Myasthenia Gravis And Urinary Incontinence

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What Does Treatment With Botulinum Toxin Involve

Treatment with Botulinum toxin involves a day case procedure in hospital or a day procedure unit with the use of either general or local anaesthesia.

The recommended dose of Botulinum toxin for OAB is 100 Units whereas the dose recommended in people with neurological problems is 200 to 300 Units.

A cystoscope is passed into the bladder through the urine pipe and is used to inject the solution of Botulinum toxin. Tiny amounts of diluted Botulinum toxin solution is injected directly into about 20 to 30 locations inside the bladder muscle using a fine needle.

Muscular wall of inside of a bladder due to OAB.

Botulinum toxin solution is injected directly into the bladder muscle using a fine needle under guidance of the cystoscope.

Bladder appearance immediately after injection with Botulinum toxin solution.

The procedure has minimal side effects and patients are discharged home quickly after the procedure.

It is important to realise that the effects of the treatment with Botulinum toxin are NOT immediate and become apparent within 1 to 2 weeks.

A review appointment is made within 1 to 2 weeks after the treatment with Botulinum toxin to check bladder emptying .

How Is Myasthenia Gravis Treated

Specific treatment for myasthenia gravis will be determined by your healthcare provider based on:

• How old you are

• How well you can handle specific medicines, procedures, or therapies

• How long the condition is expected to last

• Your opinion or preference

There is no cure for myasthenia gravis, but the symptoms can often be controlled. Myasthenia gravis is a lifelong medical condition. Early detection is the key to managing the condition.

The goal of treatment is to increase muscle function and prevent swallowing and breathing problems. Most people with this condition can improve their muscle strength and lead normal or near normal lives. In more severe cases, help may be needed for breathing and eating.

Treatment may include:

• Medicine. Anticholinesterase medicines, steroids, or medicines that suppress the immune systemâs response medicines may be used.

• Thymectomy. This is surgical removal of the thymus gland. The role of the thymus gland in myasthenia gravis is not fully understood, and the thymectomy may or may not improve symptoms. However, it reduces symptoms in more than 70% of people who do not have cancer of the thymus, possibly by altering the immune system response.

• Plasmapheresis. A procedure that removes abnormal antibodies from the blood and replaces the blood with normal antibodies from donated blood.

• Immunoglobulin. A blood product that helps decrease the immune systemâs attack on the nervous system. It is given intravenously .

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Medication For Urge Incontinence And Overactive Bladder Syndrome

If bladder training is not an effective treatment for your urge incontinence, your doctor may prescribe an antimuscarinic. Antimuscarinics may also be prescribed if you have overactive bladder syndrome , which is the frequent urge to urinate with or without urinary incontinence.

The first antimuscarinic that may be tried is called oxybutynin. There are two different types of oxybutynin tablets, and it is also available as a patch that you stick to your skin. If oxybutynin is not effective or unsuitable, other antimuscarinics that may be prescribed include:

• darifenacin
• tolterodine
• trospium

Your doctor will usually start you at a low dose to minimise any possible side effects. The dose can then be increased until the medicine is effective.

You will be assessed after six weeks to see how you are getting on with the medication, and again after three to six months to see if you still need it.

Antimuscarinics should not be taken or should be used with caution by:

• people with an untreated eye condition called angle closure glaucoma
• people with myasthenia gravis, a condition that causes some muscles around your body to become weak
• people with severe ulcerative colitis, a long-term condition that affects the colon

Your doctor will discuss any other medical conditions you have to determine which antimuscarinics are suitable for you.

Side effects

There are many possible side effects of antimuscarinics, including:

• dry mouth

For more information see our .

Getting The Most From Your Treatment

• Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress and review your treatment. It may take up to 4-6 weeks before you feel the full benefit from these tablets.
• Drinks containing caffeine may make your symptoms worse. This is because caffeine is a natural diuretic and will make you want to pass urine. If you drink a lot of caffeine-containing fluids, consider switching to decaffeinated alternatives.
• Try to maintain a normal life as much as possible with regard to drinking and visiting the toilet. However, drinking late at night may mean your sleep is disturbed by the desire to get up and go to the toilet, so you may want to avoid drinking too much during the evening.
• Your doctor may suggest that you do some pelvic floor exercises to strengthen the muscles around the underside of your bladder. These can help to improve your symptoms.
• If you buy any medicines, check with a pharmacist that they are suitable to take with solifenacin. This is because some medicines can increase the chance that you will experience unwanted effects such as a dry mouth, constipation and blurred vision.

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What Complications Can Occur

Myasthenic crisis is a medical emergency that develops when muscles that control breathing become severely weakened. This may lead to acute respiratory failure and patients often require a respirator to assist breathing during the crisis. Other complications that may develop include choking, food aspiration, and pneumonia.

Factors that can trigger complications in patients with myasthenia gravis include illness , surgery, corticosteroid use that is tapered too quickly, overexertion , pregnancy, and emotional stress.

When myasthenia is properly treated, crisis is very rare. And when crisis does occur, it has a good rate of recovery thanks to the wide range of treatments and the quality of respiratory care at most hospitals.

Causes Of Urge Incontinence

The urgent and frequent need to pass urine can be caused by a problem with the detrusor muscles in the walls of the bladder. The detrusor muscles relax to allow the bladder to fill with urine, then contract when you go to the toilet to let the urine out.

Sometimes the detrusor muscles contract too often, creating an urgent need to go to the toilet. This is called detrusor overactivity. The reason your detrusor muscles contract too often may not be clear, but possible causes include:

• neurological conditions, which affect the brain and spinal cord, such as Parkinsons disease or multiple sclerosis
• conditions affecting the lower urinary tract , such as urinary tract infections or tumours in the bladder
• drinking too much alcohol or caffeine
• certain medications

Some of these possible causes will lead to short-term urinary incontinence others may cause a long-term problem.

If the cause can be treated, this may cure your incontinence.

Recommended Reading: Neurological Causes Of Urinary Incontinence

Important Information About All Medicines

Having An Open Discussion

There are all kinds of questions. Which ones work the best? When and how do I decide to use diapers or pads? Do I just go to a store and get them off the shelf? … Or do I order incontinence supplies and have them ship directly to me, discreetly.

To me, this second option keeps us from having an open and honest discussion about urinary incontinence. Not that there is anything wrong with having them shipped. But it adds to the feeling of being alone and guarding our secret. It leaves us to suffer by ourselves.

Society tells us it is something to be ashamed of … like it is our fault. For everyone that needs diapers or pads, no matter the reason, it is not your fault.

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Is It Risky For Women With Myasthenia Gravis To Have Children

Myasthenia gravis symptoms sometimes get worse during pregnancy but equally often get better or stay the same. Some medications for myasthenia gravis are safe to use during pregnancy and breastfeeding, but some others arent recommended, so this should be discussed with your doctor.

Between 10 and 20 percent of babies born to mothers with myasthenia gravis are born with a temporary form of myasthenia gravis, due to the transfer of antibodies across the placenta. These symptoms respond well to treatment and usually disappear within days to weeks causing no permanent disability.

How To Take Liquid

If you are giving this medicine to a child to help stop them wetting the bed, give the last dose just before bedtime.

Oxybutynin liquid will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount of medicine.

Recommended Reading: Common Urinary Tract Infection Antibiotics

Myasthenia Gravis And Urinary Incontinence

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Urologic Symptoms Of Multiple Sclerosis

Multiple sclerosis is a disorder that affects patients in many different ways, depending on the part of the neuraxis involved in the demyelinating process. About 10% of patients present with bladder or sexual symptoms, and 65-90% have genital involvement at some time in the course of their disease. These complaints may involve incontinence, urgency, retention, or impotence.

Electromyography of the urethral sphincter seldom shows a significant abnormality. Eardley et al studied 24 patients and found only minor abnormalities in 88%.

Mathers et al studied 23 patients with MS and bladder or rectal dysfunction using cortical and lumbar transcutaneous electrical stimulation, pudendal nerve stimulation, single-fiber EMG, and manometry they found central conduction times to be abnormal in 10 and absent in 8. Peripheral conduction was decreased, and fiber density was increased in 3.

Mayo and Chetner studied 46 women and 43 men with MS aged 22-71 years and found that detrusor abnormalities were extremely common, with 63% failing to empty completely because of hypocontractile bladders and 6% with complete areflexia.

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What Is The Prognosis

Symptoms of myasthenia gravis usually progress to maximum severity within three years. After three years, patients usually stabilise or improve. The prognosis of myasthenia gravis has improved significantly with the introduction of immunosuppressive medication with the majority of patients becoming symptom free if they are adequately treated. However most patients do have to remain on tablets for life as the symptoms generally return if they stop the medication.

Is there anything I can do to stop my symptoms getting worse?Myasthenia gravis cannot be prevented, but avoiding the following triggers may help patients prevent exacerbations:

• Emotional stress
• Illness
• Low levels of potassium in the blood
• Medications .

When taking a new prescription drug for the first time, it is important to consult your doctor about its possible effects on myasthenia gravis. Also, you might want to keep a MedicAlert bracelet or card handy to inform emergency medical personnel that you have myasthenia gravis and that certain drugs can be harmful to you.

Electrical Stimulation And Bladder Training

Electrical Stimulation

Electrical stimulation is a more sophisticated form of biofeedback used for pelvic floor muscle rehabilitation. This treatment involves stimulation of levator ani muscles using painless electric currents. When the pelvic floor muscles are stimulated with these small electrical currents, the levator ani muscles and urinary sphincter contract and bladder contraction is inhibited. Similar to biofeedback, electrical stimulation can be performed at the office or at home. Electrical stimulation can be used with biofeedback or pelvic floor muscle exercises.

Bladder Training

Bladder training involves relearning how to urinate. This method of rehabilitation is usually used for active women with urge incontinence and sensory urge symptoms known as urgency. Many people who have urge incontinence sense that they have to urinate, but their bladder is not full and they do not urinate much when they return to the bathroom frequently. This means that, although their bladder is not full, it is signaling for them to void.

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More Urinary Incontinence Catheters

Indwelling Urethral Catheterization

Indwelling urethral catheters are commonly known as Foley catheters. Urethral catheters used for extended treatment need to be changed every month. These catheters may be changed at an office, a clinic, or at home by a visiting nurse. All indwelling catheters that stay in the urinary bladder for more than two weeks begin to have bacterial growth. This does not mean that a person will have a bladder infection, but infection is a risk, especially if the catheter is not changed regularly. Foley catheters should not be used for prolonged periods because of the risks of UTI, and a suprapubic tube may be recommended. Urethral catheters are not used to treat urge incontinence. Other complications associated with indwelling urethral catheters include encrustation of the catheter, bladder spasms resulting in urinary leakage, blood in the urine , and inflammation of the urethra . More severe complications include formation of bladder stones, development of a severe skin infection around the urethra , kidney damage, and damage to the urethra .

Most doctors use a suprapubic catheter for long-term catheterization and only use Foley catheters in the following situations:

Suprapubic Catheterization

Intermittent Catheterization

How Is Neurogenic Bladder Diagnosed

A doctor will do an exam and may order several tests of the nervous system and the bladder to diagnose neurogenic bladder: These include:

• Urodynamic studies: These bladder function tests measure how much urine the bladder can hold, the pressure within the bladder, how well urine flows, and how well the bladder empties when it is full. Special sensors may be placed on the skin near the urethra or rectum to see if the muscles and nerves in those parts of the body are working properly.
• Cystoscopy: The doctor may perform this procedure to examine the inside of the bladder and urethra with the use of a small telescope .
• X-rays

Read Also: Natural Remedies For Urinary Urgency

Review Of Pharmacology Mode Of Action And Pharmacokinetics Of Mirabegron

Mirabegron has been identified as an orally selective beta-3 adrenoreceptor agonist. Animal studies have shown that mirabegron administration decreases the frequency of bladder contractions during the filling phase. Mirabegron is metabolized in the liver. Importantly, mirabegron acts as a substrate for and is metabolized by cytochrome P450 3A4 and 2D6 . CYP2D6 possesses a genetic polymorphism and shows phenotypic variability, making individuals either poor or extensive metabolizers. A phase 1 study compared single dose pharmacokinetics of mirabegron in CYP2D6 poor and extensive metabolizers . After fasting, subjects received a single oral dose of 160 mg of mirabegron. Plasma and urine samples showed that the percentage of the unchanged dose excreted in the urine was higher in the PM subjects than in the EM subjects .

Studies have also assessed the interactions of mirabegron with various drugs and in different populations. A study involving 28 healthy patients who were genotyped as extensive CYP2D6 metabolizers examined the effect of multiple mirabegron doses on desipramine . Subjects received 50 mg desipramine on days 1, 18, and 38 in addition to mirabegron 100 mg from day 5 through day 23. The half-life of desipramine was prolonged, with a 1.8 increase in Cmax.