Posted by medlib on March 2, 2003, at 20:25:54
In reply to Re: Not being able to completely empty bladder » medlib, posted by noa on March 2, 2003, at 12:40:05
Hi Noa--
I can't tell you how glad I am to see you back on PB! Or, perhaps, it's just that I *haven't* told you? I live so much in my head that I'm never quite sure how much of what I've compose mentally I've actually communicated--probably a lot less than I think. You've been my hero on PB from the first; in fact, your name was what attracted me to this thread. I think of you every time I try to restrain myself from saying absolutely everything I know that is even slightly related to something that relates to something that someone asked about (i.e., "How would Noa say this?"). I'll never get rid of my run-on sentences; but, sometimes, thanks to you, there're fewer of them.
Apparently not this time, however. About incontinence and psych drugs. SSRIs, once touted as "clean" (side effect free) drugs, are only "clean" when compared to TCAs. They *do* have anticholinergic side effects, just not as many or as intense as those of TCAs. As you noted, those SEs are usually dose related. Docs differ on the number of categories they divide incontinence into; all told, there are 5--stress, urge, overflow, functional and transient. "Functional" refers to any permanent loss of the neural innervation which allows voluntary control of urinary muscles. That can happen in the brain (Alzheimers, stroke) or peripherally (diabetes, tumor). "Transient" refers to temporary I (incontinence) caused by things like infection, childbirth or pelvic injury. The other 3 categories overlap significantly and can mimic each other. "Overflow" refers to leakage from an overfilled bladder. Some urologists say that few women suffer from this type of I; I figure that these are simply ignorant, er, poorly informed, males. (Overflow incontinence is the most common cause of I in older women.) In the arcane world of medical specialties, most urologists treat primarily male urinary and sexual dysfunctions. In big cities, you can find urogynecologists who specialize in women's urinary problems.
The category distinctions of I help some in suggesting how best to intervene. But, as far as I'm concerned, Kegels offer *some* help with all types of I except functional. They strengthen pelvic muscles, and they also seem to heighten awareness and enable more rapid deployment of those constriction abilities. So, although urge incontinence is caused by spasms of overactive bladder muscles (I call them "trigger-happy"), strong, quick pelvic muscles can keep the leakage to a level which can be managed by thin pads. Urge I is characterized by slow release of bladder muscles and incomplete emptying; that's also true of overflow I. The bladder muscle spasms of urge I convince us that we need to urinate when we don't; after awhile, one learns to ignore that signal even when it's appropriate, and then overflow I occurs. BTW, your gyn's explanation of urge I isn't quite complete. Yes, overactive serotonin nerve cells lining the urinary tract can trigger contractions that the brain fails to override; but it also works in the other direction just as often. Overactive brain serotonin neurons can respond to auditory, visual and mental perceptions of water flow by triggering inappropriate release of urine when one sees or hears running water, or even just drinks liquids. Caffeine and alcohol, both natural diuretics, make urge I worse. Estrogen seems to help it. Some younger women with urge I experience a worsening of symptoms during the last week of their menstrual cycle, when estrogen levels are diminished.
There's a fairly good overview of I at
http://www.niddk.nih.gov/health/urolog/pubs/uiwomen/uiwomen.htm Helpful graphics. A resource that I use for so many things that I must have mentioned it before is "Women's Bodies; Women's Wisdom" by Christiane Northrup.Whether or not you should see a urogynecologist would depend on how much of a problem your Effexor is causing. I remember that you had a hard time of it when you were on lithium, especially at night. Since you know what's causing your I, specialist diagnostic skills really aren't relevant. A urogyn *could* help if your problem isn't under adequate control. I know several women who've been helped by collagen injections, for example. I wouldn't go to a general urologist, tho; his practice likely would be too heavily male for me to feel comfortable with his experience base re women.
I was interested in the comment about Vit. B12 and anticholinergic SEs. That's not something I was aware of. I was interested also in your lab B12 result. You must have had truly extensive blood work done; B12 levels sure aren't part of the basic SMA20 screen done for most yearly physicals. B vitamins are all water soluble; so, normally, the body gets rid of excess in the urine. (People used to get injections of extra B12 for increased energy.) I know little about fish oil; but lipids are *not* water soluble, of course. Perhaps there's a way Vit. B12 stays lipid-packaged? Don't know.
Well, time to close this "book" before it turns into a serial. And, since I lack the patience to read anything which has more than 1 part, I don't have enough chutzpah to create one. Here's hoping that someday we get psych meds that don't use a sledgehammer to kill a fly.---medlib, who need not worry about living that long.
poster:medlib
thread:204632
URL: http://www.dr-bob.org/babble/20030301/msgs/205359.html