Differential Diagnosis for Urinary Symptoms in a 39-year-old Woman with Multiple Sclerosis
- Single most likely diagnosis:
- Neurogenic bladder due to multiple sclerosis: This is the most likely diagnosis given the patient's history of multiple sclerosis, recent exacerbation, and symptoms of urinary urgency, frequency, and incontinence. The postvoid bladder scan showing a contracted, small bladder also supports this diagnosis, as it suggests an overactive bladder which is common in neurogenic bladder.
- Other Likely diagnoses:
- Overactive bladder: This condition is characterized by urinary urgency, frequency, and incontinence, which are all present in this patient. However, the presence of multiple sclerosis and the postvoid bladder scan results make neurogenic bladder a more specific diagnosis.
- Urinary tract infection (UTI): Although the urine dipstick is negative for leukocyte esterase and nitrite, a UTI cannot be completely ruled out, especially in a patient with neurogenic bladder who may have altered bladder sensation and emptying.
- Detrusor overactivity: This is a condition where the detrusor muscle contracts inappropriately, leading to urinary urgency and frequency. It can be a component of neurogenic bladder or a separate entity.
- Do Not Miss diagnoses:
- Urethral stricture or obstruction: Although less likely, any obstruction in the urethra could cause urinary retention and overflow incontinence, which might present similarly to the patient's symptoms. Missing this diagnosis could lead to significant morbidity.
- Bladder cancer: Although rare in this age group, bladder cancer can cause irritative bladder symptoms. Given the patient's age and lack of risk factors like smoking, this is less likely but should not be entirely dismissed without further evaluation if initial treatments fail.
- Rare diagnoses:
- Other neurodegenerative diseases (e.g., Parkinson's disease, spinal cord injuries): These conditions can also cause neurogenic bladder but are less likely given the patient's established diagnosis of multiple sclerosis.
- Autoimmune disorders affecting the bladder: Conditions like interstitial cystitis could present with similar symptoms but are less likely given the patient's history and physical examination findings.