Multiple Sclerosis and the Bladder Lonny S. Green, M.D. Virginia - - PDF document

5/5/2014 1

Multiple Sclerosis and the Bladder

Lonny S. Green, M.D. Virginia Women’s Center

Goals

• Understand how the bladder may be affected by

multiple sclerosis

• Understand strategies to cope with symptoms
• Understand when to seek help

5/5/2014 2

Plan of Action

• Understand normal anatomy and function
• Understand problems that may arise
• Understand assessment methods
• Understand symptom management

Definition

• Urinary incontinence is

an involuntary loss of urine

• It is NOT normal at any

adult age

5/5/2014 3

Ignorance is the Rule… Not the Exception

• 83% of adults know little or nothing about

incontinence

• 72% of adults are not aware of any medical

treatment option for incontinence

Millions Suffer in Silence… Just waiting for encouragement

• Many women wait several years before discussing

incontinence with a physician

– 1999 NAFC Study: Incontinent patients hide their condition on avg. 7.5 years

• Incontinence sufferers want to know their options

5/5/2014 4

Embarrassment and Fear

• f Incontinence are Rampant
• 81% of adults are “very concerned” about

becoming incontinent

• 55% of adults are too embarrassed

and discouraged to discuss the subject

Impact on Quality of Life

• Fear of odor
• Embarrassment
• Limitation of daily activities
• Decrease intimacy

– 24% women report losing urine during intercourse

• Social isolation
• Low self-esteem
• Depression

– 2-3 times higher

• Sleep disturbances

5/5/2014 5

5/5/2014 6

Types of Urinary Incontinence

• Stress - involuntary loss of urine during coughing,

sneezing, laughing or other physical activities.

• Urge - involuntary loss of urine associated with an

abrupt and strong desire to void. Typically patients have little or no warning to void.

• Mixed - a combination of stress and urge

incontinence.

5/5/2014 7

“Neurogenic Bladder”

• A bladder whose function is affected by a neurologic

process

• MS: demyelination can interfere with signals

between brain, spinal cord and bladder

Bladder Symptoms

• Urgency
• Frequency
• Urge Incontinence
• Hesitancy
• Nocturia
• Infections

5/5/2014 8

Work Up

• History
• Physical
• Imaging, if appropriate
• Labs
• Diagnostics: UD, other

Bladder Function

• Store urine at low pressures
• Empty urine at appropriate place and time

5/5/2014 9

Bladder Problems

• Failure to store
• Failure to empty

Failure to Store

• Frequency
• Urgency
• Urge Incontinence

5/5/2014 10

Management

• Timed voids
• Reduce bladder irritants
• Exercises
• Clothing strategies
• Medications

Medications: Storage Issues

• Anticholinergics: Ditropan, Oxytrol, Detrol, Levsin,

Vesicare, Enablex. Sanctura, Gelnique

• Beta 3 Agonist: Myrbetriq

5/5/2014 11

Medications: Storage Issues

• BOTOX

Failure to Empty

• Bladder Dysfunction
• Outlet (sphincter) dysfunction

– Sx: elevated PVR; hesitancy; UTI’s

5/5/2014 12

Failure to Empty: Treatments

• Timed and double voiding
• Check positioning
• Self-catheterization
• Alpha blockers

Other Treatments

• Suprapubic Tube
• Diversion

5/5/2014 13