Bladder Dysfunction In Multiple Sclerosis Research Articles

Reasons for Hospital Admission in Individuals With Multiple Sclerosis.

Health care utilization is higher in individuals with multiple sclerosis (MS) than in the general population. However, there are limited data on the reasons for their hospital admissions. Our primary objective is to analyze the reasons for the hospitalization of individuals with MS with the goal of identifying preventable causes. We conducted a retrospective analysis of a cohort of adults with a confirmed diagnosis of MS admitted to Duke University Hospital between January 2018 and January 2020. This yielded a cohort of 210 individuals. Data were analyzed using descriptive statistics. The most common reason for admission was urinary tract infection (UTI; 10.3%). The average length of stay was 6.1 days for the individuals with MS vs 5.5 days for the general population. The 30-day readmission rates were 14.9% and 15.5%, respectively. A significant number of admitted patients were not on any disease-modifying therapy (DMT), and no difference in median age was identified between those with a DMT vs those without. Length of stay and readmission rates were similar to those of the general population in this contemporary cohort. Given the prevalence of bladder dysfunction in MS, it is not surprising that a UTI was the most common reason for admission. Actively addressing management of and techniques for bladder dysfunction may decrease the admission rate for individuals with MS. Though we now have more treatment options for MS, many individuals with the highest health care utilization are not on a DMT. Future research is needed to identify the factors that can be addressed to support these patients and reduce preventable hospitalizations.

Management of bladder dysfunction in multiple sclerosis: a systematic review and meta-analysis of studies regarding bladder rehabilitation.

The aim of the study was to investigate the efficacy of rehabilitation programs for bladder disorders in patients with multiple sclerosis (MS) and to guide physicians in delineating therapeutic tools and programs for physiatrists, using the best current strategies. A search was conducted on PubMed, EMBASE, the Cochrane Library and Web of Science. Studies were eligible if they included adults with bladder disorders related to MS and described specific treatments of rehabilitation interest. The search identified 190,283 articles using the key words "multiple sclerosis" AND "rehabilitation" AND "urinary" OR "bladder," of which the reviewers analyzed 81 full-texts; 21 publications met the criteria and were included in the systematic review. The systematic review identified the specific rehabilitation treatments reported in the current literature. The meta-analysis compared the scores and scales used to quantify bladder disorders due to MS, both before and after rehabilitation or in a comparison with a control group. The present study suggests the need of a specific therapeutic protocol, based on the degree of disability and symptom complexity in patients with MS-related neurogenic lower urinary tract dysfunction (NLUTD). Particularly, the meta-analysis shows the effectiveness of peripheral tibial nerve stimulation (PTNS) and pelvic floor muscle training (PFMT) for neurogenic detrusor overactivity (NDO). However, the goal of physiotherapy is to treat incontinence without making urinary retention worse and vice-versa, reducing the loss of urine urgency, while ensuring the emptying of the bladder.

Bladder dysfunction in multiple sclerosis: A preliminary data from an ongoing hospital based study

Bladder dysfunction in multiple sclerosis: A preliminary data from an ongoing hospital based study

Bladder and urodynamic changes in multiple sclerosis

BackgroundUrinary dysfunction is a common symptom during the course of multiple sclerosis (MS). Long-term follow-up of the natural history of bladder dysfunction in MS has been seldom addressed.ObjectiveTo identify the type and the course of voiding dysfunction in MS patients in relation to the urodynamic changes of the lower urinary tract (LUT)Subjects and methodsAn observational prospective study including 120 MS patients with urinary dysfunction rated by the American Urological Association (AUA) symptoms questionnaire and assessed by urodynamic studies and followed for 1 year.ResultsIrritative symptoms were the most frequently encountered symptoms (90%), whereas overactive bladder was recorded by urodynamic studies in 35% of subjects. Urinary symptoms severity score was higher in patients with initial urodynamic abnormalities by the end of the 1-year follow-up period (P < 0.001). A statistically significant relationship was found between urinary symptoms severity score and each of expanded disability status scale (EDSS) and urodynamic pattern of abnormalities (P < 0.01).ConclusionIrritative symptoms and overactive bladder seem to be the most frequent urinary dysfunction in MS patients. Urinary symptoms are related to the degree of disability. The initial urodynamic abnormalities are associated with worse urinary dysfunction outcome after 1 year.

Neurogenic lower urinary tract dysfunction in multiple sclerosis, neuromyelitis optica, and related disorders.

Multiple sclerosis (MS), neuromyelitis optica (NMO), and related disorders are major immune-mediated central nervous system diseases affecting the spinal cord. We reviewed the occurrence of neurogenic lower urinary tract dysfunction (NLUTD) in these categories of diseases. We systematically reviewed the literature regarding bladder dysfunction in MS, NMO spectrum disorder (NMOSD), and related disorders (acute disseminated encephalomyelitis, acute immune-mediated myelopathy, and meningitis-retention syndrome). The literature, although somewhat limited for diseases other than MS, suggests that bladder dysfunction is not uncommon in these diseases, presumably reflecting lesions in the spinal descending and ascending pathways. The pattern of bladder dysfunction is a combination of overactive bladder and large post-void residuals/urinary retention. Post-void residual is measured by portable ultrasound devices. Because of the complexity of bladder behavior, careful consideration of bladder management is necessary in MS, NMO, and related disorders: e.g., antimuscarinics, etc., for overactive bladder and clean, intermittent self-catheterization for urinary retention. These management practices should help improve patients' quality of life.

The Effectiveness of a Behavioral Program on Severity of Urinary Incontinence Among Iranian Women With Multiple Sclerosis

Background and aims: Urinary incontinence is common among multiple sclerosis (MS) patients, whichaffects their quality of life negatively. This study examined the effectiveness of a behavioral trainingprogram on severity of urinary incontinence among Iranian women with MS.Methods: This is a quasi experimental study. The sample was selected using purposeful samplingfrom all those who presented for routine follow-up care and treatment in an MS clinic in Tehran fromMarch 2015 to September 2015. The training consisted of 2 sessions (each were 45 minutes) video,small group discussion and group lecture in which all aspects of the urinary incontinence were taught.Before the study initiation, patients were asked to complete the Incontinence Questionnaire-UrinaryIncontinence Short Form (ICIQUI-SF) and a demographic questionnaire. Three month after the firsteducational intervention, MS patients were reassessed using the ICIQUI-SF. Data analyzed in SPSS 21.Results: The mean total scores of ICIQ-SF were 12.4 ± 3.3 and 7.1 ± 3.2 before and after training,respectively. According to the results of paired t test, this difference before and after study wasstatistically significant (P < 0.001). The mean scores of “number of urine leak” were 2.7 ± 0.9 and 1.5± 0.8 before and after intervention, respectively (P < 0.001). The mean scores of “amount of urine leak”were 3.3 ± 1.4 and 2.1 ± 0.9 before and after intervention, respectively (P < 0.001). The mean scoresof “effect of urine leak on everyday life” were 6.3 ± 2.1 and 3.6 ± 2.0 before and after intervention,respectively (P < 0.001).Conclusion: Behavioral training could be effective strategy in management of bladder dysfunctionin MS patients. Health-care providers should be aware of this and plan for use. Further study in thisregard is strongly recommended.

Bladder dysfunction in multiple sclerosis: a 6-year follow-up study.

Bladder dysfunction (BD) is the most common autonomic disturbance in multiple sclerosis, but often overlooked and undertreated. The purpose of this longitudinal study was to explore the changes in the frequency of BD symptoms in MS cohort after a period of 3 and 6years of follow-up, as well as to investigate the correlations between the presence of BD symptoms and both clinical characteristics and the health-related quality of life (HRQoL) at each subsequent point of estimation. The study population comprises a cohort of 93 patients with MS (McDonald's criteria, 2001). At each time point (baseline, and at the 3- and 6-year follow-up) of estimation, Expanded Disability Status Scale, Hamilton Rating Scale for Depression, Fatigue Severity Scale, Szasz Sexual Functioning Scale and HRQoL (measured by MSQoL-54) were assessed. The proportion of patients with at least one symptom of BD significantly increased over time, for both men and women (from 48.1% at baseline to 51.9% after 3years and to 71.4% after 6years of follow-up for males and from 45.5% at baseline to 50.0% after 3years and to 66.7% after 6years of follow-up for females). The most common BD problem was urgency of urination. The presence of BD was statistically significantly associated with higher level of physical disability, sexual dysfunction and HRQoL at each point of follow-up, for both men and women. Our results suggested outstanding frequency of BD in patients with MS, with increasing tendency over time.

Advances in the Management of Neurogenic Detrusor Overactivity in Multiple Sclerosis

Bladder dysfunction in multiple sclerosis (MS) can be socially disabling, have negative psychological and economic consequences, and impair patients' quality of life. Knowledge of the functional anatomy and physiology of the urinary tract is essential to understand the symptoms associated with central nervous system lesions and the pharmacotherapies used to treat them. Treatments for neurogenic detrusor overactivity (NDO) have consisted mainly of administration of anticholinergic drugs, which have been shown to provide suboptimal clinical benefits and be poorly tolerated. The US Food and Drug Administration (FDA) approval of intravesicular botulinum toxin therapy provides a second-line option for MS patients with NDO not responsive to anticholinergic drugs. We performed a review of key literature pertaining to the intravesicular application of botulinum toxin. In the management of NDO, administration of intravesicular botulinum toxin using clean intermittent catheterization decreases the incidence of urinary tract infections, promotes urinary continence, and improves quality of life for 9 months after a single injection; moreover, those benefits are maintained with repeated injections over time.

Multiple sclerosis and bladder dysfunction

Bladder dysfunction in multiple sclerosis (MS) often results in distressing urinary symptoms that can seriously limit daily activities and have an adverse effect on quality of life. Professionals managing patients with MS should have a good understanding of the bladder dysfunction and the modern treatments available to control the urinary symptoms. Fortunately, with simple investigations and the institution of appropriate treatment continence can often be achieved. In view of the progressive nature of multiple sclerosis the patients need regular review of their bladder management by a well-trained multidisciplinary team.

Bladder Dysfunction in Multiple Sclerosis

Bladder Dysfunction in Multiple Sclerosis

Bladder dysfunction in multiple sclerosis

Multiple sclerosis (MS) is a relatively common disease of young adults. Patients with MS can have a wide range of symptoms and may develop significant disability. The cause of MS is unknown, but immunological mechanisms are important. In MS, the pathological features include prominent demyelination and inflammation, but there is also evidence of neurodegeneration. Bladder symptoms are common in MS. The bladder is under neural control, and bladder disturbance is usually attributed to demyelination or loss of axons from the neural pathways, particularly those in the spinal cord, that control the bladder. However, as with other symptoms in MS, the presence of bladder disturbance does not always correlate well with MRI lesions. We speculate that other possible causes of bladder dysfunction in MS might include the effects of circulating toxic factors. Urgency of micturition is prominent in MS, and better understanding of the receptors involved in bladder sensation suggests possible treatment strategies through inhibiting these receptors.

Bladder dysfunction in multiple sclerosis

Bladder symptoms in patients with multiple sclerosis are common and have an adverse effect on the quality of life. Involvement of the spinal cord is thought to be the pathophysiological basis for bladder dysfunction, resulting in detrusor overactivity and a variable component of incomplete bladder emptying. Anticholinergics, and if necessary, clean intermittent self-catheterisation, are best for first-line management. Other currently unlicensed treatments are being used as second-line treatments. In very disabled patients a suprapubic catheter is often best for long-term management.

Therapy Insight: bladder dysfunction associated with multiple sclerosis

Bladder dysfunction is a common problem for patients with multiple sclerosis. The severity of symptoms often correlate with the degree of spinal cord involvement and, hence, the patient's general level of disability. The emphasis of management is now mainly medical and is increasingly offered by nonurologists. Treatments can be highly effective, relieving patients of what are otherwise very troublesome symptoms that would compound their neurological disability. This article gives an overview of the neural control of the bladder, followed by an explanation of the pathophysiology of detrusor overactivity secondary to neurological disease. A review of methods available for treating bladder dysfunction in multiple sclerosis then follows. The treatment options for this disorder are largely medical and include established first-line measures such as anticholinergics, clean intermittent self-catheterization and the use of desmopressin, as well as potential second-line agents, such as cannabinoids, intravesical vanilloids and intradetrusor botulinum neurotoxin type A. The diminishing role of surgical intervention is also discussed.

Relation between objective and subjective measures of bladder dysfunction in multiple sclerosis

The authors studied 297 patients with multiple sclerosis (MS), correlating urinary symptoms (bowel/bladder Functional System [FS] score of the Expanded Disability Status Scale [EDSS] and bladder dysfunction score of the Guy's Neurological Disability Scale [GNDS[) vs objective measurement of bladder dysfunction (postmicturition residual volume). EDSS and GNDS were of no value for predicting the presence of a clinically relevant postvoiding volume. Therefore, the authors recommend ultrasound scanning of residual volume in every patient with MS, even in the absence of subjective urinary symptoms.

THE CAUSE AND NATURAL HISTORY OF ISOLATED URINARY RETENTION IN YOUNG WOMEN

Using a questionnaire mailed to patients we evaluated the course and natural history of urinary retention in women, of which the cause is attributed to electromyography abnormality of the striated urethral sphincter. Previously urinary retention in young women has often been considered to be due to multiple sclerosis or a manifestation of a psychogenic disorder. A questionnaire was mailed to 216 women with abnormal sphincter electromyography and urinary retention. Of the 112 responses we analyzed the 91 from those who had been in complete urinary retention. Mean patient age at the onset of complete retention was 27.7 years (range 10 to 50). No patients had neurological features indicating a cauda equina lesion or central demyelination and none had progressed to features of a general neurological disorder. Mean maximum bladder capacity at the initial episode of complete retention was 1,208 ml. Of the women 65% reported an event that had apparently precipitated urinary retention, most commonly a gynecologic surgical procedure using general anesthesia. Sacral neuromodulation was the only therapeutic intervention that restored voiding. The concept of an organic cause of urinary retention in otherwise healthy young women has considerable importance in terms of correct management. Neurological investigation in these women does not reveal underlying neurological disease. It is thought that this disorder is due to a primary failure of relaxation of the striated urethral sphincter.

Bladder Dysfunction in Multiple Sclerosis

Multiple sclerosis (MS) involves focal neural demyelmation 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 cervi cal cord involvement. Forty percent of patients have lumbar cord involvement and 18 percent have sacral cord involvement. The cerebral cortex and midbram may also be affected. Lesions in any of these areas can affect voiding function.

Prevalence of bowel dysfunction in patients with multiple sclerosis and bladder dysfunction.

Urinary dysfunction is common in cases of multiple sclerosis (MS). The close proximity of those neural pathways which control the bladder to those which control anorectal function might be expected to lead to a high coexistence of bladder and bowel symptoms. Seventy-seven consecutive patients with clinically definite MS attending a uroneurology clinic were interviewed about their bowel function. All patients had clinical evidence of spinal cord disease with varying degrees of impaired mobility and sufficiently severe disturbance of bladder control to seek medical advice. Thirty-six per cent of these patients had constipation. Twenty per cent had "current incontinence", although another 30% had had at least one episode of faecal incontinence more than 3 months previously. Some patients had both constipation and faecal incontinence. A total of 52% currently had at least one bowel symptom. The pattern of bowel symptoms did not correlate with the pattern of urinary disturbance, or the duration of MS, or the degree of disability. Bowel symptoms are common in patients with MS, but even in those with urinary dysfunction are not universal. Whereas bladder dysfunction in MS is clearly related to spinal cord disease, the neurological basis for the bowel dysfunction is less clear.

Erectile dysfunction in multiple sclerosis. Associated neurological and neurophysiological deficits, and treatment of the condition.

Forty-eight men with multiple sclerosis and erectile dysfunction were evaluated. Emphasis was placed on the neurological features and the relationship between impotence and the bladder dysfunction in multiple sclerosis. Erectile failure was invariably associated with pyramidal signs in the lower limbs and with urinary symptoms. All of the men with impotence and marked pyramidal dysfunction in their legs were found by cystometric studies to have bladder hyperreflexia. The severity of the urinary symptoms was related to the degree of pyramidal impairment in the lower limbs. The posterior tibial and the pudendal cortical evoked potentials were abnormal in most of the men with multiple sclerosis and erectile failure. However, recording the pudendal cortical responses in patients with multiple sclerosis and impotence provided no more information than the tibial cortical evoked potentials. The neurological examination findings together with the results of the neurophysiological and cystometric tests suggest that erectile dysfunction in multiple sclerosis is due to spinal lesions situated proximal to the sacral cord. The feasability of papaverine intracorporeal injection therapy for men with multiple sclerosis and impotence was assessed. Papaverine intracorporeal injections produced satisfactory erections in the majority of the impotent men. Erectile failure in patients with multiple sclerosis was successfully managed for up to 2 years, by intracorporeal self-injection therapy.

Urinary symptoms and the neurological features of bladder dysfunction in multiple sclerosis.

One hundred and seventy patients with multiple sclerosis and bladder dysfunction were evaluated. Emphasis was placed on the relationship between their neurological features and urinary symptoms. The severity of the urinary symptoms was related to the degree of pyramidal impairment in the lower limbs so that both problems are thought to reflect the extent of spinal involvement. No other neurological features correlated with bladder dysfunction. Detrusor hyperreflexia was the commonest finding on cystometry and no patient had areflexia. More than half of the patients had a significantly raised post-micturition residual volume but symptoms were largely unreliable in predicting poor bladder emptying. In this series only two patients had evidence of upper tract disease: both men with severe, longstanding neurological disease who had indwelling catheters. Detrusor hyperreflexia can be anticipated in patients with MS who have irritative urinary symptoms and pyramidal signs in their lower limbs. After measurement of the residual volume appropriate treatment can be instituted.

Review Article: Management of Sexual and Bladder Dysfunction in Multiple Sclerosis

Multiple sclerosis (MS) is a devastating degenerative neurological disease that has among its sequelae significant urological pathology. Sexual and bladder dysfunction are the most common. Both of these sequelae can have a major effect on a patient's ability to function emotionally and socially. We shall review the pathogenesis of bladder and sexual dysfunction in the MS patient and discuss available diagnostic and treatment modalities.