Those of us who live with chronic and severe asthma know all to well the many and bizarre side effects that this disease can throw at us….God knows I certainly do. Whether a direct result of the condition itself, or from the medications and/or the various treatments used to manage it. But, this latest side effect took me totally by surprise. Proving once again that there’s more to severe lung disease than just difficulty breathing.
Below are just a few of the many complications and side effects that I’ve encountered and have written about. They are:
Steroid Psychosis/ICU Delirium: a side effect of prednisone and other potent medications, being critically ill and spending a lot of time in an ICU and/or being on a ventilator.
Posterior Glottic Stenosis:, an injury involving the developement of scar tissue between and around the vocal cords, caused by frequent and multiple intubations.
Optic Nerve Neuropathy i.e. a non-ischemic stroke of the eye ball: A result of high blood pressures experienced during a severe asthma exacerbation.
Well, now you can add Urinary Retention to that list.
Its not the easiest subject to talk about, and don’t worry, I wont be posting any pictures:-). Still, I think it’s important for people who suffer from asthma or COPD, to know that this particular side effect, while rare, does occur in people who take certain medications for their breathing. More about that later.
But first, when I say “urinary retention”, I don’t mean the type of discomfort or difficulty in going that a lot of men my age experience, Im talking about the sudden and total inability to pee at all!
Essentially what happened, is that I woke up one morning and couldn’t go. I felt the urge like I do every morning, but this time nothing would come out. Nada, zilch, nothing! I had to go, but couldn’t. At first I wasn’t sure what was happening. Could it be a kidney stone? I’ve had those before, but they caused a lot of pain. I wasn’t experiencing any pain, I just had the strong urge to go, but couldn’t. I was getting a little freaked out that my bladder might burst, so of course I Googled my symptoms.
The gist of what I read, is that if you can’t pee, but your bladder feels full, that you need to see a doctor or go to an Urgent care center right away, so that they can insert a catheter in you to drain your bladder. If you wait too long and don’t get the urine out, it could potentially back up into your kidneys, which can be life threatening.
Well, after several more attempts at trying to go, and after straining really hard, I was finally able to get a few drops out…I mean literally a few drops. I guess it helped release some of the pressure in my bladder, but obviously something was wrong. So I took Googles advise and booked the soonest appt I could get at the local Urgent Care center. Dreading what was in store when I got there, I remembered the name of a Urologist who I had seen a couple years earlier for a kidney stone problems and messaged him thru MYChart. By some miracle and he actually got back to me within 5 minutes (when does that ever happen?). He told me that instead of going to Urgent Care, to go directly to his office. He said if I needed to be catharized, they could do it there. I cant tell you how I relieved I was. The last thing I wanted was to have a bunch of strangers in an Urgent care center putting a catheter in me. As a retired healthcare worker, I know its a pretty common procedure, but let’s face it, as a patient it can be quite embarrassing. I figured at least at the Urologists office they deal with this everyday, so no big deal. I could already feel my anxiety level dropping.
Arriving at his office, he was super casual about the whole thing and assured me it wasnt a big deal. He scanned my bladder, which turned out to only have 200 mls in it (not considered a lot). At first he thought I was just dehydrated and therefore couldnt go. But, after reading about my most recent hospitalization and all the straight catherizations they did on me instead of putting in a Foley, he thought my inability to pee might be due to inflammation of the urethra or maybe a stricture. He didn’t seem to think my symptoms were related to prostate issues, but in anycase, should the problem persist, he gave some catheter samples to use at home and told me to follow up with him in a few months.
Over the next few days my symptoms persisted, but I was able to get out a small amount (30-60 mls). Better than nothing. I only had to catherize myself 2 times, which I learned how to do by watching a Youtube video. Not as difficult as I thought it would be. Im not a fan of urinary catheters, but the new hydrophilic ones are pretty cool…. they dont require lube. The material theyre made of becomes ultra slippery when exposed to the saline that theyre packaged in.
So now you might be wondering how these urinary issues are related to my asthma? After doing my own research and then talking with both my Urologist and Pulmonologist, there are 3 plausible explanations:
#1) My urinary symptoms could be due to a pre-existing condition like an enlarged prostate. Like the majority of men my age and older, I do have BPH, though it’s mild and Ive never had any noticeable symptoms of it. Everything down there works just fine. Usually when you have prostate related issues, theyre more chronic in nature and tend to wax and wane in intensity. Symptoms like the urgency to go, the need to go a lot, especially at night, and decreased flow and hesitancy… that sort of thing. None of that happened to me. Everything was working normally until one morning I simply couldnt go. And though Im prone to having UTIs, its doubtful I had an infection, as my lab work and urine cultures came back normal
#2) Another potential cause of my symptoms, especially the pain, is inflammation of the Urethra. Two weeks prior to all this, I was in the hospital for asthma. Normally when youre intubated they put an indwelling catheter in your bladder, called a Foley catheter. They do this not only because your asleep for long periods, but also so they can get a precise measurent of how much fluid is going into you body ( ie through IVs) and how much is coming back out. They usually keep the foley catheter in for a couple of days after you come off the ventilator. This time however, I think due to infection control concerns and my delirum, they removed the Foley right after I was extubated, and instead, did intermittent catherizations or ICs. This is where they insert a catheter to drain your bladder and then immeditaly remove it. I remember the Nurses would scan my bladder with an ultrasound machine several times a day, and if there was more than 400 ml of urine in it, they would drain it with a catheter. This went on for 2-3 days till I was able to go on my own. By the time I left the hopsital everything was back to normal and I was going fine.
#3)Lastly, and the most likely and interesting scenario, is that I had a reaction to one of my inhaled asthma medications. It turns out that Urinary Retention, though rare, is a potentially serious side effect of anticholenergic drugs like Tiotropium, aka Spiriva . Though its difficult to prove a direct causal effect between the use of Tiotropium and the development or worsening of urinary retention symptoms, it’s well known that anticholenergic drugs in general have an affect on bladder function. Manufactures of anticholinergic bronchodilator drugs like Tiotropium and Yupelry clearly state on their websites and product packaging, that the condition can occur. Because I’d had only been taking Tioptropium for a few weeks and because of the sudden onset of the urinary retention, there’s strong suspicion that this is indeed what happened. To be safe I temporarily stopped taking Spiriva.
Now obviously the complications Ive talked about here can occur in other conditions as well, but the fact that they can happen witg asthma should be a reality check to those who might not think that asthma is that big of a deal.
In any event, Im pleased to say that my symptoms seem to be getting better. I no longer have to do self-caths, and the discomfort of going has dimished as well. After discussing this again with my Urologist, Ive decided to re-start the Spiriva. Though the drug may have caused my urinary rention problems, it helps my breathing a lot, so it’s kind of a trade off. If I start experiancing these problems again Ill have to think seriously about whats more important, being able to breath or being able to pee. Crazy huh?