotics have been associated with urinary incontinence, including chlorpromazine, thioridazine, chlorprothixene, thiothixene, trifluoperazine, fluphenazine including enanthate and decanoate , haloperidol, and pimozide.

Additionally, whereas some patients experience urinary incontinence within hours of initiating antipsychotic therapy, others do not experience incontinence for weeks after initiation. In most cases, the incontinence remits spontaneously upon discontinuation of the antipsychotic. Typical antipsychotics are primarily dopamine antagonists and lead to stress urinary incontinence, whereas atypical antipsychotics are antagonists at serotonin receptors.

If it is not possible to discontinue the antipsychotic, urinary incontinence caused by antipsychotics can be managed with a variety of pharmacologic agents.

Desmopressin is perhaps the most effective, but also the most expensive, therapeutic agent available for this use.

Other agents include pseudoephedrine, oxybutynin, benztropine, trihexyphenidyl, and dopamine agonists. Antidepressants: There are a number of classes of antidepressants, all with varying pharmacologic properties. This makes it difficult to generalize the underlying mechanisms that lead to urinary incontinence as a result of antidepressant use.

However, all antidepressants result in urinary retention and, eventually, in overflow incontinence. Some also act as antagonists at adrenergic, cholinergic, or histaminergic receptors at therapeutic doses.

Diuretics: The purpose of a diuretic is to increase the formation of urine by the kidneys. Calcium Channel Blockers: Calcium channel blockers decrease smooth-muscle contractility in the bladder. This causes urinary retention and, accordingly, leads to overflow incontinence. Sedative-Hypnotics: Sedative-hypnotics result in immobility secondary to sedation that leads to functional incontinence.

Blocking angiotensin receptors with ACE inhibitors or angiotensin receptor blockers decreases both detrusor overactivity and urethral sphincter tone, leading to reduced urge incontinence and increased stress urinary incontinence. This was demonstrated in a female patient with cystocele who was receiving enalapril. The patient developed a dry cough and stress incontinence, which ceased within 3 weeks of discontinuing the ACE inhibitor.

Hydroxychloroquine: Hydroxychloroquine has recently been identified as an agent that can induce urinary incontinence. There is currently only one report supporting this finding. In this report, a year-old female patient developed urinary incontinence as an adverse reaction to hydroxychloroquine administered at therapeutic doses to treat rheumatoid arthritis. Urinary incontinence remitted with drug withdrawal and reappeared when the drug was readministered.

Medications should be reviewed and offending agents should be stopped or dose-limited. If a spontaneous voiding trial fails after adjustment of medication and several days of catheterization, a referral to urology is warranted 8.

For patients with a limited life expectancy for whom causative medications cannot be adjusted, life-long indwelling catheterization or intermittent catheterization are reasonable options. Although many clinicians may consider catheterization to be burdensome, a survey of patients with neurogenic bladders using long-term indwelling or intermittent self-catheterization found that the majority of patients felt that the use of catheterization positively impacted quality of life 9.

Novel Pharmacologic Management Strategies If the offending pharmacotherapy cannot be stopped, targeted pharmacotherapies may be able to counteract urinary retention, although such use is considered investigational. Opioid antagonists such as naloxone and methylnaltrexone can block opioid receptors and allow for normal urination per a case report and a single, pre-clinical controlled trial 10, One case report described the reversal of citalopram-related AUR by the addition of mirtazapine Chronic urinary retention in men: how we define it, and how does it affect treatment outcome.

BJU Int. Fast Facts can only be copied and distributed for non-commercial, educational purposes. Tricyclic antidepressants may interfere with both processes, and lead to leakage, also called urinary incontinence.

For some people, sneezes can cause a little urine to leak. Trouble is, certain antihistamines can relax the bladder, blunting its ability to push out urine. The good thing about decongestants such as Sudafed pseudoephedrine and Suphedrine PE phenylephrine is that they temporarily quell nasal congestion by constricting blood vessels, ultimately lessening swelling.

Among older adults who went to the doctor because of incontinence, 60 percent were taking medications that had urinary symptoms as a side effect, per a previous study. Among the most common medications they were taking? Calcium channel blockers. This class of medication, used to treat hypertension , may cause the bladder to relax and affect its ability to empty properly, says Hudspeth.

One of those potential side effects is excessive urination and thirst, which may affect up to 70 percent of individuals who take lithium long term, per a paper published December in the International Journal of Bipolar Disorders. That condition is called diabetes insipidus, which is not the same as type 1 or 2 diabetes.

Drug-induced urinary retention is generally treated by urinary catheterization, especially if acute, in combination with discontinuation or a reduction in dose of the causal drug. Studies have been carried out examining the effects of preventive measures for anaesthesia-related urinary retention, both during and after surgery, particularly into the effect of using opioids in combination with non-opioid analgesic drugs on the incidence of postoperative urinary retention.

Although combination therapy reduces the opioid-related adverse events, the effect on urinary retention yields contradictory results.