Association of diuretic use and overactive bladder syndrome in older adults: A propensity score analysis

Abstract

Diuretics use and overactive bladder syndrome are common in older adults. However, the relationship between the two has not been well studied. Data were collected by self-administered questionnaires including the Urge Urinary Distress Inventory (Urge-UDI) and the Urge Incontinence Impact Questionnaire (Urge-IIQ), and by outpatient chart abstraction. Patients (n = 172) had a mean age of 79 ± 7.5 (± S.D.), 76% were women, and 48% were African Americans; 76% had hypertension, 32% had heart failure, and 66% were receiving diuretics (57% loop diuretics). Overall, 72%, 68%, and 73% of patients respectively reported urinary frequency, urgency and urge incontinence. Diuretic use was associated with increased frequency (81% versus 55% non-diuretic; odds ratio = OR = 3.48; 95% confidence interval = CI = 1.73–7.03) and urgency (74% versus 57% non-diuretic; OR = 2.17; 95% CI = 1.11–4.24) but not with incontinence (OR = 1.74; 95% CI = 0.87–3.50). When adjusted for propensity scores, diuretic use had independent associations with frequency (adjusted OR = 3.09; 95% CI = 1.20–7.97) and urgency (adjusted OR = 2.50; 95% CI = 1.00–6.27). In addition to frequency and urgency, loop diuretic use was also associated with incontinence (OR = 2.54; 95% CI = 1.09–5.91), which lost significance after propensity adjustment (adjusted OR = 1.88; 95% CI = 0.57–6.17). Overall summary mean Urge-IIQ score was 1.83 ± 0.85 (±S.D.) with 1.75 ± 0.86, 1.68 ± 0.76, and 2.03 ± 0.88, respectively for no-diuretic, non-loop, and loop-diuretic patients (one-way ANOVA p = 0.063). Overactive bladder symptoms were common among ambulatory older adults and were associated with diuretic use, and had stronger associations with loop diuretic use.

Relationship Between the Use of Diuretics and Overactive Bladder in Patients with Heart Failure

“…Fitzgerald et al [11] found that nocturia was higher in patients with cardiac disease and using diuretics. Ekundayo et al [7] have studied and found that OAB symptoms were common among older people and were associated especially with loop diuretic use. Palmer et al [5] did not find any relation between OAB and diuretic use in heart failure patients.…”

“…Diuretic use is also common among heart failure patients. By increasing urine production by the kidneys, diuretics increase urinary frequency and may cause urinary urgency and incontinence [7]. However, whether diuretic use is associated with OAB has not been well studied and there are contradictory publications in this issue [5,7].…”

“…By increasing urine production by the kidneys, diuretics increase urinary frequency and may cause urinary urgency and incontinence [7]. However, whether diuretic use is associated with OAB has not been well studied and there are contradictory publications in this issue [5,7]. The objective of this study was to determine the prevalence of OAB in outpatient heart failure patients and to evaluate the clinical and laboratory parameters that may be associated with OAB.…”

The Problem of Polypharmacy in Female Patients with Overactive Bladders – Cross-Sectional Study in a Specialist Outpatient Department

“…The mechanisms have been described in many different studies and vary widely. Diuretics increase urine production [15], alpha-receptor blockers reduce the pressure and thus the resistance of the urethra [16], calcium channel blockers lead to polyuria [17] and beta-receptor blockers result in, via a dominance of the parasympathetic nervous system on the detrusor, to an increased contraction readiness of the bladder wall [18]. Also ACE inhibitors can trigger stress incontinence by way of increased coughing that increases the intra-abdominal pressure [19].…”

“…31 % of all patients consumed drugs that have sedative and constipation-inducing effects and so favour urinary incontinence. The third most frequent mechanism was increased urine output or polyuria that can occur after consumption of, above all, diuretics or calcium blockers [15,17]. 28 % of the patients took drugs that increased the production of urine.…”