A UK consensus on the management of the bladder in multiple sclerosis

Abstract

Bladder symptoms in multiple sclerosis (MS) are common and distressing but also highly amenable to treatment. A meeting of stakeholders involved in patients' continence care, including neurologists, urologists, primary care, MS nurses and nursing groups was recently convened to formulate a UK consensus for management. National Institute for Health and Clinical Excellence (NICE) criteria were used for producing recommendations based on a review of the literature and expert opinion. It was agreed that in the majority of cases, successful management could be based on a simple algorithm which includes using reagent sticks to test for urine infection and measurement of the post micturition residual urine volume. This is in contrast with published guidelines from other countries which recommend cystometry. Throughout the course of their disease, patients should be offered appropriate management options for treatment of incontinence, the mainstay of which is antimuscarinic medications, in combination, if necessary, with clean intermittent self-catheterisation. The evidence for other measures, including physiotherapy, alternative strategies aimed at improving bladder emptying, other medications and detrusor injections of botulinum toxin A was reviewed. The management of urinary tract infections as well as the bladder problems as part of severe disability were discussed and recommendations agreed.

Usefulness of sacral nerve modulation in a series of multiple sclerosis patients with bladder dysfunction

“…Furthermore the use of SNM is discouraged in MS for the progressive features of the disease [4] and a limitation to the use of this therapy in MS patients is its contraindication to magnetic resonance (MRI) examination.…”

“…The most frequent are storage symptoms (urinary frequency, urgency, and urge incontinence) while voiding symptoms (hesitancy, incomplete voiding and urinary retention) exist to a lesser degree [3]. Therapeutic options for storage symptoms vary and they include, with or without associated clean intermittent self-catheterization, conservative treatments such as anticholinergic drugs -although the published data provide limited evidence for their efficacy in MS [4,5]. In patients with severe bladder overactivity unresponsive to anticholinergics there is evidence for the use of bladder injections of botulinum toxin A [6,7] and also emerging evidence on the use of cannabinoids [8] and tibial nerve stimulation [9].…”

Autonomic dysfunction in multiple sclerosis

“…Suprapubic vibration and Crede manouever can be given a trial in patients with incomplete bladder emptying [36]. Pharmacological treatment of detrusor hyperreflexia is based on anticholinergics such as oxybutynin, which reduce detrusor activity.…”

The TRUST (EvaluaTion of Bladder Function in Relapsing-Remitting MUltiple Sclerosis Patients Treated with Natalizumab) Observational Study

“…Several guidelines are available for the diagnosis and management of bladder symptoms in patients with MS. [24][25][26][27] These guidelines suggest that when appropriate, pharmacologic adjunctive treatment for neurogenic bladder in patients with MS can be considered. Although somewhat effective, these approaches can increase the risk of additional side effects, add to the cost of treating MS, and do not resolve symptoms for all patients.…”