Is urinary incontinence (bladder leakage) common in patients with Multiple Sclerosis (MS)?

Bladder Leakage in Multiple Sclerosis

Yes, urinary incontinence (bladder leakage) is very common in patients with Multiple Sclerosis (MS), affecting approximately 35% of MS patients according to recent studies. 1

Prevalence and Significance

• Symptomatic bladder dysfunction occurs at some time in most patients with MS 2
• Urinary incontinence is one of the three most common non-neurological complications in MS patients 3
• Studies show that approximately 35% of MS patients report urinary incontinence 1
• Lower urinary tract dysfunctions (LUTD) have significant social impact on MS patients 4

Types of Bladder Dysfunction in MS

Neurogenic bladder in MS typically presents with:

• Detrusor overactivity (most common, ~48% of cases) 5
• Impaired detrusor contractility (30%) 5
• Poor bladder compliance (15%) 5
• Increased post-void residual indicating incomplete emptying 5

Common Urinary Symptoms in MS

• Urinary urgency
• Urinary frequency
• Nocturia (nighttime urination)
• Urinary retention
• Urinary incontinence 3

Risk Factors for Urinary Complications

Studies have identified specific risk factors for developing urinary complications in MS:

• Duration of MS greater than 8.5 years 4
• EDSS (Expanded Disability Status Scale) score above 7 4
• Female gender (females show higher incidence of urinary incontinence) 1
• Progressive disease course 1
• Absence of disease-modifying treatments 1

Assessment and Management Approach

Assessment

1. Urodynamic evaluation is the gold standard for diagnosing the exact type of bladder dysfunction 5
2. Post-void residual measurement (preferably by portable ultrasound) to assess for retention 5
3. Urinalysis and culture to exclude infection 5
4. Bladder diary documenting fluid intake, voiding times and volumes, and incontinence episodes 5

Management Options

First-Line Interventions

1. Clean intermittent catheterization (CIC) is the gold standard for treating voiding disorders associated with neurogenic bladder 5

   • Recommended frequency: every 4-6 hours while awake
   • Each catheterization should yield less than 500mL to prevent bladder over-distension

2. Pharmacological management:

   • Antimuscarinic medications (e.g., oxybutynin) are first-line treatments for patients with detrusor overactivity 5
   • Beta-3 adrenergic receptor agonists (e.g., mirabegron) may be used as alternatives or adjuncts when antimuscarinic side effects are problematic 5
   • Alpha-blockers may improve bladder emptying by reducing outlet resistance 5

3. Behavioral techniques:

   • Timed voiding schedule every 2-3 hours during waking hours 5
   • Urgency suppression techniques 5
   • Fluid management (2-3L per day unless contraindicated, avoid evening fluids) 5
   • Avoid bladder irritants (caffeine, alcohol, acidic foods) 5

4. Pelvic floor muscle training (PFMT):

   • Shown to significantly decrease urine leakage and neurogenic bladder symptoms 6
   • Increases endurance and power of pelvic floor muscles 6

Complications and Monitoring

Untreated neurogenic bladder can lead to:

• Recurrent urinary tract infections
• Upper urinary tract deterioration
• Renal failure
• Bladder stones 5

Monitoring Recommendations

• Renal ultrasound every 6-12 months to assess for hydronephrosis 5
• Urodynamic studies at baseline and periodically (every 1-2 years) to assess for changes in bladder function 5
• Regular reassessment of urodynamic parameters following treatment 5

Impact on Quality of Life

• Urinary incontinence has a significant negative impact on quality of life in MS patients 1
• Currently available treatments for lower urinary tract symptoms appear insufficient in many cases 1
• The condition requires more attention in clinical management and research 1

Bladder leakage in MS is not just a common symptom but a significant factor affecting patients' quality of life that requires proactive management and regular monitoring to prevent complications.