will possible med side effect affect me?

alan · 10-08-2001, 07:05 PM

I'm a C-5, with a severe full body pain problem, as most of you probably have seenn from previous posts of mine. My bladder is managed solely via condom catheter - it goes when it wants. I do the majority of my drinking in the evening, and usually pass 1500 ml or more urine daily, depending on how much liquid I consume in an individual evening.

My question is this: My doctor wants to try elavil again for my pains, but eventually at a higher dose than previous trials. A possible side effect of elavil is urinary retention. Is my bladder now so conditioned by 20 years of reflex voiding that it will always do so at whatever volume triggers release, regardless of any medication side effect, or can the elavil mess things up? Is anyone here on elavil, or has used it in the past without bladder-related problems? Nurses, what's your opinion?

If my pain allows it, I have an appointment with a urologist this month, the first in many years (being homebound due to pain interferes with everything, including getting to doctors. I hate this burning body, I really do. Quadhood is a cakewalk compared with it.)

zaziwe · 10-08-2001, 08:00 PM

Hey Alan,

I have been on Elavil for over 5 years, now taking 125mg daily. It hasn't interfered too much with my ability to void, although it is difficult at times.

Hang in there brother

David Berg · 10-08-2001, 09:03 PM

Alan,

I know of other central pain patients who use Elavil with some degree of success. I've heard opinions that it simply helps to sedate the nervous system.

I can't help you with an answer about urine retention. Is there anything you can do to help compensate?

David Berg

SCI-Nurse · 10-08-2001, 10:26 PM

Any of the tricyclic antidepressants such as Elavil have an anticholergic effect on the bladder. This increases the capacity and decreases tone. They are often given at lower doses that the antidepressant dose to help keep someone dry between caths, and also are often used for neuropathic pain management.

Unfortunately, it is not possible to predict ahead of time what effect the Elavil will have on your bladder, but you are wise to be concerned. It would be best to check your residual urine amounts (3 times at least) with each increase of your dosage of Elavil, and if you see the amounts increasing you may need to consider either decreasing the dose or cathing several times daily to handle this. Be sure you are working both with your pain management physician and your urologist on this change.

(KLD)

alan · 10-09-2001, 12:29 PM

I currently have no urologist, or pain doctor (those have all given up on me.) I am dealing solely with my internist. I made an appointment with a urologist, after many years since my last one, but the increasing pains, which now are level 10 in several key areas and have me totally homebound, may prevent me from getting there. I'm going to post a note in the pain forum with a little description of the various pains and how they affect my (non)life. I have a long text file I wrote, but I don't know a way to post it to one of these boards.

Can you suggest some meds for neuropathic pain that don't have the side effect of urinary retention? Maybe there are some I haven't tried over the years. My doc is willing to try anything - he's a quality guy who has been my doctor for 25 years.

Who else here manages their bladder solely by letting it void reflexively?

TD · 10-09-2001, 05:24 PM

I tried voiding that way for five years. I was told to drained my bladder daily. The results were higher risk of UTIs and stretching the bladder muscles. My latest urodynamics study shows I have some pretty high pressure too. I am told this can be dangerous and can do damage to your kidneys. I, too, have an appointment with my urologist to discuss having a stent put in to alleviate this problem.

I have been through the gamut and found nothing to stop the burning tingles although Neurontin has helped. I can only tolerate 1200 mg/day before it starts to make me drowsy. My burning tingles are still there but have dropped from an 8 or 9 to about a 5. I have good days and bad. On the bad days there is nothing that seems to help. Good luck on finding something and let me know if you do. If I have not tried it I will give it a whirl.

"And so it begins."

alan · 10-09-2001, 06:56 PM

UTIs are one thing I don't get. I send in a urine sample every month.

Spoke too soon - just got the results of this month's sample, and it looks like I've got my first UTI in years. :-(

I think I've tried every med in the PDR by now. :-( No help.

[This message was edited by alan on October 10, 2001 at 03:51 PM.]

SCI-Nurse · 10-10-2001, 05:21 PM

Alan, don't be too quick to call this a UTI. A positive culture is not a UTI unless you have other symptoms such as a fever, chills, increased spasticity, AD, etc. It is best to just watch a positive culture that indicates colonization than to take antibiotics which may just result long term in more drug-resistant bugs.

For those who want to use a "wet" method (requiring a drainage bag) such as reflex voiding and use of condom catheter, it may be necessary to lower outlet pressure if you have DSD by the use of either a sphincterotomy or a urethral stent. If you live in hope of a cure, you probably will want to opt for the latter as it is potentially reversable, while the former is not.

(KLD)

alan · 10-10-2001, 07:04 PM

It's a UTI - I have the symptoms. :-(

I'm not living in hope of a cure for SCI (for pain, yes), but I wouldn't do anything permanent just in case one came along. With my luck, the day after I had some permanent change made, the cure would come.

alan · 10-11-2001, 06:32 PM

Can I see any urologist, or must it be a rehab-associated urologist? What tests should I have performed (by either type?) Are they done in the office?

10-08-2001, 07:05 PM	#1
alan Senior Member Join Date: Jul 2001 Location: Baltimore, MD Posts: 6,169	will possible med side effect affect me? I'm a C-5, with a severe full body pain problem, as most of you probably have seenn from previous posts of mine. My bladder is managed solely via condom catheter - it goes when it wants. I do the majority of my drinking in the evening, and usually pass 1500 ml or more urine daily, depending on how much liquid I consume in an individual evening. My question is this: My doctor wants to try elavil again for my pains, but eventually at a higher dose than previous trials. A possible side effect of elavil is urinary retention. Is my bladder now so conditioned by 20 years of reflex voiding that it will always do so at whatever volume triggers release, regardless of any medication side effect, or can the elavil mess things up? Is anyone here on elavil, or has used it in the past without bladder-related problems? Nurses, what's your opinion? If my pain allows it, I have an appointment with a urologist this month, the first in many years (being homebound due to pain interferes with everything, including getting to doctors. I hate this burning body, I really do. Quadhood is a cakewalk compared with it.)

10-08-2001, 10:26 PM	#4
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,331	Tricyclics Any of the tricyclic antidepressants such as Elavil have an anticholergic effect on the bladder. This increases the capacity and decreases tone. They are often given at lower doses that the antidepressant dose to help keep someone dry between caths, and also are often used for neuropathic pain management. Unfortunately, it is not possible to predict ahead of time what effect the Elavil will have on your bladder, but you are wise to be concerned. It would be best to check your residual urine amounts (3 times at least) with each increase of your dosage of Elavil, and if you see the amounts increasing you may need to consider either decreasing the dose or cathing several times daily to handle this. Be sure you are working both with your pain management physician and your urologist on this change. (KLD)

10-09-2001, 05:24 PM	#6
TD Senior Member Join Date: Aug 2001 Location: Phoenix, AZ, USA Posts: 649	voiding reflexively I tried voiding that way for five years. I was told to drained my bladder daily. The results were higher risk of UTIs and stretching the bladder muscles. My latest urodynamics study shows I have some pretty high pressure too. I am told this can be dangerous and can do damage to your kidneys. I, too, have an appointment with my urologist to discuss having a stent put in to alleviate this problem. I have been through the gamut and found nothing to stop the burning tingles although Neurontin has helped. I can only tolerate 1200 mg/day before it starts to make me drowsy. My burning tingles are still there but have dropped from an 8 or 9 to about a 5. I have good days and bad. On the bad days there is nothing that seems to help. Good luck on finding something and let me know if you do. If I have not tried it I will give it a whirl. "And so it begins."

10-10-2001, 05:21 PM	#8
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,331	UTI Alan, don't be too quick to call this a UTI. A positive culture is not a UTI unless you have other symptoms such as a fever, chills, increased spasticity, AD, etc. It is best to just watch a positive culture that indicates colonization than to take antibiotics which may just result long term in more drug-resistant bugs. For those who want to use a "wet" method (requiring a drainage bag) such as reflex voiding and use of condom catheter, it may be necessary to lower outlet pressure if you have DSD by the use of either a sphincterotomy or a urethral stent. If you live in hope of a cure, you probably will want to opt for the latter as it is potentially reversable, while the former is not. (KLD)

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10-08-2001, 08:00 PM	#2
zaziwe Member Join Date: Jul 2001 Posts: 35	Hey Alan, I have been on Elavil for over 5 years, now taking 125mg daily. It hasn't interfered too much with my ability to void, although it is difficult at times. Hang in there brother

10-08-2001, 09:03 PM	#3
David Berg Moderator Join Date: Sep 2001 Location: St. Louis, MO Posts: 7,007	Alan, I know of other central pain patients who use Elavil with some degree of success. I've heard opinions that it simply helps to sedate the nervous system. I can't help you with an answer about urine retention. Is there anything you can do to help compensate? David Berg

10-09-2001, 12:29 PM	#5
alan Senior Member Join Date: Jul 2001 Location: Baltimore, MD Posts: 6,169	I currently have no urologist, or pain doctor (those have all given up on me.) I am dealing solely with my internist. I made an appointment with a urologist, after many years since my last one, but the increasing pains, which now are level 10 in several key areas and have me totally homebound, may prevent me from getting there. I'm going to post a note in the pain forum with a little description of the various pains and how they affect my (non)life. I have a long text file I wrote, but I don't know a way to post it to one of these boards. Can you suggest some meds for neuropathic pain that don't have the side effect of urinary retention? Maybe there are some I haven't tried over the years. My doc is willing to try anything - he's a quality guy who has been my doctor for 25 years. Who else here manages their bladder solely by letting it void reflexively?

10-09-2001, 06:56 PM	#7
alan Senior Member Join Date: Jul 2001 Location: Baltimore, MD Posts: 6,169	UTIs are one thing I don't get. I send in a urine sample every month. Spoke too soon - just got the results of this month's sample, and it looks like I've got my first UTI in years. :-( I think I've tried every med in the PDR by now. :-( No help. [This message was edited by alan on October 10, 2001 at 03:51 PM.]

10-10-2001, 07:04 PM	#9
alan Senior Member Join Date: Jul 2001 Location: Baltimore, MD Posts: 6,169	It's a UTI - I have the symptoms. :-( I'm not living in hope of a cure for SCI (for pain, yes), but I wouldn't do anything permanent just in case one came along. With my luck, the day after I had some permanent change made, the cure would come.

10-11-2001, 06:32 PM	#10
alan Senior Member Join Date: Jul 2001 Location: Baltimore, MD Posts: 6,169	Can I see any urologist, or must it be a rehab-associated urologist? What tests should I have performed (by either type?) Are they done in the office?