From the Guidelines
Urinary incontinence in multiple sclerosis is primarily caused by neurological damage to the pathways controlling bladder function, leading to detrusor overactivity, detrusor-sphincter dyssynergia, and sensory issues. The demyelination process in MS disrupts nerve signals between the brain, spinal cord, and bladder, resulting in various types of bladder dysfunction 1. The location of MS lesions determines the type of bladder dysfunction, with pontine and spinal cord lesions being particularly significant.
Common Causes of Urinary Incontinence in MS
- Detrusor overactivity, where the bladder muscle contracts involuntarily, causing urgency incontinence
- Detrusor-sphincter dyssynergia, where the bladder and urethral sphincter muscles don't coordinate properly, leading to incomplete emptying and overflow incontinence
- Sensory issues, where patients don't feel the need to urinate until the bladder is very full
Management and Treatment
According to the AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction, onabotulinumtoxinA injections can improve bladder storage parameters, decrease episodes of incontinence, and improve quality of life measures in patients with MS refractory to oral medications 1. The guideline recommends onabotulinumtoxinA as a treatment option, with a strong recommendation and evidence level of Grade A.
Key Considerations
- Bladder problems typically worsen during MS flares and may improve during remission periods
- Other contributing factors include reduced mobility, cognitive impairment, and medication side effects
- Management typically involves a combination of anticholinergic medications, behavioral techniques, pelvic floor exercises, and sometimes intermittent catheterization for those with retention issues 1
From the Research
Causes of Urinary Incontinence in Multiple Sclerosis
- Urinary incontinence is a common symptom in people with multiple sclerosis, affecting approximately 35% of patients 2
- The relapsing-remitting course and progressive loss of mobility associated with multiple sclerosis make management of urinary urgency and incontinence difficult 3
- Lower urinary tract symptoms (LUTS) including frequent urination, nocturia, and urge urinary incontinence negatively impact quality of life 2
Factors Associated with Urinary Incontinence
- Female gender, presence of LUTS therapies, and absence of disease-modifying treatments are associated with higher rates of urinary incontinence 2
- Disease duration and Expanded Disability Status Scale (EDSS) scores are also positively associated with urinary incontinence 2
- The presence of LUTS therapies is associated with higher PPBC scores, indicating a greater impact on quality of life 2
Management and Treatment of Urinary Incontinence
- Pelvic floor muscle training (PFMT) is a convenient and effective treatment tool that can significantly improve health-related quality of life and reduce the severity of urinary incontinence and overactive bladder symptoms in people with MS 4
- PFMT can also improve leakage episodes, pad usage, sexual dysfunction, compliance to treatment, and treatment satisfaction 4
- A pelvic floor exercise program (PFEP) can improve bladder function, reduce depression, and prevent or delay sexual dysfunction in women with MS 5
- Telerehabilitation-based PFMT is a feasible and acceptable mode of delivery, with greater exercise compliance and satisfaction compared to home-based PFMT 6