Mechanism of urinary retention with/post MDMA?

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Just to clarify, I'm aware of SIADH and the effects of MDMA on urine production, I'm just trying to clarify why people have trouble peeing - even when they have full bladders - after taking MDMA.

Presumably this is a problem with autonomic sphincter control. Anyway, lists of anticholinergic effects list urinary retention...

Peripheral Effects; Decreased salivation, Decreased bronchial secretions, Decreased sweating, Increased pupil size, Inhibition of accommodation, Increased heart rate, Urinary retention, Decreased gastrointestinal motility.

Which is all fine, but a friend of mine has pointed out that a few SSRIs (which are pharmacologically obviously very similar in effects to MDMA) are listed as having urinary retention as a side effect as well... ...and some places I've read have said that this is due to SIADH... ...I'm aware of the decreased urine production with SIADH, but I wasn't aware of sphincter dysfunction...

Further reading has turned up a couple of places that refer to a urinary retention effect of vasopressin IN ADDITION to its anti-diuretic effects... ...which i guess isn't totally surprising, given its effects on vascular smooth muscle...

Anyway, can anyone confirm? Is the retention of urine (cf - fluid retention) due to an anti-cholinergic action, or due to increased levels of vasopressin, or both? If both - which is most significant?

Is there anything that can be done to affect this pharmacologically?

 

[BilZ0r]

MDMA isn't that much of an anticholinergic AFAIK (M1 affintiy ~5uM; SERT affinity ~100nM), I suspect a lot of the not being able to pee effect comes from adrenergic constriction of the sphincter and relaxation of the bladder. (but maybe the anti cholinergic thing plays a part as one can't conciousless pee?).

serotonin-noradrenaline reuptake inhibitors are used in stress-incontinence, so there is obviously an effect going on there; co-incidentally, there was a recent review in the BJP, which you can enjoy here:
http://www.ncbi.nlm.nih.gov/entrez/...uids=16465176&query_hl=10&itool=pubmed_docsum

But it all gets very complicated as some receptors are high affinity (5-HT1A) and some receptors are low affintiy (5-HT2A) serotonin sensors, and these receptors have different effects in different animals.

But ultimately, if you want to pee on MDMA, you just need to relax, an 99% of the time, you'll be fine.

 

[fastandbulbous]

Isn't it something to do with the release of anti-diuretic hormone preventing people from pissing on MDMA?

 

[search]

Isn't it something to do with the release of anti-diuretic hormone preventing people from pissing on MDMA?

vasopressin = antidiuretic hormone

see above

 

[BilZ0r]

The vassopressin/ADH thing will stop the production of urine, but people report having full bladders and not being able to go... that sounds like an autonomic thing, whether it is antimuscarinic or sympathomimetic, I don't know.

 

[Splatt]

Speed and MDMA combined seem to be really bad. Or MDA+MDMA. Or just even high dose MDMA.

I've found relaxing works sometimes.. and control of sphincter muscle.
But there's been times where I've had water retention soo bad, my face becomes very very puffy and wide, almost like my head is even squashed down, my neck becomes fatter, and some very very forced weird stuff comes out mentally and physically. When I could finally piss there was easily like 3 litres or more coming out. It felt really bad... but aftewr the piss my symtpons went away after 20 min.