Bladder Symptoms Provoked by Short, Rapid-Acting Loop Diuretics: A Frequent but Often Overlooked Problem

Bladder dysfunction entails overactive bladder (OAB) defined as symptoms of urinary urgency, frequency, and/or nocturia with or without incontinence if there is no obvious pathology or infection or lower urinary tract symptoms that includes recognized causes of bladder dysfunction.

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Symptoms of OAB are reported in about 15% of the adult US population. This is increased 2- to 3-fold in patients with congestive heart failure (CHF), hypertension, cardiovascular disease (CVD), chronic kidney disease (CKD), or the elderly where it often accompanies prescription for short, rapid-acting loop diuretics. However, less than 2% of patients seeking care for OAB receive treatment. The fear of urinary incontinence from short, rapid-acting loop diuretics may contribute to medication nonadherence and less well-controlled, apparently resistant hypertension. The bladder contracts to rapid stretch. Thus, less rapid-acting diuretics such as thiazides or extended-release formulations of loop diuretics may be preferable for those with bladder dysfunction. Alternatively, the use of a mineralocorticosteroid receptor antagonist, angiotensin receptor antagonist/neprilysin inhibitor, or sodium glucose-linked transport type 2 inhibitor may allow a reduction in the dose of a short, rapid-acting loop diuretic for those with bladder dysfunction.

A worsening of symptoms from bladder dysfunction by short, rapid-acting loop diuretics occurs frequently in patients with CVD, CHF, hypertension, and CKD where it can contribute to impaired quality of life and poor adherence and thereby to worsening outcomes.