How bad are your bladder problems? Do you need help? #ClinicSpeak #MSBlog #MSResearch
“The elephant in the room; bladder problems. Urinary problems, in particular urinary tract infections (UTIs) are a major cause of comorbidity in MSers and significantly impact on quality of life. The axons subserving bladder function are very long and liable to be impacted early in the course of MS. Most MSers have bladder problems. This causes anxiety; will there be a toilet close by in case I need to go urgently? I rather not go to the movies; my urinary frequency makes the whole experience unpleasant. I keep waking up at night to go to toilet; I never get a good night’s sleep and feel terrible in the morning. My daytime fatigue is almost certainly made worse by not sleeping at night. I can’t stand these anti-cholinergics my continence advisor has given me. My mouth is always dry and my constipations is so much worse. I have just read on this blog that anticholinergics slows cognition and increases my chance of developing dementia. What should I do? I have had several infections this year and I am worried that things are getting worse. I believe there is research showing that MSers with recurrent infections do worse than those without infections. The last time I saw my continence advisor I was told that I needed to start intermittent self-catheterisation; my residual volume after emptying my bladder was 180ml. I don’t want to use catheters. My GP is reluctant to give me urinary antiseptics to prevent more UITs; he says they will select for bacteria that are resistant to antibiotics and make it difficult to treat my next urinary tract infection. What should I do? You can read the previous ClinicSpeak post on managing your bladder problems.”
“We have an active research programme focusing on bladder function and recurrent UTIs. We hope with your help to develop a ClinicSpeak app to deal with some of the issues highlighted above. If you have bladder problems don’t ignore them; let your neurologist or nurse know about them. Get help!”
Khalaf et al. Lower urinary tract symptom prevalence and management among patients with multiple sclerosis. Int J MS Care. 2015 17(1):14-25. doi: 10.7224/1537-2073.2013-040.
BACKGROUND: This study was conducted to assess self-reported prevalence and management of lower urinary tract symptoms (LUTS), along with drivers of treatment seeking, among MSers.
METHODS: An online, cross-sectional survey was administered to US-residing participants with self-reported MS to assess presence of LUTS, including urinary incontinence (UI). Participants experiencing LUTS were asked additional questions related to management and current therapies. Multivariate logistic regression identified drivers of treatment-seeking behavior.
RESULTS: A total of 1052 participants completed the survey; 1047 were included in the analysis. Nine hundred sixty-six participants (92%) reported at least one LUTS, the most common being post-micturition dribble (64.9%), urinary urgency (61.7%), and a feeling of incomplete emptying (60.7%). Eight hundred twenty-six (79%) reported having some type of UI. Of those with any type of LUTS, 70% (n = 680) had previously discussed urinary symptoms with a health-care provider (HCP), while only 32% (n = 311) had seen an HCP in the past year. Logistic regression found urgency (odds ratio [OR] 1.20 [95% confidence interval (CI), 1.00-1.44]), intermittent urine stream (OR 1.40 [95% CI, 1.15-1.69]), and urgency UI (OR 1.78 [95% CI, 1.22-2.60]) to be significant predictors of seeking treatment. Of those who had discussed LUTS with an HCP, 480 (70.6%) were currently receiving at least one LUTS treatment; the most common treatments were reducing fluid intake, pelvic exercises, oral anticholinergic medications, and avoiding certain foods/alcohol.
CONCLUSIONS: LUTS are commonly experienced among people with MS but are largely untreated. Proper LUTS assessment and work-up is warranted in MSers.