Conservative bladder management in advanced multiple sclerosis

Abstract

Anticholinergics and intermittent catheterization are the cornerstones of bladder management in early multiple sclerosis (MS). In advanced MS however, bladder management is based more on tradition than on evidence. Nurses seem to deal with catheter problems and chronic incontinence. Despite the abundant use of indwelling catheters, there is a lack for guidelines on catheter-induced problems. The psychosexual and social impact of bladder problems in advanced MS is often neglected. The international multidisciplinary special interest group on sexual, urological and bowel dysfunction in MS (SUBDIMS) as a special interest group of the Rehabilitation in Multiple Sclerosis (RIMS) was confronted with a high variability in practice and a lack of guidelines. A literature review was prepared during three multidisciplinary expert meetings. This review will be the basis of further initiatives to improve the urological treatment of patients with advanced MS.

Caregiver Burden Among Informal Caregivers Assisting People with Multiple Sclerosis

“…[25][26][27] Consistent with our findings, Bosma et al 28 concluded that bladder dysfunction may increase the burden experienced by the partner or caregiver of the person with MS. However, bladder dysfunction can be prevented or symptomatically treated through various strategies, including pharmacologic therapies and behavioral approaches.…”

“…However, bladder dysfunction can be prevented or symptomatically treated through various strategies, including pharmacologic therapies and behavioral approaches. [25][26][27][28][29][30][31] Del Popolo et al 29 concluded that behavioral rehabilitation and conservative treatments for bladder dysfunction are sufficient for most MS patients, with innovations in neurourology improving urologic function and QOL for patients not responding to firstline treatments. Options for bladder management in MS care have improved, and more patients are receiving effective treatment, with bladder problems often treated at the same clinic providing neurologic care.…”

Neurogenic bladder from multiple sclerosis

“…Urodynamic evaluation is required to define bladder storage capabilities and to select the optimum catheterization interval. Chronic catheter drainage after pharmacologic therapy in patients with DO should be considered a last resort because indwelling catheters have been associated with multiple complications such as urethral erosion in males, bladder neck and urethral damage in females, and urinary tract infections [25].…”

Observance et impact sur la qualité de vie du cathétérisme intermittent chez les patients atteints de sclérose en plaques

“…L'hyperactivité détrusorienne et la DVS peuvent être associées chez 43 à 80 % des patients [13]. Le traitement des troubles vésico-sphinctériens de la SEP fait appel, selon le cas, à la pharmacopée, à la chirurgie ou à la vidange vésicale par cathétérisme intermittent (CI) [14]. Ces derniers sont indiqués en cas de DVS, de persistance d'un résidu postmictionnel significatif ou de vessie hypocontractile.…”