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Bladder Dysfunction

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In this article

Overview

Bladder symptoms occur in approximately 80% of people with MS. Common symptoms are:

  • Failure to store
  • Failure to empty
  • Combined failure to store/failure to empty

The pyschosocial Implications of bladder dysfunction include:

  • Fear of drinking liquids
  • Anxiety over loss of control, particularly during social events or exercise
  • Fear of leaving vicinity of bathroom
  • Embarrassment/shame; fear of incontinence during intercourse; increased fatigue due to interrupted sleep
  • Fear/embarrassment related to catheter use
Inability to relieve the symptoms below may necessitate a urologic consultation for further treatment.

Symptom: Failure to store

Description

  • Urgency, frequency, incontinence, nocturia
  • Capacity below 200 ml and/or post-void residual (PVR) less than 200 ml

Treatment

  • Pelvic floor exercises
  • Behavioral techniques—limiting caffeine, maintaining adequate fluid intake during day
  • Absorbent pads (men and women) and for men a condom-like sheath that connects to drainage
  • Assess mobility issues (ability to get to toilet)
  • Oral anti-muscarinics or oral β3-adrenoceptor agonists as second line to behavioral modifications
  • Transdermal (TDS) oxybutynin (patch or gel)

Symptom: Failure to empty

Description

  • Urgency, dribbling, hesitancy, incontinence, infection
  • PVR > 200 ml

Treatment

  • Check for UTI
  • Intermittent self-catheterization (ISC)
  • Dietary changes to increase acidifying urine
  • Assess mobility issues (ability to get to toilet)
  • Antispasmodics or sympatholytics

Symptom: Combined failure to store/failure to empty or detrusor-external sphincter dyssynergia (DESD)

Description

  • Urgency, hesitancy, dribbling, incontinence, infection, renal injury

Treatment

  • Residual greater than 200 ml •
  • Symptoms persist despite intermittent catheterization 
    • Intermittent catheterization
    • Anticholinergic medications
    • Antispasmodic medications
    • Sympatholytics

Resources for clinicians

Resources for patients

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