Can steroids cause urinary retention?

Steroids, also known as corticosteroids, are used to treat a variety of medical conditions, from inflammatory disorders to autoimmune diseases. They suppress the immune system, helping to relieve swelling, redness, itching, and allergic reactions. These drugs unfortunately, come with a range of possible side effects too, such as weight gain, high blood sugar levels, blurred vision, high blood pressure, mood swings, and urinary retention. Understanding the relationship between steroids and urinary retention is important to ensure proper management and to minimize their impact on quality of life.

Understanding urinary retention

Urinary retention is a condition in which the bladder cannot fully empty, leading to a urine buildup in the bladder. This results in discomfort, pain, and an increased risk of urinary tract infections. Urinary retention can be caused by neurological conditions, prostate issues, and certain medications, including steroids.

Anatomy and function of the urinary system

The urinary system is responsible for producing, storing, and eliminating urine. It is made up of the kidneys, ureters, bladder, and urethra. The kidneys filter waste and excess water from the blood, which is then passed to the bladder through the ureters. The bladder stores urine until it is ready to be excreted through the urethra.

Factors contributing to urinary retention

Factors contributing to the development of urinary retention, include:

• Neurological conditions: Conditions that affect the nerves responsible for bladder function, such as spinal cord injuries, multiple sclerosis, or Parkinson’s disease
• Prostate issues: Enlargement of the prostate gland, a common condition in older men, can obstruct the flow of urine
• Medication side effects: Certain medications, including steroids, can interfere with the normal functioning of the bladder

The link between steroids and urinary retention

Steroids, such as prednisone, can contribute to the development of urinary retention through various mechanisms.

Mechanism of action

Steroids are known to directly affect the bladder and the urinary system, causing the muscles of the bladder to relax, leading to a decreased ability to empty the bladder. This can result in the buildup of urine and the development of urinary retention.

Risk factors and prevalence

The risk of developing urinary retention while taking steroids is higher in older adults, individuals with pre-existing bladder or prostate issues, and those with underlying neurological conditions. The exact prevalence of steroid-induced urinary retention is not well-documented, as it can vary depending on the steroid, dosage, and duration of treatment.

Timing and onset of symptoms

Urinary retention is more common during the initial stages or when the dosage of the steroid is increased. Symptoms may develop gradually or suddenly, depending on the individual’s response to the medication.

Symptoms

Patients taking steroids should be aware of the potential signs and symptoms of urinary retention, which may include:

• Difficulty urinating: Incomplete bladder emptying, a weak urine stream, or a sense of straining during urination
• Frequent urination: Individuals may feel the need to urinate more often, even though they are unable to empty their bladder
• Abdominal discomfort: A sense of fullness in the lower abdomen may be experienced due to the buildup of urine
• Urinary Tract Infections (UTIs): This may manifest as burning, pain, or a feeling of urgency during urination
• Kidney damage: Untreated urinary retention can lead to kidney damage or infection

Diagnosing

Diagnosing steroid-induced urinary retention involves a combination of medical history, physical examination, and diagnostic testing.

Medical history and physical examination

Healthcare providers will gather information about the patient’s current medication regimen, including the dosage and duration of steroid use. They will also inquire about any other urinary or bladder issues, as well as the onset of the patient’s symptoms.

The healthcare provider may perform a palpation of the abdomen to assess the size and fullness of the bladder. They may also perform a digital rectal examination in men to evaluate the prostate gland.

Treatment options

Treatment involves a varied approach, addressing both the underlying condition and the symptoms.

Steroid dosage and regimen

The first step may be to adjust the steroid dosage or regimen. Healthcare providers may consider using a low dose or changing to a different type of steroid to reduce the impact on the urinary system.

Bladder management techniques

Depending on the severity of the urinary retention, healthcare providers may recommend bladder management techniques, such as:

• Intermittent catheterization: Where a small tube is inserted into the bladder to empty it at regular intervals
• Indwelling catheter: May be placed to continuously drain the bladder and prevent the buildup of urine
• Bladder training exercises: Pelvic floor muscle exercises or bladder training techniques to improve bladder control and function

Medication

In some cases, additional medications to help manage the urinary retention may be prescribed:

• Alpha-blockers: To help relax the muscles of the bladder and prostate, improving urine flow
• Anticholinergic medications: To reduce bladder spasms and improve bladder emptying
• Antibiotics: To treat the underlying infection

Addressing underlying conditions

In some cases, the urinary retention may be related to an underlying medical condition, such as an enlarged prostate or a neurological disorder. In these cases, healthcare providers may recommend additional treatments or referrals to specialists to address the underlying condition.

Prevention

To prevent or reduce the risk of steroid-induced urinary retention, healthcare providers and patients can use the following strategies:

• Careful monitoring: Can help detect urinary retention early and allow for timely intervention
• Dose optimization: Healthcare providers may adjust high doses to find the lowest effective dose
• Bladder-friendly lifestyle: Maintaining a healthy fluid intake, avoiding bladder irritants, and engaging in pelvic floor exercises to support bladder function
• Early intervention: To facilitate an early diagnosis and management
• Working with specialists: Referral to a urologist or other specialist may be necessary to address underlying issues

Conclusion

Steroid-induced urinary retention is a potential side effect that patients and healthcare providers should be aware of when using corticosteroid medications. Understanding the reasons, symptoms, and seeking medical advice are important to reduce the impact of this condition and to ensure the safe and effective use of steroids.

Sources

• Drug-induced urinary retention: incidence, management and prevention – PubMed
• Prednisolone (Oral Route) Side Effects – Mayo Clinic
• Prednisone (Oral Route) – Side effects Uses, Dosage and Warnings