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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Rainee on February 28, 2003, at 10:20:51
I have been on a SSRI since 96 and have been taking xanax for about 6 months.
It's been several months that I have noticed that I get the urge to go but can't empty my bladder all the way and have keep going back to let little bits out. I have been checked by a Dr and thye don't see any abnormalities with the bladder.
can these drugs cause this?Thanks
Posted by Cindybee on February 28, 2003, at 14:56:05
In reply to Not being able to completely empty bladder, posted by Rainee on February 28, 2003, at 10:20:51
Rainee, I am on xanax and SSRI's and have the same problem. I haven't discussed it with my doctor though. I think it has something to do with the xanax. Any way it makes me feel like I am always on the verge of a bladder infection. I find I have to go all the time too.
Posted by tina on February 28, 2003, at 15:35:43
In reply to Not being able to completely empty bladder, posted by Rainee on February 28, 2003, at 10:20:51
This is happening to me right now Rainee. I'm on Effexor. It's never happened with other AD's, just this one.
I wonder why these drugs do this? I hope someone else has a more scientific answer. I just wanted to add my name to the list so you feel less alone in this.`
good luck
tina
Posted by noa on February 28, 2003, at 21:04:31
In reply to Re: Not being able to completely empty bladder » Rainee, posted by tina on February 28, 2003, at 15:35:43
I have similar problems. Mostly, an extremely sudden urge to go, and difficulty holding it in, followed by, after initial release of some urine, the hesitancy that you describe.
At one point, I did try to get some answers. With some reading on the internet, and some conjecture from folks here, I guess I came to beleive that the best guess is that Serotonergic medications are activating several of the serotonin receptors in the muscle tissue of the bladder. This could make the bladder contract/spasm and not be able to unspasm in order to fill up completely. Hence the frequency and the sudden urge to go. It could also make the sphincter muscles spasm so that urine would not release when it is supposed to.
It is worse for me at higher doses of Effexor, so, after discussing it with pdoc, I did lower the Effexor dose a couple of years ago (compensated with raising Serzone dose). This dose change was for this SE but also for a related one--the muscle spasms at night, ie, myoclonus and RLS.
I deal with it by being more deliberate about monitoring when I need to go, trying to be more attuned to the earliest warning signals possible. I also have been wearing those ultra thin maxi pads (Always), just in case, and carry extras with me. As for the other aspect of the problem, the hesitancy--I guess I try to be patient, though I do get annoyed at having to make return trips every 5-10 minutes sometimes!! But I also have used some relaxation strategies followed by "pushing", using pelvic muscles.
I guess I take it pretty much in stride now, but every once in a while it really really IRKS me. I guess I am willing to deal with it, for now, but do continue to hold out hope that a new med or treatment will eventually come along to replace this rather imperfect one with such SEs. But for now, it is the best I've found and I have learned to manage the problem more or less, and it pales in comparison to my depressive disorder. But it does stink, this SE, doesn't it?
Posted by Patient on March 1, 2003, at 17:02:17
In reply to Not being able to completely empty bladder, posted by Rainee on February 28, 2003, at 10:20:51
Hi Rainee and all who have posted to you,
I have studied this a while back after starting on SSRI's about 3 years ago.
An inability to urinate or completely relieve the bladder can also be caused by anticholinergic effects of these drugs. An anticholinergic agent is any drug that diminishes the effect of acetylcholine, a neurotransmitter. Anticholinergic effects include: rapid heart rate, inability to urinate, dialation of pupils, and constipation.
One way to try to counteract this effect is to increase acetylcholine through supplementation, such as vitamin B12 which is linked to the production of acetylcholine, as well as choline, one of the B vitamins. The best product I have found to increase acetlycholine is royal jelly. It is the only natural source of pure acetylcholine. Royal jelly must be combined with honey to preserve its potency. I keep mine refrigerated since it spoils easily. I no longer have problems with constipation. Give it a try. You can find it at health food stores. You only need a teaspoon a day.
Posted by noa on March 1, 2003, at 22:34:17
In reply to Re: Not able to empty bladder-anticholinergic, posted by Patient on March 1, 2003, at 17:02:17
Interesting. Thanks for info.
I just got my labs back and for first time in my life my B12 level was through the roof! I wonder if anything I'm taking (only new thing is fish oil) somehow raises the level of B12. Also, does having it in your blood necessarily mean it is available for use by the cells?
Posted by medlib on March 2, 2003, at 4:25:58
In reply to Not being able to completely empty bladder, posted by Rainee on February 28, 2003, at 10:20:51
Hi Rainee--
According to drug lit, both Xanax and SSRIs can cause urinary retention, though Xanax does so in far fewer pts. I suspect that what you are experiencing may be the additive result of meds producing the same side effect. SSRIs have differing half lives, and Xanax has a fairly short half life. It may help some to take these 2 meds at different times of day, if you're not doing so already.
The problem with drug remedies for side effects caused by other drugs is, of course, that the remedy itself has side effects. Another problem is that the drugs we have available so far are not specific enough--they affect *all* serotonin receptors, not just the helpful ones. There are more serotonin receptors than all other receptor types combined, and there are far more serotonin receptors in the gut and related organs than in the brain.
Well, enough of that blather. One of the worst results of urinary retention is the occasional overflow incontinence. I find that good, old-fashioned Kegel exercises that strengthen the pelvic muscles help most with that embarrassing annoyance. It takes consistent repetition to maintain the improvement, however--not too different from other fitness exercises, I guess.
Sometimes, it seems to me that you just can't win for losing. Hope that you find a combination that helps more than it harms. Good luck!---medlib
Posted by noa on March 2, 2003, at 12:40:05
In reply to Re: Not being able to completely empty bladder » Rainee, posted by medlib on March 2, 2003, at 4:25:58
Hi, Medlib! Thanks for the info.
I'm interested in what you said about "overflow" incontinence. I had only heard about "stress" incontinence and "urge" incontinence. I have though I have the latter, which my gyno tells me is from brain's inability to override the urge factor. I guess I thought of it as being related to the serotonin receptors inthe urinary tract, sending signals to the brain, affecting the muscles, etc. and bladder not relaxing to full size. But "overflow" sounds a bit like "stress" incontinence, if the kegel exercises help. My gyno didn't think the kegels would make a difference for me.
I get both the urge incontinence, mostly near misses, plus the retention--ie, sudden strong urge to go, difficulty holding it in, release of small amount of urine (definitely not enough to have warranted the strong, full bladder urge feeling), and then followed by retention. As I said, I have always attributed this to the Effexor, because it started soon after I had reached sizable dose, and was worse at higher doses than now, after lowering dose somewhat.
Any thoughts? Should I see a urologist? Thanks.
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.
Posted by SLS on March 2, 2003, at 21:11:45
In reply to Not being able to completely empty bladder, posted by Rainee on February 28, 2003, at 10:20:51
Hi.
This thread is too much for me to read, so forgive me if this is repeating something already said. Perhaps Urecholine (bethanechol) would help. It might allow for a more complete emptying of the bladder and reduce the frequency of the need to pee. It would certainly help initiate urination if the side effect is anticholinergic in origin.
- Scott
Posted by Patient on March 3, 2003, at 7:09:00
In reply to Re: Not able to empty bladder-anticholinergic, posted by noa on March 1, 2003, at 22:34:17
That is quite unusual compared to one being deficient in B12. I would also find it strange that suddenly the test shows a very high increase in B12. It can be high in certain blood disorders, as well as obesity. If I were the doctor I would want to make sure a glitch didn't happen with the test, as well as test your gastrointestinal mucoprotein intrinsic factor-this helps one to absorb vitamin B12. Many people with malabsorption problems have problems with deficient intrinsic factor that they do not absorb B12 readily--that is why I suggested a sublingual form of B12, which absorbs through your mucosa in your mouth-that way, bypassing the stomach.
It could be the fish oil. One of the largest amounts of B12 source is seafood.
The intrinsic factor is part of the gastric juices and assists in absorption by binding to vitamin B-12, which helps attach the vitamin to a receptor in the membranes of the lower small intestine. The vitamin is then transported into the cells. Vitamin B-12 is transported in the bloodstream bound to transcobalamin 1 and 11. In this way it circulates to the tissues, and is concentrated in the liver and, to some extent, the kidneys. Vitamin B-12 is then released as needed to other tissues of the body and to bone marrow. I would think if it is in your blood serum, then it is available to cells, but I'm not certain--I would ask your doctor certainly about this. Vitamin B 12 is not normally part of a general blood test. Are you getting it tested due to anemia?
Water-soluble vitamins in excess tend to be excreted in the urine, rather than stored in the tissues as are fat-soluble vitamins. The body stores up to one year's worth of vitamin B12 in the liver, kidneys, and heart.
The next time I was tested I would stop the fish oil supplements a week or two prior to testing, just to see if this would make a difference. Tell you doctor that you are taking them, as they should know more about this.
Posted by medlib on March 3, 2003, at 17:28:28
In reply to Re: Not being able to completely empty bladder » noa, posted by medlib on March 2, 2003, at 20:25:54
Hi folks--
Just ran across this recent FDA approval last night; it's a new med for urge incontinence available in patch form, so it can bypass the GI tract.
http://www.healthscoutnews.com/view.cfm?id=511707
Scott's suggestion of bethanechol is a good one (no surprise there!). It has a low incidence of SEs and it doesn't interact with most other meds. I was unable to take it due to nausea, but my reaction was an atypical one (no surprise there, either). Most people have no probs w. it.
Anyway, this is 1 prob that has some viable solutions; no need to suffer in embarrassed silence. Besides, urinary probs are much more socially acceptable than MI--isn't everything?
medlib
Posted by noa on March 3, 2003, at 18:42:34
In reply to Re: Not being able to completely empty bladder » noa, posted by medlib on March 2, 2003, at 20:25:54
THANK YOU for that detailed explanation. I read it and you helped me understand a lot. I will visist the site you linked at NIH, and I am going to print out your post so I can also revisit it again. Thank you!
Posted by noa on March 3, 2003, at 18:43:49
In reply to Re: Not able to empty bladder-noa, posted by Patient on March 3, 2003, at 7:09:00
Patient, Thank you so much for the info! I will ask my doctor about it.
Posted by noa on March 3, 2003, at 18:44:24
In reply to Re: Not being able to completely empty bladder, posted by SLS on March 2, 2003, at 21:11:45
Scott--Thanks. I don't know if I'm ready to go that route, but thank you for the info!
Posted by syringachalet on March 5, 2003, at 0:25:28
In reply to Re: Not being able to completely empty bladder » SLS, posted by noa on March 3, 2003, at 18:44:24
I have known a number of people that their urinary incontinence was due to constipation from the TCA and SH they had prescribed for them.
The fact that they were "FOP"full of poop...that they had that full colon pressing on a bladder that was doing the best it could.
It is not uncommon for most people to NOT want to talk to their MD about constipation when taking these meds long-term. But it is something to keep in mind when you have to make that third trip to the potty during the night...lol
syringachalet
This is the end of the thread.
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