Bladder Dysfunction and MS

     Multiple sclerosis (MS) involves focal neural demyelination with relative sparing of axons and resultant impaired nerve conduction. Demyelination commonly affects the posterolateral columns of the spinal cord, with the majority of patients having cervical cord involvement. Forty percent of patients have lumbar cord involvement and 18 percent have sacral cord involvement. The cerebral cortex and midbrain may also be affected. Lesions in any of these areas can affect voiding function.

     Fifty percent to 90 percent of all MS patients will experience bladder dysfunction during the course of the disease, and voiding dysfunction is the presenting symptom in 10 percent of patients. Therefore, it is imperative that one consider MS in the differential diagnosis of patients with significant voiding complaints.

BLADDER DYSFUNCTION IN MULTIPLE SCLEROSIS PATIENTS

     The incidence of bladder dysfunction in MS patients is shown in the TABLE below. Urinary incontinence related to neurogenic bladder dysfunction is caused by one of three problems: (1) failure to store, (2) failure to empty, or (3) a combination of the two. It is important to rule out urinary tract infection and other nonneurogenic causes, particularly in multiparous women who may have gynecologic causes for incontinence.

Treatment Options

      The goals of treatment are to restore continence, relieve urinary symptoms, reverse or stabilize upper urinary tract changes if they are present, and facilitate complete bladder emptying. To accomplish this, a common strategy is to create complete urinary retention and add clean intermittent catheterization for emptying.

     The course of MS is unpredictable often involving exacerbations and remissions. Therefore, treatment should be as flexible and conservative as possible, with the option for modification based on repeat urodynamic studies if it becomes necessary. Additionally, the clinician should be aware that the lower urinary tract symptoms do not necessarily correlate with the pathophysiology of the bladder dysfunction. Therapeutic options for bladder dysfunction in MS patients are divided into no surgical and surgical treatment.

MS Incontinence Treated Properly

      Patients with MS and bladder dysfunction often present with a broad range of voiding symptoms. Once the diagnosis of MS is confirmed, a patient's urine should be sent for culture. If the culture is positive, the patient should be treated with appropriate antibiotics based on the sensitivity of the organism(s).

      Once the urine is free of infection, or if the initial urine culture is negative, all MS patients should have a post-void residual (PVR) checked either by in-and-out catheterization or ultrasound of the bladder (bladder scan). Referral to a urologist is indicated if the urinary tract infection cannot be cleared or there is no relief of the initial symptoms despite a clean urine culture.