Tuesday, September 27, 2022

Multiple Sclerosis Urinary Retention Treatment

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Why Might A Person With Multiple Sclerosis Become Incontinent

Bladder Changes in Multiple Sclerosis

Nerve damage caused by MS can affect how the body interprets the signals between the brain and the bladder and bowel. In the bladder, the muscles that store the urine and and the muscles that empty the bladder can be affected. The two sets of muscles need to coordinate in order to expel urine. Often, in MS patients, the coordination of these muscles can be affected, which leads to incontinence problems.

Most bowel incontinence issues are caused by constipation, which in turn can lead to overflow incontinence. If a person is less mobile due to MS, this can lead to sluggish bowels and constipation. Many medications for MS can affect bowel motility too. Faecal incontinence can also happen if there are disruptions in the signals from the brain to the bowel resulting in weak sphincter muscles.

Someone with MS may experience

Treatment Approaches When You Have Problems Emptying Your Bladder Or Starting To Urinate

Trying to relax when passing urine can help to improve hesitancy. For some people the sound of running water, for example from a tap, can relax the bladder valve to start the urine flow.

Catheters

If you have problems emptying your bladder, your health professional may suggest using a catheter. A urinary catheter is a thin, hollow tube that’s used to drain urine from your bladder. There are a few different types of catheter available and they are all inserted and used in slightly different ways. Catheters may be used when needed , usually several times a day and this is a procedure that you carry out yourself. For some people more permanent catheters are the best option. Using a catheter can sound daunting but for many people it’s a positive and life-changing step that can give you better control over your bladder.

Using catheters means my bladder empties properly, and I get less of those awful water infections.

Supra pubic vibration

There is some evidence to suggest that a vibration device or buzzer, such as the Queen Square bladder stimulator, placed over the pubic area can help the muscle at the bottom of the bladder that acts like a tap or value to relax and improve emptying if hesitancy is a problem.

Ways To Take Back Control When Ms Causes Bladder Dysfunction

Bladder problems are common in multiple sclerosis, but lifestyle changes, physical therapy, and medication can all help.

Bladder problems are very common in people with multiple sclerosis , affecting at least 80 percent of those who have it, according to the National Multiple Sclerosis Society . In some cases, bladder dysfunction is the first sign a person has MS.

Bladder dysfunction occurs when MS lesions areas of damage to the myelin sheath that normally protects nerve fibers block or delay nerve signals that control how the bladder and the muscles surrounding the bladder store or release urine, a condition called neurogenic bladder, says Kristi Epstein, an advanced practice registered nurse and a certified nurse practitioner who specializes in treating people with MS.

This disruption in the nerve signal can cause the bladder to be spastic or overactive, as well as retain urine or not empty correctly both bladder tone and sphincter control can be affected in MS patients, says Epstein.

In overactive bladder, the muscles controlling the bladder contract involuntarily and too frequently before the bladder actually fills with urine, according to the National MS Society. This can lead to symptoms such as:

  • Urgency, an intense feeling that you need to urinate immediately
  • Frequency, or taking trips to the bathroom more than eight times in 24 hours
  • Nocturia, or waking up at night to urinate
  • Incontinence, or loss of bladder control

Also Check: Physical Therapy For Urinary Incontinence

Approach To The Patient With Urinary Retention

Possible Etiology of Urinary Retention Based on History and Physical Examination Findings

*Most patients will present with one or more lower urinary tract symptoms. Symptoms include frequency, urgency, nocturia, straining to void, weak urinary stream, hesitancy, sensation of incomplete bladder emptying, and stopping and starting of urinary stream.

Patients with 150 to 200 mL of retained urine may have a percussible or palpable bladder

Information from references 5, 6, 28, and 29.

Possible Etiology of Urinary Retention Based on History and Physical Examination Findings

*Most patients will present with one or more lower urinary tract symptoms. Symptoms include frequency, urgency, nocturia, straining to void, weak urinary stream, hesitancy, sensation of incomplete bladder emptying, and stopping and starting of urinary stream.

Patients with 150 to 200 mL of retained urine may have a percussible or palpable bladder

Diagnostic Testing in Patients with Urinary Retention

note:Imaging studies and diagnostic procedures are guided by the clinical context and suspected diagnoses.

CT = computed tomography MRI = magnetic resonance imaging.

Information from references 5, 6, and 28 through 30.

Diagnostic Testing in Patients with Urinary Retention

note:Imaging studies and diagnostic procedures are guided by the clinical context and suspected diagnoses.

CT = computed tomography MRI = magnetic resonance imaging.

Information from references 5, 6, and 28 through 30.

Finding Toilets When You’re Out

PPT

Carry our free ‘I need some help’ card. It explains you have MS and urgently need the toilet. Get it by calling 0300 500 8084 or email .

Find a public toilet at Toilet Map or download one of the public toilet apps.

Join the National Key Scheme. For a few pounds you get a key that lets you into over 9,000 locked accessible toilets in the UK.

If you need a public toilet bigger than standard accessible ones, or you need a hoist, check out Changing Places.

Contact your council to see if theres a Community Toilets Scheme locally. It lets you use toilets in shops, restaurants and pubs without paying.

Recommended Reading: How To Prevent Urinary Retention

How Are Bladder Problems Treated

When you see your health professional they will take a full history of your symptoms and they might ask you to keep a detailed bladder diary for a short period of time. As different types of bladder problems are treated differently, health professionals need to find out the cause of your bladder problems so they can find the most appropriate treatment options for you. This will usually involve the following investigations.

  • Urine test Your health professional may ask for a sample of your urine so they can test it for any infection this is sometimes called a ‘dipstick test’. Your urine will be test for bacteria using a small, chemically treated stick that is dipped into your urine sample. If bacteria are present it will change colour, indicating you may have a urinary tract infection .
  • Bladder ultrasound If there is no sign of a urinary tract infection, the amount of urine left in your bladder after urinating will be measured. This is carried out with a simple ultrasound scanner which is gently applied to your lower abdomen and moved over the skin. This creates an image of your bladder and shows how much fluid is left inside. If there is less than 100ml left after your bladder has been emptied, then symptoms are more likely to be due to problems storing urine. If more than 100ml remains after emptying, then the symptoms are likely to be due to problems with emptying the bladder.

Planned Times For Drinking And Urinating

Drink water at designated times during the day, and plan bathroom breaks afterward.

Bladder training can be helpful, too. This technique involves keeping a journal and scheduling times to urinate, whether or not you feel the urge, says Epstein.

Double voiding is another technique that can help, the Urology Care Foundation says. To double void, urinate, wait a few minutes, then try to urinate again.

Read Also: Urinary Tract Infection Prescription Online

Prevalence Of Luts In Ms

LUTS are common in MS patients. Based on the North American Research Committee on Multiple Sclerosis Registry, a large survey of more than 9700 MS patients, 65% reported moderate to severe urinary complaints. Nocturia, followed by urinary urgency and frequency were the most prevalent signs. Urinary incontinence and poor bladder emptying were noted less frequently. summarizes the data on and prevalence of LUTS in these patients.

Treatment Approaches When You Need The Toilet Urgently Or Frequently

Multiple Sclerosis (M.S.) Pathophysiology, Treatment, Nursing Care RN & LPN NCLEX

Bladder training

The aim of bladder training is to increase the length of time between using the toilet. You gradually increase the time between urinating . It may take weeks or months to be effective but your continence advisor or MS specialist nurse can put together a timetable to support you to achieve this.

Medication

You may be offered drugs that block the messages that start bladder contractions and reduce how often you need to empty your bladder these are called antimuscarinic drugs. They are also thought to reduce sensations of urgently needing to reach the toilet. These drugs may be taken orally as tablets or through skin patches. Some examples of antimuscarinics include oxybutynin , tolterodine , solifenacin , fesoterodine and trospium .

If antimuscarinics haven’t been effective for you or if the side effects were too difficult to tolerate, mirabegron or desmopressin may be suggested. Mirabegron is taken orally as tablets and works by relaxing your bladder muscle, allowing your bladder to fill and store urine correctly. Desmopressin is a nasal spray that’s used to treat day and night time frequency. It reduces the amount of urine the body produces.

Bladder injections

Nerve stimulation

You will need at least 12 weekly sessions lasting 30 minutes each. Effects may not always last long after the sessions have stopped and more sessions may be needed, however it’s still a useful and effective treatment for some people.

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Gaining Control Of Ms

You should talk to your provider right away if you experience urinary symptoms so that the appropriate therapy can be prescribed, says Epstein. Early intervention leads to fewer complications and improved quality of life, she says.

Your doctor may refer you to a urologist a specialist in diseases of the urinary tract for a complete checkup, diagnosis, and treatment plan. A urologist may perform urodynamic testing, or urodynamics, which examines the lower urinary tract function, including pressure, volume, and how the bladder is storing and releasing urine, according to Stanford Health Care.

This can range from simple observation to precise measurements using sophisticated instruments to better measure how the bladder and urethra are working, says Kaplan.

Bladder problems can often be managed effectively with certain lifestyle adjustments, medication, physical therapy, or devices. The following are some treatment options.

What Can I Do If I Have Bladder Problems

Get in touch with a health professional if bladder problems are affecting your daily life your MS specialist nurse, GP or continence advisor will be able to help.

Get to know your bladder by keeping a diary. This gives you an overview of how your bladder problems affect you over time. You could keep notes in a notebook or there are smart phone apps available to help you monitor your bladder function. It’s useful to note what you have to eat and drink, any medication you take, when you go to the loo, any problems with stopping or starting, and if you have any bladder accidents. You can share this with your health professionals. It can also help you to see what difference changing something in your diet has made, for example drinking less caffeinated drinks.

Recommended Reading: Urinary Tract Infection In Pregnancy

Odds Are It Will Happen To You

I knew that about 80% of MS patients ended up with bladder dysfunction of some kind, so I was not particularly surprised I ended up in that group. But the suddenness of this life-altering change took me by surprise.

The really good news is that I found catheterization became casually routine without too much anxiety after the first year. It took me months before I dared to try it in a public restroom, but I was in a situation where I had no choice. I had to be at a public facility for too many hours to be able to wait. Since I cathd so frequently, I worked out a system and have only dropped a catheter in the toilet bowl twice. Lesson learned always carry multiple supplies.

Consider A Bowel Training Program

UBQMS: Urinary Bothersome Questionnaire in Multiple ...

These programs are similar to the concept of emptying your bladder at regular intervals. A doctor can work with you on when you could more comfortably go to the bathroom each day.

Its possible for some people to train their bowels to move at designated times. This program can take up to three months to see results.

Also Check: Over The Counter Urinary Tract Infection Remedy

Utis And Ms: How To Prevent This All

Why are people who have MS prone to UTIs? And how can you prevent more of them? Find the answers here.

Canva Everyday Health

At least 80 percent of people who have multiple sclerosis have some bladder dysfunction, which can lead to frequent bladder or urinary tract infections , according to the National Multiple Sclerosis Society .

Its common for people who have MS to have difficulties fully emptying their bladder, which puts them at increased risk of UTIs, notes the NMSS. Urine that stays the bladder too long breeds an abundance of bacteria, which eventually leads to infection. Holding urine also allows mineral deposits to form stones that can lead to infection and irritate bladder tissues.

Talking to your doctor about any bladder dysfunction issues you may have can help stave off repeated UTIs, which can be serious in some cases for people who have MS. Taking steps to prevent UTIs, and seeking prompt diagnosis and treatment when youre having symptoms, can also be helpful.

How Common Are Bladder And Bowel Dysfunction With Multiple Sclerosis

Impairments in bladder function with multiple sclerosis are common and may affect up to 78 to 90 percent of patients during the course of MS. The prevalence of bowel dysfunction in MS is estimated to be about 68 percent of patients. Bladder and bowel symptoms are relatively common in MS and can be treated. Goals for bladder and bowel management include maximizing independence and preventing incontinence and complications.

Read Also: Why Do Opiates Cause Urinary Retention

Lower Urinary Tract Disorders In Multiple Sclerosis Patients: Prevalence Clinical Features And Response To Treatments

Silvia Seddone

Department of Ageing, Neurosciences, Head-neck and Orthopaedics Sciences, Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

Monia Marturano

Department of Woman and Child Health and Public Health Sciences, Urogynecology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

Riccardo Bientinesi

Department of Medical and Surgical Sciences, Urological Clinic, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

Matteo Lucchini

Department of Ageing, Neurosciences, Head-neck and Orthopaedics Sciences, Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

Pierfrancesco Bassi

Department of Medical and Surgical Sciences, Urological Clinic, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

Massimiliano Mirabella

Department of Ageing, Neurosciences, Head-neck and Orthopaedics Sciences, Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

Urinary Retention In Adults: Diagnosis And Initial Management

Multiple sclerosis and incontinence

BRIAN A. SELIUS, DO, and RAJESH SUBEDI, MD, Northeastern Ohio Universities College of Medicine, St. Elizabeth Health Center, Youngstown, Ohio

Am Fam Physician. 2008 Mar 1 77:643-650.

Urinary retention is the inability to voluntarily urinate. Acute urinary retention is the sudden and often painful inability to void despite having a full bladder.1 Chronic urinary retention is painless retention associated with an increased volume of residual urine.2 Patients with urinary retention can present with complete lack of voiding, incomplete bladder emptying, or overflow incontinence. Complications include infection and renal failure.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

In men with benign prostatic hyperplasia, initiation of treatment with alpha blockers at the time of catheter insertion improves the success rate of trial of voiding without catheter.

A = consistent, good-quality patient-oriented evidence B = inconsistent or limited quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 579 or .

SORT: KEY RECOMMENDATIONS FOR PRACTICE

In men with benign prostatic hyperplasia, initiation of treatment with alpha blockers at the time of catheter insertion improves the success rate of trial of voiding without catheter.

Read Also: Home Remedies For Urinary Frequency

Causes Of Problems Storing Your Urine

In MS, problems storing urine happen because messages are interrupted between the bladder emptying reflex in your spinal cord and the part of your brain that has control over when you empty your bladder. This can result in the reflexes telling the bladder muscle to contract as soon as it starts filling. The bladder can become overactive and spasm or tighten unpredictably, resulting in an immediate or frequent urge to go. This is also known as overactive bladder.

I feel as though my bladder has a life of its own.

Symptoms Of Urinary Tract Infections

According to the NMSS, symptoms of a urinary tract infection can include:

What a person with MS may notice instead of or along with common UTI symptoms is a worsening of MS symptoms known as a pseudoexacerbation, per the NMSS. This occurs when the urinary tract infection along with the rise in body temperature causes other MS symptoms to flare up temporarily. While these symptoms mimic a true exacerbation or flare, there is no underlying disease activity.

Because these are atypical symptoms for a urinary tract infection, a first UTI in a person with MS may be hard to diagnose, says Dr. Otero.

After that, Otero adds, when they have symptoms theyve had before and that turned out to be a UTI, we can do urine tests to see what is happening.

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When Your Bladder Doesnt Empty Like It Should

A test will show your if bladder isnt emptying fully. When it doesnt, pee is left in it. Bacteria grow in this, causing urinary tract infections. These can make your MS symptoms worse, and even trigger a relapse.The usual treatment is for you to use catheters to empty your bladder properly. Some people find a vibrating device held near their bladder might also help it empty.

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