Bladder Dysfunction and Treatments
Bladder symptoms in MS are often a result of demyelination, either in an area within the spinal cord which controls bladder function, or along axons (nerves) which carry messages to and from the brain concerning bladder function. The location of the demyelination will determine the type of bladder dysfunction along with the specific symptoms experienced.
The most common symptoms for individuals with MS are frequency (the urge to urinate often) and urgency (the urge to urinate immediately and the difficulty in holding the urine once the urge is felt). Some patients find that they cannot urinate (hesitancy, retention) despite the urge being felt. Others may experience dribbling (small amounts of leaking urine) or a full loss of control resulting in an unexpected emptying of the bladder (incontinence).
Types of Bladder Dysfunction
A spastic bladder occurs when the bladder fills too quickly and urinating becomes an automatic reflex. Also called a "failure-to-store" or "small" bladder, this condition eventually causes the bladder muscles to become thick and spastic (with tight muscles). It can cause dribbling, frequency, and/or incontinence.
Known as "failure-to-empty" or "big" bladder, a flaccid bladder occurs when messages of bladder fullness are no longer perceived and the bladder overfills. The walls of the bladder become weak, stretched, and unable to empty upon command. Symptoms include frequency, urgency, dribbling, hesitancy, or overflow incontinence.
The third condition is called a dyssynergic bladder (also referred to as a "conflicting" bladder). With this condition, movements and functions of the bladder wall muscles and sphincter (a muscle that controls the release of urine) no longer work in conjunction with one another. The bladder may contract to empty while the sphincter contracts, causing urine to be retained. This situation can also reverse, with the bladder not forcing the urine out when the sphincter is relaxed and prepared to allow urine to flow.
Treating Bladder Dysfunction
The treatment of bladder dysfunction differs depending upon the type of bladder problem diagnosed. An up-to-date listing of treatments appears in Dr. Randall T. Schapiro's fifth edition of his book, Managing the Symptoms of Multiple Sclerosis (Demos Medical Publishing, 2007).
The spastic bladder is often treated with medications. According to Dr. Shapiro's book, common options include: oxybutynin (Ditropan®, Ditropan XL®), hyoscyamine (Levsinex®, Levbid®, Bystospaz®), flavoxate hydrochloride (Urispas®), imipramine (Tofranil®), solfenacin (Vesicare®), tolterodine tartrate LA (Detrol LA®), trospium CL (Sanctura®), darifenacin (Enablex®), and several cold medications.
A relatively new treatment option uses Botox® injections (botulinum toxin type A) for urinary incontinence with MS. The Journal of Urology published an article titled, "Botulinum toxin type A is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study" (2005 Jul;174:196-200). Patients with spinal-cord injury or MS received localized, intramuscular injections (two doses) of either Botox or a placebo. This study concludes that "...[Botox] can provide rapid, well tolerated, and clinically significant decreases in the signs and symptoms of urinary incontinence caused by neurogenic detrusor [muscle] overactivity during a 24-week study period." No safety issues were experienced with this treatment.
In his book, Dr. Shapiro comments about using Botox injections for treating spastic bladder, "This treatment is becoming more popular but remains somewhat experimental. It needs to be repeated about every three months as it wears off." He also notes that specific exercises developed by physical therapists for overactive bladder, as well as biofeedback techniques, may help decrease the stimulation of the bladder.
The other two types of bladder dysfunction mentioned have fewer treatment options. For the flaccid bladder, an "intermittent" catheter is frequently prescribed. This is an effective and safe method which involves inserting a narrow tube through the urethra and into the bladder, often several times daily.
For the treatment of dyssynergic bladder, an alpha blocker drug is sometimes prescribed. While this medication is commonly used to treat high-blood pressure, it may help to increase coordination and control within the bladder. Alpha blockers prescribed for this latter purpose include phenoxybenzamine (Dibenzyline®), clonidine, and terazosin (Hytrin®).
For More Information
Other types of bladder issues may occur for individuals with MS, and other types of treatment are available. For more information, readers may visit MSAA's website at www.mymsaa.org, click on publications, and click on MSAA's booklet, Multiple Sclerosis - Managing Symptoms. Those without internet access may call MSAA's Helpline at (800) 532-7667 to request a copy of the chapter devoted to "Bladder Problems." A brief overview of bladder problems may also be found in the Symptom Awareness column of the Fall 2003 issue of The Motivator, which may be accessed through MSAA's website or Helpline phone number, as listed above. In addition to those mentioned, references include the Multiple Sclerosis Council for Clinical Practice Guidelines' report entitled, "Urinary Dysfunction and Multiple Sclerosis."
Thanks go to MSAA Healthcare Advisory Council Member Amy Perrin Ross, APRN, MSN, CNRN, MSCN for her assistance.
Written by Susan Wells Courtney
|Last Updated on Tuesday, 29 January 2013 16:27|