Tamsulosin for Female Urinary Retention 
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Tamsulosin for Female Urinary Retention 

Tamsulosin is usually prescribed for female urinary retention. It is also known as Flomax. There are a few studies about the effectiveness of Tamsulosin in preventing urinary retention after surgeries(1). We will discuss it in detail. 

Understanding Tamsulosin for Female Urinary Retention and Male BPH

Alpha-blockers, like tamsulosin, are most commonly seen in male patients. They are used in the treatment of the symptoms of benign prostatic hyperplasia (BPH). Due to this, in the case that a prescription that is taken to the pharmacy for a female may be uncommon and lead to doubts and speculation. It turns out that this drug extends to women who are facing bladder blockages and urinary retention.

The normal use of tamsulosin is in the treatment of BPH, a condition that affects men as they age. Nearly half of the men between the ages of 51-60, the number rising to 90% for males over 80. The condition occurs when the prostate expands to twice or three times its normal size. This causes it to press gradually against the urethra. Thus, resulting in the restriction of urinary flow and causing urinary issues. The drug has been a mainstay for the treatment of this BPH in men and those with lower urinary tract symptoms (LUTS). There has been ongoing research on the use of alpha-blockers for women.

What is the use of tamsulosin?

Beyond the main purpose of this drug in relieving the urinary symptoms associated with BPH, it has found application in the clearance of kidney stones. The mechanism of action of the drug involves the paralysis of the muscles that are around the urethra and the bladder sphincter. These muscles are active in the control of urine release till the individual can find a restroom.

The decrease of the BPH that is symptomatically observed with tamsulosin is tied directly to the drug’s ability to preferentially antagonize alpha-1a receptors. It, therefore, relaxes smooth muscles in the prostate and the neck of the bladder. The drug’s affinity and selectivity for the alpha 1a receptor subtype results in superior efficacy than other drugs in the treatment of BPH. It does so without any of the hypotensive effects that are common with other less selective agents. Unfortunately, it also relaxes the iris dilator muscle, leading to miosis.

Off-label uses: Efficacy and Benefits

The most common off-label use of tamsulosin is in the assistance of the passage of kidney stones. This is done by increasing the urinary fluid volume and pressure. Tamsulosin for women also helps in the relaxation of the smooth muscles of the ureters. Some studies have verified that tamsulosin increases the rate of expulsion of kidney stones. It does so while decreasing the time needed for expulsion and the need for added pain management, hospitalization, or surgery. Tamsulosin is also prescribed off-label to women and men to treat:

  • overactive bladders,
  • facilitate voiding in patients with and without multiple sclerosis, and
  • treat patients with urinary retention. 

This is achieved by antagonizing alpha-1a receptors with subsequent relaxation of urinary tract smooth muscles.

Tamsulosin for Female Urinary Retention 
Picture courtesy: Freepik

Limitations

While tamsulosin is effective in easing urination, it doesn’t have any impact on prostate health. It provides short-term relief for the urinary symptoms associated with BPH but doesn’t address the underlying causes.

Side effects

Some people have reported side effects like dizziness, rhinitis, and abnormal ejaculation. There has also been a potential side effect of hypotension. This drug has not been approved by the FDA for use in women. It is also listed as a category B medication for pregnancy. This means that the side effects of Flomax in females during pregnancy are unknown. 

Common side effects reported are fatigue, drowsiness, dizziness and asthenia, stress incontinence and urgency, and hypotension.

Impact on sleep quality

review (2) evaluated the tamsulosin treatment of lower urinary tract symptoms in women. All trials showed a statistically significant improvement with tamsulosin in female lower urinary tract symptoms (especially in females with voiding dysfunction). This, as well as an improvement in their quality of life and sleep quality. However, some people reported several side effects like dizziness and asthenia, stress incontinence and urgency, drowsiness, fatigue, and hypotension. Tamsulosin has been studied and has been found helpful in the reduction of excessive nighttime urination in women.

Effects on Nighttime Urination and Urinary Retention in Elderly Female

The drug has been studied and found to be helpful for the reduction of excessive nighttime urination in women. 

Elderly women experience weakened pelvic muscles, hormonal changes, and other age-related health conditions. Sometimes, there is the problem of urinary retention. Tamsulosin offers a solution by relaxing bladder muscles and easing urine flow. The elderly require considerate care and this helps improve their quality of life.

Effects on kidney stones

As far as the treatment for kidney stones goes, the primary aim is pain control with non-steroidal anti-inflammatory drugs (NSAIDs) to help in relieving ureteral spasms. Tamsulosin was noticed to help in the passage of kidney stones by reducing smooth muscle stimulation. Therefore, it was designated as medical expulsive therapy (MET) along with calcium blockers and antispasmodic agents. Kidney stones can pass through more quickly when treated with MET therapies. There has also been data to suggest better efficacy from tamsulosin over nifedipine, meaning it gets used more often. Tamsulosin is also less of a concern in causing hypotension due to its uroselectivity. 

Eye effects

The expanded use of tamsulosin has been established to have an association with intraoperative floppy iris syndrome (IFIS). This condition has been associated with perioperative cataract surgery concerns. IFIS is precipitated by the drug’s effects on the iris dilator smooth muscles. It is characterized by: 

  • poor pupillary dilation before surgery, 
  • progressive miosis during the procedure, 
  • iris movement and undulation hindering phacoemulsification, 
  • iris prolapse through cataract incision site and 
  • posterior capsule rupture. 

Also, recently, an increased risk of postoperative complications has surfaced. Patients who use the drug currently, and even the ones who used alpha-1a blockers in the past are more at risk for postoperative complications including retinal detachment, lost lens fragments, and severe inflammation or infection. In order to decrease the surgical ophthalmic risks, eye care practitioners must be prepared. However, stopping the medication before surgery has not proven to lessen or halt the IFIS. It is generally not recommended. 

The knowledge of the patient’s previous or current use of any alpha-1a blocker will allow the surgeon to take preoperative and intraoperative precautions. This will make for fewer IFIS complications. With the increased and expanded use of tamsulosin and other alpha-1a antagonists for males and females, eye care practitioners should be diligent in reviewing each patient’s medication history. They should also inform the surgeon when referring for cataract surgery. Also, asking the patient about current or previous urinary tract or prostate issues is an easy way to determine potential problems. 

FAQ

Why is tamsulosin given to females?

The usage of tamsulosin in females is off-label and not FDA-approved. However, it has been effective for female urinary retention treatment. It can also be used to handle conditions related to the urinary tract. These include overactive bladder symptoms or difficulties passing kidney stones. However, prescribing tamsulosin to females is done by a healthcare provider based on the individual’s specific medical needs. They also have to consider potential risks and benefits.

References 

  1. Chapman, Graham C. MD∗,†,‡; Sheyn, David MD∗,†,‡; Petrikovets, Andrey MD∗,†,‡; Mahajan, Sangeeta T. MD∗,†; El-Nashar, Sherif MD, PhD∗,†; Pollard, Robert MD∗,‡; Mangel, Jeffrey M. MD∗,‡. Tamsulosin to Prevent Postoperative Urinary Retention After Female Pelvic Reconstructive Surgery. Female Pelvic Medicine & Reconstructive Surgery 26(11):p 682-687, November 2020. | DOI: 10.1097/SPV.0000000000000650 
  2. Meyer LE, Brown JN. Tamsulosin for voiding dysfunction in women. 2012. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK143326/

The information provided in this blog is for educational purposes only and should not be considered as medical advice. It is not intended to replace professional medical consultation, diagnosis, or treatment. Always consult with a qualified healthcare provider before making any decisions regarding your health. Read more

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