Portal hypertension is an increase of the pressure within the portal vein and its most common cause is cirrhosis of the liver. However, some other conditions increasing vascular resistance could be also implemented in the development of this situation. The major symptoms for patients with portal hypertension are gastrointestinal bleeding, ascites, encephalopathy and coagulation disorders. Several drugs can be used to reduce portal hypertension complications, with non-selective beta-blockers to be the one of the most common therapeutic choices. Non-selective beta-blockers apart from decreasing cardiac output via β-1 receptors, cause splanchnic vasoconstriction by blocking β-2 receptors, resulting in unopposed α-1 activity. This non-selective action over β-2 and α-1 receptors, could have an indirect impact on bladder function, implying symptoms like frequency or urinary incontinence (UI). The aim of this study is to explore any association of non-selective β-blockers with incontinence and their possible influence in quality of life of patients with portal hypertension.

This is a descriptive study, including outpatients receiving non-selective β-blockers, pooled up from the Internal Medicine Department and the Neuro-urology and Urodynamics Unit of our Hospital. Patients have been allocated into two Groups; Group A included patients receiving any non-selective β-blocker for high blood pressure, while Group B included those taking such therapy for clinically non-significant portal hypertension and a hepatic venous pressure gradient less than 5 mmHg. All of them were receiving treatment for at least 6 months before the survey begins. Exclusion criteria were any treatment for lower urinary tract symptoms at last six months, medical history of urological or gynecological surgeries, history of recent urinary tract infections, men with a known benign prostate enlargement regardless of receiving treatment, diabetes, already diagnosed nocturnal polyuria, receiving diuretics, neurological diseases and any grade of kidney damage. The evaluation of symptoms and their impact on quality of life have been based on Overactive Bladder Symptoms Score (OABSS) and ICIQ-SF questionnaire. All patients were fully informed about the study, signing an informed consent form. Data were analyzed with SPSS v.23, so as to examine relationships between β-blockers, presence of urinary incontinence and impact on quality of life, as well as the role of portal hypertension as an independent factor.

Finally, 44 patients have been enrolled and all of them completed the survey, including 24 women and 20 men with a mean age of 69.5 years old. Throughout subjects, 21 patients have been allocated in Group A and 23 in Group B, with a self-report of urinary incontinence of 23.8% and 34.8% respectively. There was no statistical difference in the prevalence of incontinence between two Groups (p= 0.104). The mean OABS score, among patients with UI in Group A was 8.5, while in Group B it was 9. Additionally, the mean ICIQ-SF in the same subgroup of patients has been calculated at 14.5 and 16.5 for each Group. No statistical difference has been detected for these variables (p= 0,963 and p= 0.207 respectively). More specifically, looking at the interference of urinary incontinence in patients’ quality of life, Group A has been scored at a mean of 4.5, while Group B at mean score of 6.5, proving also a quite marginal statistical difference between the two Groups (p= 0.03).

Patients receiving non-selective β-blockers could have symptoms of incontinence, affecting their quality of life. Focusing on those who need this medication for portal hypertension, it seems that their quality of life is more affected comparing to those without this underlying disease. However, the limitations of our study are that we have no data for lower urinary tract symptoms before treatment begins and there can be no cease of therapy, as it is considered as unethical.

Urinary incontinence seems to be considerable among patients receiving β-blockers, but portal hypertension tends to appear as an independent factor only in the area of patients’ quality of life. Prospective studies could disclose more clinically applicable results.

Mauseth SA, Skurtveit S, Skovlund E, Langhammer A, Spigset O. Medication use and association with urinary incontinence in women: Data from the Norwegian Prescription Database and the HUNT study. Neurourol Urodyn. 2018 Apr;37(4):1448-1457. doi: 10.1002/nau.23473.
Tannenbaum C, Johnell K. Managing therapeutic competition in patients with heart failure, lower urinary tract symptoms and incontinence. Drugs Aging. 2014 Feb;31(2):93-101. doi: 10.1007/s40266-013-0145-1.
Hwang R, Chuan F, Peters R, Kuys S. Frequency of urinary incontinence in people with chronic heart failure. Heart Lung. 2013 Jan-Feb;42(1):26-31. doi: 10.1016/j.hrtlng.2012.08.003.