Managing Urinary Issues: Insights for Patients with Heart Conditions

Q: Managing Urinary Issues: Insights for Patients with Heart Conditions

Hello： <br>In my opinion, at the age of 53, prostate issues should not be too severe. <br>Difficulty in urination may be due to posture and reduced activity after illness, leading to pelvic weakness, which can cause urinary difficulties. <br>I recommend that, aside from managing

Urinary problems

Hello, Doctor: I have a stent in my heart and have undergone two catheter ablations.
I am experiencing chest tightness, chest pain, back pain, pain in my ribs and armpits, as well as frequent palpitations and episodes of paroxysmal supraventricular tachycardia (PSVT).
In August, I underwent a gastrointestinal endoscopy and developed a high fever after leaving the hospital, which led to a 36-hour emergency visit.
I was prescribed sulfa drugs and later diagnosed with Stevens-Johnson syndrome at a clinic.
My diarrhea improved after a month; however, I have mild benign prostatic hyperplasia that is obstructing the bladder outlet.
The urology medication dosage has been gradually reduced.
In recent days, I have been urinating only 100-200 cc daily and need to lie down for a long time before I can urinate.
Due to medication mismanagement, I have experienced palpitations and PSVT episodes.
I have also vomited bile and have liver issues.
I have been taking sulfa drugs and aspirin for four weeks, but I am allergic to contrast agents.
What treatment options do you recommend? I have been given medication at the Changhua outpatient clinic and sent home; I am unsure how to seek further medical care and communicate effectively with my physician.

Wang Yiren, 50~59 year old female. Ask Date: 2019/10/24

Dr. Du Shixi reply Urology

Hello:
In my opinion, at the age of 53, prostate issues should not be too severe.
Difficulty in urination may be due to posture and reduced activity after illness, leading to pelvic weakness, which can cause urinary difficulties.
I recommend that, aside from managing heart conditions effectively, urinary medications should not be discontinued.
It's important to drink water in a consistent manner, avoiding large fluctuations in intake.
If possible, try to get up and move around.
Additionally, it would be best to limit the consumption of coffee and tea.
I also suggest a professional evaluation by a urologist at the hospital.
Proper medication should help improve the situation.
Wishing you good health.

Reply Date: 2019/10/24

More Info

Managing urinary issues in patients with heart conditions can be quite complex, especially when there are multiple underlying health concerns. In your case, the presence of coronary artery disease (CAD), a history of stent placement, and episodes of paroxysmal supraventricular tachycardia (PSVT) complicate the management of urinary symptoms, particularly in the context of benign prostatic hyperplasia (BPH) and potential medication side effects.

Understanding Your Symptoms
1. Urinary Retention: The difficulty in urination, where you mention needing to lie down for a long time before being able to urinate, could be attributed to BPH. This condition can obstruct the urethra, making it difficult for urine to flow from the bladder. The prostate gland enlarges with age, and this can lead to urinary symptoms such as hesitancy, weak stream, and incomplete bladder emptying.

2. Medication Effects: Certain medications, especially those used for heart conditions or hypertension, can have side effects that impact urinary function. For instance, diuretics can increase urine production, while some heart medications may lead to fluid retention or affect bladder control.

3. Heart Conditions: Your history of heart issues, including stent placement and episodes of PSVT, may also contribute to your overall health status and how your body manages fluid balance. It's essential to monitor how your heart condition interacts with urinary symptoms, as both systems are interconnected.

Recommendations for Management
1. Consultation with Specialists: Given your complex medical history, it is crucial to maintain open communication with both your cardiologist and urologist. They can work together to ensure that your heart condition is managed while addressing your urinary issues. A multidisciplinary approach is often the most effective.

2. Medication Review: Have a thorough review of all medications you are currently taking. This includes any over-the-counter medications and supplements. Your healthcare providers can assess whether any of these might be contributing to your urinary retention or exacerbating your heart symptoms.

3. Prostate Management: For BPH, there are several treatment options available, including alpha-blockers (which can help relax the muscles around the prostate and bladder neck) and 5-alpha-reductase inhibitors (which can reduce prostate size). Discuss these options with your urologist to find a suitable treatment plan.

4. Monitoring Symptoms: Keep a detailed log of your urinary symptoms, including frequency, volume, and any associated symptoms (like pain or urgency). This information can be invaluable for your healthcare providers in tailoring your treatment plan.

5. Hydration and Diet: Ensure you are adequately hydrated, but also be mindful of fluid intake in the hours leading up to bedtime to minimize nocturia (the need to urinate at night). A balanced diet that supports heart health can also be beneficial.

6. Emergency Plan: Given your history of severe reactions (like the Steven-Johnson syndrome you mentioned), it’s essential to have an emergency plan in place. This includes knowing when to seek immediate medical attention, especially if you experience severe symptoms like chest pain, significant changes in heart rhythm, or severe abdominal pain.

7. Follow-Up Care: Regular follow-ups with your healthcare providers are essential. They can monitor your heart condition, adjust medications as necessary, and ensure that your urinary symptoms are being effectively managed.

Communication with Healthcare Providers
When discussing your symptoms with your healthcare providers, be clear and concise about your experiences. Use specific terms to describe your urinary issues, such as "difficulty initiating urination," "weak urine stream," or "feeling of incomplete bladder emptying." This will help your doctors understand the severity and nature of your symptoms, leading to a more effective treatment plan.

In summary, managing urinary issues in the context of heart conditions requires a careful, coordinated approach. By working closely with your healthcare team and actively participating in your care, you can find effective strategies to address both your heart and urinary health concerns.

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