Bladder Dysfunction: Medications and Long-Term Effects

Q: Bladder Dysfunction: Medications and Long-Term Effects

Question 1： The physician prescribed urology medications： tamsulosin 0.2 mg, one capsule in the morning and one in the evening; baclofen 5 mg, one capsule in the morning and one in the evening. <br>What are the long-term side effects of taking these medications? Will taking baclo

Bladder dysfunction with poor bladder contraction elasticity and a post-void residual of 40cc?

Since childhood, I have been unable to urinate in public when others are nearby.
I have suffered from pathological urinary retention and would only urinate when the restroom was empty, leading to severe urinary retention.
Now, I experience symptoms such as frequent urination, difficulty initiating urination, abdominal straining to urinate, urgency, and a sensation of incomplete emptying.

On January 30, 2013, I had a uroflowmetry report showing the following results: peak flow rate of 6 ml/s, time to peak flow of 110 seconds, voided volume of 186 ml, flow time of 112 seconds, voiding time of 222 seconds, average flow rate of 2 ml/s, and residual urine of 40 ml.

Currently, I am taking the following medications:
- Cardiology: Somil S.C.
Tab - 40 mg, Diltiazem (Cartil) 60 mg (one of the two before bedtime).
- Psychiatry: Zoloft 50 mg (2 tablets), Mirtazapine 50 mg (2 tablets), Sertraline 50 mg (1 tablet), Zolpidem 10 mg (2 tablets), Flunitrazepam 2 mg (2 tablets), Alprazolam 0.5 mg (2 tablets at night).
- Metabolism: Metformin HCl 850 mg, Lyrica (Pregabalin) 75 mg (2 tablets).
- Orthopedics: Acetaminophen (Depyretin) 500 mg (1 tablet before bedtime).
- ENT: Loratadine 10 mg.
- Urology: Tamsulosin 0.2 mg (2 tablets), Baclofen 5 mg (1 tablet twice daily), Bethanechol chloride 25 mg (three times daily).
I have been taking these medications long-term.
My most recent report from the hospital indicated a residual urine volume of 40 cc, while the previous report from seven years ago showed 40 cc as well.
The most recent assessment indicated a residual urine volume of 50 cc.
The physician mentioned that my uroflowmetry and urodynamics tests require abdominal pressure to urinate, indicating poor bladder elasticity, weak bladder contractions, and reduced bladder capacity due to long-term urinary retention.
Question 1: The physician prescribed Tamsulosin 0.2 mg (2 tablets daily) and Baclofen 5 mg (1 tablet twice daily).
What are the long-term side effects of these medications? Will long-term use of Baclofen 5 mg lead to irreversible and permanent weakening of bladder contractions?
Question 2: Can Bethanechol chloride 25 mg help with bladder weakness? Will long-term use of this medication lead to irreversible and permanent weakening of bladder contractions?
Question 3: Among the medications listed above, which ones may contribute to further weakening of the bladder?
Thank you, doctor, for addressing these three questions.
I hope you can provide answers to each one.

cellexc, 30~39 year old female. Ask Date: 2020/09/26

Dr. Cai Zhuorong reply Urology

Question 1: The physician prescribed urology medications: tamsulosin 0.2 mg, one capsule in the morning and one in the evening; baclofen 5 mg, one capsule in the morning and one in the evening.
What are the long-term side effects of taking these medications? Will taking baclofen 5 mg for several years lead to irreversible and permanent weakening of bladder contractions?
Answer: For the side effects of baclofen, please refer to the package insert.
It will not cause further weakening of the bladder.
Question 2: Can bethanechol chloride 25 mg help with bladder weakness? Will taking this medication for several years lead to irreversible and permanent weakening of bladder contractions?
Answer: The action of bethanechol is to promote smooth muscle contraction; it will not cause further weakening of the bladder.
Question 3: Which of the medications mentioned above could potentially lead to increased bladder weakness?
Answer: Your issue may not necessarily be caused by the medications.
It is recommended to undergo video urodynamic testing.

Reply Date: 2020/09/26

More Info

Understanding bladder dysfunction, especially in the context of medication use, is crucial for managing symptoms and improving quality of life. Based on your description, it appears you have been dealing with significant bladder issues, including urinary retention, urgency, and residual urine. The medications you are currently taking, particularly tamsulosin, baclofen, and bethanechol chloride, can have various effects on bladder function.

Question 1: Long-term effects of Tamsulosin and Baclofen
Tamsulosin is an alpha-1 adrenergic antagonist primarily used to treat benign prostatic hyperplasia (BPH) and improve urinary flow. It works by relaxing the muscles in the prostate and bladder neck, which can help alleviate urinary symptoms. Long-term use of tamsulosin is generally considered safe, but potential side effects include dizziness, headache, fatigue, and in some cases, retrograde ejaculation. There is no strong evidence to suggest that tamsulosin will cause permanent bladder dysfunction or make the bladder weaker over time. However, it is essential to monitor your symptoms and discuss any concerns with your healthcare provider.

Baclofen is a muscle relaxant that is often used to treat spasticity. While it can help with muscle relaxation, it may also lead to urinary retention as a side effect. Long-term use of baclofen can potentially lead to tolerance, meaning that over time, you may require higher doses to achieve the same effect. There is a concern that prolonged use could contribute to bladder dysfunction, particularly if it leads to increased urinary retention. However, the exact nature of these effects can vary significantly among individuals.

Question 2: Effects of Bethanechol Chloride
Bethanechol chloride is a cholinergic agent that stimulates bladder contractions, making it useful for treating urinary retention. It can help improve bladder emptying and is often prescribed for patients with bladder dysfunction. Long-term use of bethanechol is generally well-tolerated, but it can cause side effects such as abdominal cramps, diarrhea, and increased salivation. There is no substantial evidence to suggest that long-term use of bethanechol will lead to irreversible bladder dysfunction. Instead, it is intended to enhance bladder contraction and improve urinary flow.

Question 3: Medications that may worsen bladder function
Among the medications you are taking, baclofen and potentially tamsulosin could contribute to bladder dysfunction if they lead to increased urinary retention. While baclofen is not primarily indicated for bladder issues, its muscle-relaxing properties can affect bladder control. On the other hand, Zolpidem and Flunitrazepam, both of which are sedative-hypnotics, can also impair bladder function indirectly by causing sedation and affecting overall muscle tone and coordination.

Conclusion
In summary, while some of your medications may have side effects that could impact bladder function, it is essential to work closely with your healthcare provider to monitor your symptoms and adjust your treatment plan as necessary. Regular follow-ups and possibly bladder function tests can help assess the effectiveness of your current regimen and identify any potential issues early on. If you experience worsening symptoms or new side effects, do not hesitate to reach out to your doctor for further evaluation and management.

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