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Medical Edge Newspaper Column from Mayo Clinic

Diuretics and Overactive Bladder

Dear Mayo Clinic: My sister-in-law takes hydrochlorothiazide, a diuretic, for blood-pressure control. Now her doctor wants to prescribe Detrol LA [tolterodine tartrate] for her overactive bladder. Is this combination safe? Wouldn’t the new medication try to undo what the diuretic is doing? — Plainfield, Ill.

Answer: The combination you describe is safe, effective and not uncommon.

Hydrochlorothiazide and other diuretics (sometimes called water pills) help control blood pressure by making the kidneys excrete more sodium in urine. The sodium takes water with it from the blood, which decreases the amount of fluid flowing through the blood vessels, reducing pressure on the arteries’ walls.

The diuretic is commonly taken in the morning. As the bladder fills repeatedly for four to six hours afterward, the patient needs to make more frequent trips to the bathroom. It is important for the medical provider to know what other drugs a patient is taking. Many — such as analgesics, sleep medications and antidepressants — can also affect bladder function.

Assuming that other drugs are not complicating matters, your sister-in-law has urinary frequency from two sources — her diuretic and an overactive bladder (OAB) — which are treated separately. OAB resulting from involuntary contractions of the bladder not only can increase frequency of urination but can cause urinary urgency and urinary-urge incontinence. It affects men and women alike, especially as they age.

Integral to OAB treatment is behavior modification: bladder retraining, timed voiding, fluid management, and the avoidance of caffeine and other bladder irritants — such as citrus juices. Another approach is to use anticholinergics (anti-spasm drugs), including the
Detrol LA you mention. These medications are meant to reduce involuntary bladder contractions, which typically occur throughout the day and night.

If your sister-in-law has symptoms suggestive of OAB, the Detrol LA or other anticholinergic medications may help. And because their only purpose is to reduce involuntary bladder contractions, they will not counteract or interfere with her diuretic. Therefore hydrochlorothiazide and Detrol LA are safe to use together.

— John B. Gebhart, M.D., Urinary Continence Clinic, Mayo Clinic, Rochester, Minn.

Additional Resources:
Hypertension
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Readers: When someone you love dies, your grief can't be planned or mapped out. Grieving is a unique and natural experience because of your unique relationship with the person who died.

Grief can encompass many physical symptoms -- an upset stomach, a tightening in the throat, actual pain around the heart, headaches, difficulty breathing, exhaustion, an inability to concentrate and forgetfulness. Some people describe grief as numbness, or feeling like the wind has been knocked out of them. Feelings of anxiety, fear and anger -- even anger toward the deceased – are not uncommon.

Grief can last one year, two years or even longer. In that time, you may find things go well for awhile, and then with no warning, you may be overtaken by a wave of grief. Here are some suggestions on ways to deal with grief:

Share your story: It's important to put your feelings into words. A close friend or family member who can act as a sounding board is invaluable as you struggle to sort through feelings. Don't be afraid to let the tears flow. Crying can release sadness along with anger, guilt, loneliness and exhaustion.

Put words to paper: Keep a journal. Write letters to your deceased loved one -- share regrets, things you wanted to say that never got said, how you feel, what you miss.

Join a support group: Talking with others who understand and share the experience of grief can be a healing gift to you.

Be kind to yourself: Grief affects your mind, body and soul. Do what you can to care for yourself with a healthy diet, exercise and adequate sleep.

Seek professional help if needed: If the intense disabling part of grief lasts longer than two months, talk with your doctor. You could be dealing with depression or post-traumatic stress disorder. In addition, seek professional help if you resort to using excessive amounts of drugs or alcohol to deal with your grief.

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.