For patients with diabetes and heart failure, even small tweaks to medications or habits can tip the scales and worsen urinary symptoms.
Frequent urination isn’t just inconvenient—it’s often a sign that medications, fluid management, and underlying conditions are interacting in complex ways.
On Healthcasts, clinicians weighed in on strategies to relieve bladder symptoms without compromising overall health, sharing tried-and-true approaches that prioritize symptom relief and safe management of comorbidities.
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Post:
A 55-year-old man is presenting with worsening symptoms of OAB, characterized by increasing urgency and nocturia. He reports voiding at least 10-15 times per day and 2-3 times per night. His past medical history includes hypertension, poorly controlled type 2 diabetes (A1c 9.2%), heart failure with reduced ejection fraction (40%), and depression.
His current medications include furosemide, insulin degludec, metformin, sacubitril/valsartan, atorvastatin, and amitriptyline.
Key takeaways about managing an overactive bladder:
Urology
"Even as a urologist, I believe that medical conditions such as heart failure and diabetes take precedent over voiding concerns. I would still offer intervention to help alleviate the urgency/frequency of urination, but often these symptoms will persist until his other medical conditions improve."
Urology
"First, educating the importance of improving sugar control/A1C. Second would obtain PVR to ensure that he is not having overflow incontinence. Third, educating that a diuretic's job is to make urine, so decreasing the oral intake of caffeine might help. Could possibly try mirabegron, but an anticholinergic may increase his thirst due to dry mouth, and he may consume more liquids and exacerbate CHF."
Family Practie
"First, improve what you can, such as better blood sugar control and minimizing bladder irritants. Furosemide can increase urine frequency, and if the dose can be minimized, that would decrease urine frequency and check for prostate pathology. A bladder relaxant may be helpful."
Urology
"Unfortunately, it seems that the patient's poorly controlled DM (an A1c of 9.2% show inadequate management) and need for diuretics is exacerbating his urinary symptoms. We could utilize alpha-blockers to allow for better flow and emptying. But more likely than not, his other medical comorbidities should be managed.
While the primary is working on these, I would offer cystoscopy to assess whether his lower urinary tract has abnormalities (strictures or BPH) and either anticholinergics/beta-3 agonists for his urgency/frequency symptoms, with education that it may improve but not fully resolve his symptoms until the medical comorbidities are managed."
Family Practice
"Not a one-size-fits-all answer, but need better diabetic control with more insulin (and may need to consider stopping metformin due to CHF) or adding a GLP1-agonist. Once he has better diabetic control, he may urinate less. Are you confident this is OAB and not a med effect or BPH? If he limits salt, you could probably taper down furosemide. I would avoid anticholinergics, especially since he's on amitriptyline already."
What medications would you suggest to help this patient reduce his bladder symptoms? Visit the full post on Healthcasts to share your suggestion and read other perspectives from the community.