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Antipsychotics treat schizophrenia. Similarly to mood stabilizers, these medications can also cause diabetes insipidus, which, in turn, triggers OAB and urinary incontinence. According to a review of studiessome of the drugs that can cause urinary issues include:.
Be sure to speak with a medical professional if you begin experiencing any of the symptoms of an OAB or if your symptoms are getting worse. These symptoms include:.
To treat urinary problems caused by medications, your doctor may suggest either trying a different medication or adding a medication that can help get your urination back on track. In addition, you can improve your symptoms by avoiding bladder irritants, limiting drinking before bed, and practicing Kegels or other exercises.
Certain medications can affect your bladder and cause different urinary symptoms. In addition to the drugs discussed above, some medications cause urinary retention inability to completely empty your bladder.
Other medications can cause bladder tumors or UTIs. Finally, many medications can cause your urine to change colorwhich may be a cause of concern.
Nocturia, which is the medical name for increased nighttime urination, can be caused by :. OAB may be triggered by certain medications. These include diuretics and other blood pressure drugs along with certain psychotropic drugs antidepressants, antipsychotics, and lithium.
Be sure to speak with a doctor if you begin experiencing any unusual symptoms related to urination or if these symptoms worsen. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.
Although all three conditions are similar, learn the differences between overactive bladder, urinary incontinence, and UTI, including what causes each.
Read on to find out what options you have. Discover causes of abdominal pain and frequent urination, including UTI, anxiety, and others.
Certain foods can irritate the bladder and exacerbate OAB symptoms. Read more on what foods can irritate your bladder and tips to identify and manage…. You can help normalize your overactive bladder naturally by avoiding artificial sweeteners, caffeine, and alcohol, losing weight, and performing….
Here's what we…. A Quiz for Teens Are You a Workaholic? How Well Do You Sleep? Health Conditions Discover Plan Connect.
Medications that May Cause Overactive Bladder. Medically reviewed by Ami Patel PharmD, BCPS — By Olga Askinazi, PhD on March 14, OAB and urinary incontinence Getting medical help Treatment FAQ Summary Overactive bladder has numerous causes, including as a side effect of certain medications.
What medications may cause overactive bladder? When to contact a doctor. How are medication-induced incontinence, OAB, and other urinary issues treated? Frequently asked questions. How we reviewed this article: Sources. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations.
We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy. Mar 14, Written By Olga Askinazi, PhD. Medically Reviewed By Ami Patel PharmD, BCPS.
Share this article. Read this next. Overactive Bladder vs. Medically reviewed by Meredith Goodwin, MD, FAAFP. Alternative Treatments for an Overactive Bladder. Medically reviewed by Debra Rose Wilson, Ph. Medically reviewed by Graham Rogers, M.
Medically reviewed by Natalie Butler, R. What Home Remedies Work for an Overactive Bladder? Is There a Connection Between Overactive Bladder and Erectile Dysfunction? Medically reviewed by Saurabh Sethi, M.
: Diuretic effect on urinary frequency| Diuretics | Heart and Stroke Foundation | It means you have to wake up more than once a night to go to the bathroom. The body usually produces more anti-diuretic hormone ADH at night, which prevents your kidneys from filtering and releasing water until you wake up. However, ADH production decreases with age. That is why older adults are at higher risk of nocturia than younger adults. ADH takes more time to be produced in children. The more fluid you drink, the more urine you make, and the more frequently you need to pee. You can tell if you are drinking enough by checking the color of your urine. But if your pee is always clear and you spend a lot longer in the bathroom, then you are probably drinking too much. Diuretic medications help your body to get rid of excess fluid. The drugs work by prompting the kidney to be more permeable to sodium. This allows more sodium in the urine, which draws more water out of the blood into urine, lowering your blood pressure. Diuretics are used as medications for high blood pressure. You should expect to pass urine a lot more when on these medications. Drinks such as coffee, tea, and soda can act as diuretics, increasing your peeing frequency. Untreated diabetes means a continually high level of glucose in your blood. The presence of glucose in your urine draws additional fluids along with the glucose, resulting in an increased peeing rate. And as you lose more fluids, your body becomes dehydrated, and you feel thirstier than usual. You will end up drinking and peeing a lot more. Urinary tract infections occur when bacteria enter via the urethra and multiply anywhere in your urinary tract. As the bacteria multiply, usually in the bladder, inflammation, and irritation increase the urge to pee. In some cases, the bladder can become inflamed without an infection. This type of inflammation results in a chronic condition called interstitial cystitis or painful bladder syndrome, which is more common in women. This condition is an urge-related form of urinary incontinence, wherein suddenly you feel the need to pee, but not much comes out. These diseases tend to cause damage to the nerves that tell the bladder muscles when to contract. Urinary incontinence is a condition where muscles that close off the urethra become weak, causing stress-inducing urinary leakage. Incontinence may be due to pregnancy and childbirth, which weaken pelvic floor muscles. Additionally, lower estrogen levels after menopause can also cause tissues to deteriorate in the urinary tract, resulting in incontinence. For men with an enlarged prostate, there may be a constant feeling of needing to pee. The growing prostate puts pressure on the urethra. It blocks the flow of urine, making the bladder work harder to expel the urine. The leftover urine can become a breeding ground for bacteria and lead to inflammation, further messing with the bladder. When pregnant, blood volume increases, and the kidneys have to work through the excess fluid. Diuretic use is also common among older adults, as the prevalence of clinical conditions such as hypertension and heart failure requiring its use increases markedly with age. By causing increased formation of urine by the kidneys, diuretics increase urinary frequency and may cause urinary urgency and incontinence. This review provides a summary of available data, focusing on the association between OAB and diuretic use in the elderly. In cold temperatures, the body constricts blood vessels, which raises blood pressure. In response to that, the kidneys will try to eliminate fluid to reduce blood pressure. This is known as immersion diuresis. Your doctor will make the diagnosis based on your symptoms. You should also take note of how often you urinate. Frequent urination can upset the delicate balance of water, salt, and other minerals in the body. That can lead to the following conditions:. The use of diuretics and frequent urination can cause this condition. Sodium is important because it helps your body regulate blood pressure and fluid levels. It also supports the nervous system. Hyperkalemia occurs if you have too much potassium in the body. Hypokalemia refers to having too little potassium in the body. This can be a complication from the use of diuretics. Excessive urination from diuresis can lead to dehydration. Without proper hydration, your body will have a hard time regulating its temperature. You may also experience kidney problems, seizures, and even shock. Read more about recommended daily water requirements. Underlying diseases that cause diuresis need medical treatment. Your doctor may be able to help you manage your excessive urination with changes in your medications and diet. With careful medical monitoring, you may be able to prevent diuresis altogether. Electrolytes like salt, potassium, and calcium perform a variety of important functions within your body. How often you pee can provide clues to your overall health. Find out what's normal and what conditions could affect your urine output. Frequent urination is the need to go more than normal. Discover nearly 20 causes, such as overactive bladder. Also, get the facts on diagnosis and…. People who have had hysterectomies are at risk for bladder issues including bladder spasms, which usually go away on their own after a few weeks…. Many different medical conditions can cause swelling in your legs, which can create the urge to pee. Are any of them serious? |
| ICS Abstract # Impact of Lower Urinary Tract Symptoms on Diuretic Adherence | Read more on what foods can irritate your bladder and tips to identify and manage…. You can help normalize your overactive bladder naturally by avoiding artificial sweeteners, caffeine, and alcohol, losing weight, and performing…. Here's what we…. A Quiz for Teens Are You a Workaholic? How Well Do You Sleep? Health Conditions Discover Plan Connect. Medications that May Cause Overactive Bladder. Medically reviewed by Ami Patel PharmD, BCPS — By Olga Askinazi, PhD on March 14, OAB and urinary incontinence Getting medical help Treatment FAQ Summary Overactive bladder has numerous causes, including as a side effect of certain medications. What medications may cause overactive bladder? When to contact a doctor. How are medication-induced incontinence, OAB, and other urinary issues treated? Frequently asked questions. How we reviewed this article: Sources. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy. Mar 14, Written By Olga Askinazi, PhD. Medically Reviewed By Ami Patel PharmD, BCPS. Share this article. Read this next. Overactive Bladder vs. Medically reviewed by Meredith Goodwin, MD, FAAFP. Firstly, the total protein was separated using gel electrophoresis and transferred to a PVDF membrane that had been incubated with primary antibodies at 4°C overnight and incubated with secondary antibodies orderly. At last, the protein bands were visualized and used for analysis. The primary antibodies of AQP1 ,, Abcam , AQP2 , Abcam , AQP3 ,, Abcam , and β-actin , Abcam , and the secondary antibodies from horseradish peroxidase-conjugated ,, CST were used in this work. The relative protein level of genes was expressed as the ratio of target gene expression level and β-action gene expression level for the data normalization. Statistical analysis was conducted using SPSS Gene expression levels comparison between different groups was conducted by Mann-Whitney U test. As shown in Table 2 , totally, 37 compounds, including 19 flavonoids, 7 anthocyanins, 2 benzaldehydes, and 9 phenolic acids were identified from CW. Among them, chlorogenic acid, procyanidin, L-epicatechin, cinnamic acid, sinapic acid, and baicalein were abundant. The content of total amino acids reached A total of 18 species of amino acids were characterized, and among them, alanine Ala , proline Pro , and phenylalanine were abundant Supplementary Table 1. To determine the acute diuretic effects of coconut water, the urine volume of CON, F, CW-L, and CW-H groups was determined after 6 and 24 h Table 3. However, the urine volume of CW-H group did not increase significantly. In terms of diuretic activity, the diuretic activity of CW-L group was 1. Table 3. The effect of acute treatment with coconut water on urinary excretion volume at 6 and 24 h in rats. Compared with the CON group, the urine CAI index of CW-L and CW-H groups increased Table 4. Table 4. Effects of acute treatment with coconut water on the urine pH values and electrolyte concentrations of rats 24 h. To determine the prolonged diuretic activity of coconut water, the urinary excretion volume of rats in the CON, F, CW-L, and CW-H groups were determined for 7 consecutive days Figure 1. Figure 1. Meanwhile, urinary electrolyte excretion significantly increased in both CW-L and CW-H groups Figure 1. Figure 2. To clarify the influence of CW treatment on the RAAS, the serum levels of ADH, ALD, Ang II, and ANP in rats were also determined Figures 2B—E. To explore the regulatory role of CW on AQP1, AQP2, and AQP3 expressions, the AQP levels in rat serum were determined by ELISA kits. Figure 3. Effect of prolonged coconut water treatment on rat serum levels of aquaporin 1 AQP1 A , AQP2 B , and AQP3 C and the mRNA expressions of AQP1, AQP2, and AQP3 in the kidney. The mRNA levels of AQP1, AQP2, and AQP3 were detected by RT-PCR. The mRNA levels of AQP1 D , AQP2 E , and AQP3 F were normalized to the model. Meanwhile, the effects of CW on the mRNA expressions of AQP1, AQP2, and AQP3 in the kidney were also determined. The AQP1, AQP2, and AQP3 protein expressions were evaluated after treatment with CW in rats Figure 4. Obviously, CW administration could effectively down-regulate the related protein expressions, including AQP1, AQP2, and AQP3 in rats, which was in accordance with the levels in serum and mRNA expressions for AQP1, AQP2, and AQP3 Figure 3. These results indicated that CW exerted significant diuretic effects by suppressing AQP1, AQP2, and AQP3 expressions in the kidney and serum. Figure 4. The levels of AQP1, AQP2, and AQP3 protein expression from different groups were detected by Western blot assay, and representative bands are shown in A. The levels of AQP1 B , AQP2 C , and AQP3 D were normalized to the model group. Coconut water is a generally accepted tropical beverage with a pleasant flavor and a variety of beneficial nutrients including free amino acids and phytochemicals like flavonoids. Coconut water is reported to possess various pharmacological activities in health and medicinal applications 11 , For example, intravenous coconut water was effective in the treatment of hypertension, probably due to its potential diuretic effect. However, the underlying mechanisms remain unclear and restrict its utilization as a natural available diuretic to replace the synthetic furosemide, which is clinically and commonly used, frequently causing side effects. In the current work, the diuretic ability of coconut water and the mechanism were investigated. The increase in urine excretion was even more significant than the furosemide treatment, especially for the CW-L group. The diuretic activity could be reflected by the diuretic index. Briefly, the diuretic activity is considered good if the diuretic index is larger than 1. In the present study, after acute treatment for 24 h, the diuretic index for CW-L and CW-H group was 1. Thus, CW-L showed good diuretic potential while CW-H showed moderate diuretic potential. The diuretic activity value of CW-L was 1. If the ratio lies between 0. However, if it is less than 0. In the present study, this value was larger than 1, thus indicating that CAI activity was not involved in the diuretic mechanism of coconut water. Diuretic agents were widely used to regulate these disorders by inhibiting water and electrolytes reabsorption into the bloodstream across tubular epithelial cells Therefore, the coconut water turned out to be more advantageous than diuretic drugs, which possibly cause electrolyte abnormality, especially for the authentic CW, which has similar osmotic pressure to rat blood 3. The RAAS exerts a profound influence on body fluid regulation and effectively controls fluid homeostasis and maintains electrolyte balance. Thus, the urine excretion could be increased by suppressing RAAS and enhancing ANP levels. In the present study, CW observably decreased ADH, ALD, and Ang II levels, while it significantly increased the ANP level compared to the CON group, which eventually suppressed RAAS activation. In some previous studies, the ethanol extract of Lagopsis supine was also observed to exert a diuretic effect via a similar mechanism 9 , It has been reported that AQP1, AQP2, and AQP3 emerge as three intrinsic membrane proteins in aquaporins that are associated with water transport, as well as primary urinary reabsorption 8. In the present study, CW remarkably decreased serum AQP1, AQP2, and AQP3 excretions and suppressed the mRNA and protein expressions of AQP1, AQP2, and AQP3 compared with the CON group in rats. This indicated that CW exhibited diuretic activity by regulating AQP1, AQP2, and AQP3 expressions in rats, which was in accordance with the previous studies 8 , 9. Much evidence relating to the diuretic effects exerted by phytochemicals has been previously reported Moreover, amino acid intake can also be used to treat kidney disease or protect the kidneys based on the effective diuretic effect 37 , Thus, we speculated that the beneficial nutrients of CW, such as flavonoids, phenolic acids, and amino acids, serve as critical factors for its diuretic activity. However, further studies are also required to verify the presumptive diuretic activity of polyphenols like chlorogenic acid and abundant amino acids like phenylalanine. Coconut water could decrease serum ADH, ALD, and Ang II levels, while it significantly increases serum ANP level and down-regulates the mRNA expressions and protein levels of AQP1, AQP2, and AQP3. In a word, CW could exhibit acute and prolonged diuretic effects by suppressing the AQP and RAAS pathways in saline-loaded rats. This work provided the basic data for CW as an alternative diuretic agent to treat kidney diseases and replace traditional medicine. It is necessary for further studies to illustrate the active substances responsible for the diuretic activity of coconut water. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. The animal study was reviewed and approved by the Ethical Committee of Experimental Animal Care of Hainan University HNUAUCC JW and MZ: methodology, software, validation, formal analysis, data curation, and writing — original draft preparation. KM: project administration. YP: Writing — review and editing. CL: investigation. GX and WZ: conceptualization, visualization, supervision, funding acquisition, and resources. All authors have read and agreed to the published version of the manuscript. This work was supported by the Major Science and Technology Project of Hainan Province zdkj The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Supplementary Figure 1 Physicochemical property of coconut Cocos nucifera L. Supplementary Figure 2 Effects of CW on the body weight A , food consumption B and water intake C of rats. Supplementary Figure 3 The representative bands of AQP1, AQP2, and AQP3 protein expression from different groups were detected by Western blot. Chakraborty M, Kamath JV, Bhattacharjee A. Potential interaction of green tea extract with hydrochlorothiazide on diuretic activity in rats. Int Sch Res Notices. doi: PubMed Abstract CrossRef Full Text Google Scholar. Cechinel-Zanchett CC, Bolda Mariano LN, Boeing T, da Costa JC, Da Silva LM, Bastos JK, et al. Diuretic and renal protective effect of kaempferol 3-O-alpha-l-rhamnoside Afzelin in normotensive and hypertensive rats. J Nat Prod. Then keep adding on 10 minutes until you find yourself holding your pee for a longer period. If you are peeing too much, you should see a urologist to determine the cause and degree of incontinence you have. Our solutions include behavioral therapies, pelvic muscle rehabilitation, incontinence devices, medication, Botox injections, and surgery. Our doctors have vast experience in diagnosing urinary incontinence and in providing the most appropriate treatments. Why Do I Pee So Much. Posted On January 12, Posted by St Pete Urology In Blog. Key takeaways The frequency of peeing can be used to monitor overall health and anticipate certain problems. A regular peeing rate and volume occur when a person is well-hydrated and there is no undue pressure on the pelvic floor, bladder, and kidneys. A normal range is voids in 24 hours and no more than twice at night if over 60 years old. Nocturia, or frequently peeing at night, can be caused by decreased production of anti-diuretic hormone ADH with age or a lack of production in children. It can also be caused by drinking too much water, taking diuretic medications, untreated diabetes, urinary tract infections, or an overactive bladder. It is important to speak with a medical professional if experiencing frequent or urgent peeing as it can be a symptom of underlying health issues. What is considered normal when it comes to peeing? What is nocturia? What causes peeing too much? Drinking too much water The more fluid you drink, the more urine you make, and the more frequently you need to pee. Accidental or therapeutic use of diuretics Diuretic medications help your body to get rid of excess fluid. Untreated diabetes Untreated diabetes means a continually high level of glucose in your blood. Urinary tract infections Urinary tract infections occur when bacteria enter via the urethra and multiply anywhere in your urinary tract. Urinary incontinence Urinary incontinence is a condition where muscles that close off the urethra become weak, causing stress-inducing urinary leakage. An enlarged prostate For men with an enlarged prostate, there may be a constant feeling of needing to pee. Pregnancy When pregnant, blood volume increases, and the kidneys have to work through the excess fluid. What are the solutions to frequent peeing? Safe, effective treatment of urinary incontinence If you are peeing too much, you should see a urologist to determine the cause and degree of incontinence you have. National Library of Medicine, www. Share Us. Find Our Office. Petersburg, FL, , USA. St Pete Urology. Reid Graves , Dr. Nicholas Laryngakis and Dr. Adam Oppenheim of St Pete Urology are board certified urologists in treating urological diseases with the use of the latest technology available. |
| Drug-Induced Urinary Incontinence | Mallappallil M et al. Increasing OAB-q Diugetic Anti-constipation effects was significantly associated with skipping diuretic doses, supporting the hypothesis that worsening Jrinary lead Hydration kits for on-the-go. decreased diuretic adherence. Frequenncy can lead to Diuretiic following fequency. What Home Remedies Work for an Overactive Bladder? Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. In addition, you can improve your symptoms by avoiding bladder irritants, limiting drinking before bed, and practicing Kegels or other exercises. How opioid use disorder occurs How to tell if a loved one is abusing opioids What is hypertension? |
| What Is Diuresis? | About this Site. Dereppe H, Hoylaerts M, Renard M, Leduc O, Bernard R, Leduc A. Ambrosini PJ. Diuretics are part of the first-line treatment for symptomatic relief of heart failure. 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. And drink most of your fluids earlier in the day to avoid trouble at night. |
Diuretic effect on urinary frequency -
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. RELATED: What Does Burning or Painful Urination Dysuria Mean? Lithium Lithobid is a mood-stabilizing medication used to treat bipolar disorder , notes the National Alliance on Mental Illness NAMI.
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, according to research. That condition is called diabetes insipidus, which is not the same as type 1 or 2 diabetes. It can cause electrolyte and fluid imbalances, so talk to your doctor if you have these side effects.
Clozapine Clozaril is an antipsychotic medication that treats schizophrenia , and it can be a particularly important medication for patients who have suicidal thoughts, according to MedlinePlus. Frequent urination is one possible side effect because it can cause diabetes insipidus, says Hudspeth.
One of the main complications of diabetes insipidus is dehydration , which has symptoms including thirst, dry skin, fatigue, dizziness, confusion, and nausea, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
RELATED: 10 Ways to Keep Your Bladder Healthy and Happy. Some good news: There was a concern that SGLT2 inhibitors would also increase the risk of urinary tract infection one symptom of UTI is a persistent urge to urinate, per the Mayo Clinic , but research has failed to find that connection.
Alpha blockers, such as doxazosin Cardura , prazosin Minipress , and terazosin Hytrin , are another class of medications used to treat high blood pressure.
They work by relaxing blood vessels to allow for adequate blood flow — but they may also relax the muscles of the urethra and cause urinary incontinence, says Hudspeth.
RELATED: The Possible Benefits of Metformin for Type 2 Diabetes and Other Health Conditions. Opioids are drugs that can be prescribed by doctors to treat pain, such as oxycodone OxyContin , hydrocodone Vicodin , morphine Arymo , and methadone Dolophine , according to the Centers for Disease Control and Prevention CDC.
These are highly addictive, and as many as 1 in 4 people who are treated long-term with these drugs experience opioid addiction, per the CDC. Clearly, that is the chief concern. But a lesser side effect is urinary problems, according to research.
If you have any concerns about your medication or new onset of urinary changes, speak to a primary care provider for an evaluation and medical guidance. Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy.
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Stephanie Young Moss, PharmD. Diuretics The point of a diuretic is to increase urination. RELATED: 8 Common Medications That May Cause Dehydration 2.
Tricyclic Antidepressants Urination is normally a well-orchestrated process. Editorial Sources and Fact-Checking. Resources Frequent Urination. Mayo Clinic. May 19, Kashyap M et al.
Prevalence of Commonly Prescribed Medications Potentially Contributing to Urinary Symptoms in a Cohort of Older Patients Seeking Care for Incontinence. BMC Geriatrics.
June 10, In the context of incontinence, emerging evidence suggests that β-blockers may increase bladder contractility and provoke symptoms of urinary urgency [ 30 , 43 ].
The effects of β-blockers on the risk of incontinence are, however, inconsistent [ 44 , 45 ] and require further investigation. Avoidance of prescribing cascades in the elderly is a key tenet of pharmacologic management in this population. Increased urinary frequency and urgency due to diuretic dose escalation during acute heart failure episodes may motivate patients to consult for incident symptoms of overactive bladder.
The overactive bladder syndrome comprises symptoms of urinary urgency, with or without urinary frequency and nocturia, in the presence or absence of urgency urinary incontinence [ 6 ].
Consultation for overactive bladder may lead to prescription of one of two oral pharmaceutical classes of medication for the treatment of overactive bladder symptoms. Both antimuscarinic agents and β3-adrenergic agonists have proven efficacy for reducing symptoms of urinary frequency, urgency and incontinence [ 46 , 47 ].
If a proper medication history is not ascertained, and neither the patient nor the consultant makes the link between heart failure medications and urinary symptoms, a prescribing cascade for the treatment of overactive bladder may ensue. Antimuscarinic drugs are the mainstay of treatment for patients with symptoms of overactive bladder, including urgency incontinence.
Blockade of M2 and M3 receptors in the bladder detrusor muscle reduces urinary urgency, frequency and urgency incontinence. However, blockade of muscarinic cholinergic receptors primarily M2 subtype on sinoatrial nodal cells can also potentially increase heart rate, which is best avoided in patients with heart failure [ 48 ].
Several antimuscarinic agents are approved for the treatment of overactive bladder syndrome, all with different relative affinities for the M2 subtype [ 48 ]. QT interval prolongation and induction of polymorphic ventricular tachycardia torsade de pointes are other theoretical concerns with the use of antimuscarinic agents in heart failure patients [ 48 ]; however, few studies have specifically investigated whether antimuscarinic agents exert these effects in the real-life setting.
Based on available information, any effects that exist appear to be modest and their clinical relevance unknown. Data suggest that the prevalence of cardiovascular co-morbidities is significantly higher in patients with than without overactive bladder, and that cardiovascular co-morbidities are found to be more prevalent in treated versus untreated patients The association between antimuscarinic agents and cardiovascular adverse events therefore warrants further investigation [ 49 , 50 ].
The β3-adrenoceptor subtype is dominant in the human detrusor muscle, and activation of the β3-adrenoceptor mediates relaxation of the detrusor during the storage phase of the micturition cycle, improving bladder storage capacity without impeding bladder voiding [ 47 ].
Mirabegron is a selective β3-adrenoceptor agonist approved for the treatment of overactive bladder. Concern about cross-reactivity with β1- and β2-adrenoceptor subtypes found in the vasculature and cardiac muscle, as well as direct stimulation of β3-adrenoceptors in the heart, have raised concern about the cardiac safety of mirabegron in heart failure patients [ 51 ].
A meta-analysis of three randomized clinical trials with a pool of over 2, patients looked at treatment-emergent adverse effects due to mirabegron [ 47 ]. Adverse effects included hypertension odds ratio [OR] 0. These results suggest no obvious effect of β3-agonists on cardiac function in participants in these trials.
However, interpretation must be made with caution as the study population was not representative of elderly patients with multiple morbidities and chronic heart failure, although many were on β-blockers for the treatment of hypertension.
Further research is warranted on the specific effects of β3-agonists in heart failure patients, as well as the combined use of β-blockers and β-agonists in this population. At Mr. He is disheveled and talks about constantly needing to run to the toilet.
Screening questions reveal that he experiences urge incontinence which is affecting his sense of dignity. Dyspnea on exertion and orthopnea are absent. Pedal edema is minimal. His skin turgor is low and he complains of dry mouth.
Urinalysis is negative. His diabetes is well-controlled but his renal function has worsened. He has started drinking two bottles of beer in the evening. does not know why he is taking oxazepam; he says it was prescribed upon discharge from hospital.
He wants to know if there are medications to take to control his urine leakage. Recommendations and practical tips for the management of heart failure patients with lower urinary tract symptoms entail a variety of pharmacological modifications and non-pharmacological interventions.
Figure 1 illustrates different therapeutic approaches to patients with stress incontinence, symptoms of urinary frequency and urgency—including urgency incontinence—and nocturia. A sudden change in urinary symptoms may signal newly decompensated heart failure or the presence of a urinary tract infection.
These possibilities should be ruled out and addressed prior to proceeding with other management strategies. Management algorithm in patients with chronic heart failure and urinary symptoms. ACE angiotensin-converting enzyme, ARB angiotensin receptor blocker, qhs every night, NSAIDs non-steroidal anti-inflammatory drugs.
Consider reassessing the need and reducing the dose of diuretics if the patient is otherwise stable. Although complete discontinuation of diuretics can lead to decompensation and relapse [ 52 ], many patients are discharged from hospital after an acute episode with high-dose oral diuretics, equivalent to the intravenous doses that were required to relieve symptoms upon admission.
When acute congestion is cleared, the lowest dose should be used that is compatible with stable signs and symptoms. ARBs do not inhibit degradation of bradykinin, thought to be responsible for the ACE inhibitor-induced cough.
ARBs and ACE inhibitors are equal in terms of reduction of mortality and morbidity in heart failure patients, but discontinuation due to adverse effects is lower with ARBs [ 53 ]. Therefore, switching to an ARB may be an alternative to avoid the side effect of coughing and consequent stress incontinence associated with ACE inhibitor use [ 40 , 53 ].
Catheter-induced urinary tract infection Patients in cardiogenic shock or those admitted with acute heart failure who have difficulty voiding often have a urinary catheter inserted to monitor urinary output.
In-dwelling catheters provide a nidus for bacterial entry into the normally sterile lower urinary tract, and increase the risk of lower urinary tract infection. Exacerbation of lower urinary tract symptoms including urinary frequency, urgency, nocturia and incontinence post-hospitalization for acute heart failure may indicate the presence of a new urinary tract infection.
Attribution of symptoms to an increased dose of diuretics may confound early diagnosis and treatment, especially as dysuria and hematuria are less commonly seen as presenting symptoms and signs of urinary tract infection in the elderly [ 54 ].
Recent guidance from the American Board of Internal Medicine for adult hospital medicine recommends that urinary catheters not be placed, or left in place, to monitor urinary output in non-critically ill patients, and that weights should be used instead to track diuresis [ 55 ]. Sedative-hypnotic prescriptions Admission to the intensive care or coronary care unit for treatment of acute heart failure elicits anxiety among patients as they grapple with the impending possibility of mortality.
Anxiety, combined with the need to reduce adrenergic stimulation and sleeplessness due to the beeps and disruptions inherent to any high-intensity monitoring unit, often leads to prescription of a sedative hypnotic [ 56 ].
Evidence suggests that many of these sedative-hypnotic prescriptions persist upon discharge, with hospitalization conferring a 2. For this reason, as well as many others, sedative-hypnotic medications are not recommended in elderly heart failure patients and should be tapered and discontinued.
Cognitive behavioral therapy is a safer and equally efficacious alternative to treat insomnia in the ambulatory care setting [ 59 ].
Fluid restriction represents a key management strategy in patients with chronic heart failure. An individualized fluid management program is recommended for each patient according to the severity of heart failure, renal function and other dietary behaviors.
Clinically, 1. Patient education with or without provision of self-management strategies for fluid management, sodium restriction, daily weighing and physical conditioning may attenuate urinary problems in heart failure patients, although formal trials are required to test the efficacy of this approach [ 60 , 61 ].
Patients with recurrent fluid retention who are able to follow instructions can be taught to adjust their diuretic dose based on symptoms of dyspnea on exertion and orthopnea and changes in daily body weight.
Use of compression stockings during the day by stable chronic heart failure patients may help prevent distal leg edema, nocturnal fluid redistribution, and nocturnal urinary frequency and urgency [ 62 ]. The benefit of compression stockings in patients with decompensated heart failure remains unclear, as the use of compression stockings has been reported to increase right atrial and pulmonary pressures [ 63 ].
Caffeinated beverages, such as tea, coffee and colas, may increase urinary urgency and enhance diuresis via the stimulatory effect of caffeine on the bladder detrusor muscle [ 64 , 65 ]. Even though randomized trials of caffeine reduction in heart failure patients are lacking, epidemiologic data suggest that caffeine intake equivalent to 2 cups mg or greater than 3 cups mg of coffee per day is significantly associated with having moderate to severe urinary incontinence in men 1.
Studies of women also reveal that there may be a physiologic link between high caffeine intake, diuresis, and prevalent and incident urgency incontinence [ 67 , 68 ].
Moderate sodium restriction may also be effective in reducing hospital readmission rates for chronic heart failure patients [ 69 ]. Alcohol consumption has been shown to increase the risk of mortality in chronic heart failure patients, although the physiologic mechanism is unclear [ 70 ].
Attention to dietary factors should therefore be recommended as part of any conservative management strategy. Pelvic floor muscle exercises, as part of any conservative management strategy for urgency incontinence, yield equivalent or superior efficacy to pharmacological management, with an uncommon risk of adverse events [ 72 ].
Although prescription of medication is effective for treating lower urinary tract symptoms, adherence to antimuscarinic agents is poor because of adverse effects such as dry mouth and constipation [ 74 , 75 ], and the use of β3-agonists has not yet been well-studied in heart failure patients, many of whom are already taking β-blockers.
Dry mouth resulting from the use of antimuscarinic agents can paradoxically lead to increased fluid consumption and worsening of heart failure symptoms.
Removal of heart failure medications contributing to lower urinary tract symptoms is the preferred management approach, rather than initiating a prescribing cascade and unavoidable therapeutic competition.
Conservative management strategies for the treatment of urinary symptoms, such as avoidance of caffeinated beverages and regular performance of pelvic floor muscle exercises should be prioritized as first-line treatment.
Upon hearing that his diuretics and sleeping pill may be contributing to his urinary symptoms, Mr. elects a trial of dose reduction and conservative management. He slowly tapers off the benzodiazepine, experiencing withdrawal symptoms that he controls with sleep hygiene techniques and persistence.
A routine of daily weighing, fluid restriction and monitoring of dyspnea symptoms allows him to completely taper off aldactone. He cuts out his morning coffee and bedtime alcohol. He wears compression stockings and every morning practices pelvic floor muscle exercises.
Under close surveillance from the cardiac team, he is able to reduce his dose of furosemide to only 20 mg daily. He only wakes up twice nightly to urinate and is able to make it to the toilet on time. Three months later he no longer leaks, is no longer depressed and has resumed playing golf with his friends.
Urinary frequency, urgency and incontinence are extremely bothersome, while nocturnal symptoms may disrupt sleep and quality of life. Healthcare practitioners should be aware that medications used to treat heart failure may indirectly provoke or exacerbate urinary symptoms, and that tapering diuretics and switching ACE inhibitors for ARBs are reasonable management approaches.
Therapeutic competition may occur as the dose of diuretic is reduced, or new medication is added to treat urinary symptoms. Judicious use of medication, combined with patient collaboration for heart failure and lower urinary symptom self-management are likely the best therapeutic approaches for improving outcomes for these challenging co-morbid conditions.
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The acute and prolonged diuretic frequenncy of coconut water CW and the underlying freqency were investigated with frequemcy saline-loaded rat model. Anti-constipation effects an acute effet experiment, CW could significantly increase urine excretion. In addition, erfect treatment of Diuretic effect on urinary frequency significantly Insulin sensitivity and HOMA-IR urinary Genetic influence on training adaptations and chloride ions, thereby considerably increasing the excretion of NaCl. However, the calcium concentration and pH value were not affected. Furthermore, CW could suppress the activation of renin—angiotensin—aldosterone system by decreasing serum antidiuretic hormone, angiotensin II, and aldosterone levels, and significantly increasing the serum atriopeptin level. CW treatment significantly reduced the mRNA expressions and protein levels of aquaporin 1 AQP1AQP2, and AQP 3. This report provided basic data for explaining the natural tropical beverage of CW as an alternative diuretic agent. It can help rfequency achieve Genetic influence on training adaptations many Diuretiv and significantly improve your effwct. However, side effects are always a edfect when you take DDiuretic, and for Genetic influence on training adaptations people, urinary incontinence Diuretic effect on urinary frequency Diabetic foot care and prevention of foot complications a common experience. So, what Diurehic can cause urinary incontinence, and what can you do about it? Read on to find out. Incontinence is a term that describes any accidental or involuntary loss of urine from the bladder. Incontinence is a widespread condition that ranges in severity from small levels of leakage to complete loss of bladder control. Furthermore, there are a number of types of urinary incontinence, and many people may experience a combination of more than one.
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