Posted by: Thixia | April 6, 2008

Urinary Dysfunction and MS 4 of 6

Treatment process 


Treatment of storage dysfunction


If the PVR test determines that you are retaining less than 100ml of urine, your provider will likely conclude that your symptoms are caused by an overactive bladder detrusor muscle.  He or she may recommend various behavioural interventions or prescribe an anticholinergic medication to relax the detrusor muscle.  These are:


·    oxybutynin (Ditropan®, Ditropan XL®, or Oxytrol Transdermal Patch®)

·    propantheline (Pro-Banthine)imipramine (Tofranil®)

·    tolterodine (Detrol® and Detrol LA®)

·    solifenacin succinate (Vesicare®)

·    darefenasin (Enablex®) 


While any of these can relieve urgency, frequency, nocturia, or incontinence, you may need to try more than one before finding the one that works best for you.  The major side effects of these medications are dry mouth and constipation, which will, in turn, need to be managed.  If the need to urinate frequently at night is not relieved by this type of medication, your provider may also prescribe desmopressin acetate (DDAVP®), a nasal spray that temporarily reduces the amount of urine produced by the kidneys and allows for a more restful sleep.  


Table 1 –


Behavioural Interventions in Treating Storage Dysfunction  Behaviour


Why it helps and tips 


·    Drink approximately 8 glasses of fluid per day – especially water.  To flush wastes, bacteria, and mineral deposits from the urinary system. 

·    Establish regular “waterbreak” times. 

·    Limit intake of fluids that contain caffeine or alcohol.  These substances act as bladder irritants and contribute to storage dysfunction. 

·    Restrict fluid intake beginning approximately two hours before starting any activity where no bathroom will be available.  Do not, however, restrict fluid intake on a continuous basis, because that greatly increases the risk of infection by interfering with the normal flushing of the bladder and making the urine overly-concentrated.  


Table 1 – Behavioural Interventions in Treating Storage Dysfunction Behaviour


Why it helps and tips


Wear an absorbent pad for extra protection.  A variety of products are available for women and for men, all containing a powder that turns to gel when moistened.  Some men may choose to use a condom catheter (also called a Texas catheter) some of the time.  This external device consists of a condom-like sheath that fits over the penis and is connected to a drainage bag.  The bag is strapped to the leg inside the trousers. 


In the event that none of these measures is effective, your provider may prescribe an anticholinergic medication to force the bladder to retain urine.  You would then be taught additional strategies for emptying your bladder 



Treatment of emptying dysfunction 


If the PVR determines that you are retaining more than 100ml of urine after voiding, your provider will probably recommend intermittent self-catheterization (ISC).  This relatively simple technique works quickly and effectively to eliminate residual urine. 



Intermittent Self-Catheterization (ISC) Procedure


  1. Wash hands thoroughly and urinate. 
  2. Wash around the urinary opening (meatus) with soap and water or a pre-packaged towelette. 
  3. Insert the catheter and allow urine to flow into the toilet. 
  4. Remove the catheter, wash it with soap and water and store in a plastic bag. 


Depending on the symptoms you are experiencing, and the amount of residual urine, your provider will recommend that you catheterize one or more times per day.  While many people are reluctant to begin this procedure, most quickly discover the comfort and security it provides.  Women are usually less resistant than men because of their experience inserting tampons, but men generally have an easier time because of the greater accessibility of the urinary opening.  



Table 2 –


Dietary Changes in Treating Emptying Dysfunction Diet


Why it helps and tips


Limit intake of citrus juices.  Surprisingly, citrus juices make urine more alkaline than acidic, which favours the growth of bacteria.  Take cranberry tablets or drink cranberry juice daily.  Generally, tablets are better than juice because juice is sweetened to counter the sour taste, and it’s wiser to avoid a daily dose of extra sugar or high-fructose corn syrup.  It is also easier to take cranberry tablets than drink the large amount of cranberry juice required to acidify the urine. 


Cranberry makes urine more acidic, which inhibits bacterial growth.  It also contains compounds that prevent bacteria from sticking to cells that line the urinary tract and may even kill some bacteria directly.  Cranberry is a helpful preventive measure but should never be used to self-treat an existing UTI. 


The regular practice of ISC acts like physical therapy for the bladder.  Some people find that bladder function returns to normal or near normal after several weeks or months.  They can discontinue ISC at that time.  For others, the practice of ISC remains a regular part of everyday life, promoting effective bladder drainage and preventing complications.  If symptoms persist in spite of ISC, your provider will probably initiate treatment for Combined Dysfunction


For those who continue to retain too much urine in the bladder, the provider may also recommend a few dietary changes (see Table 2) to make the urine more acidic.  In the event that ISC is not sufficient to take care of the problem, or other symptoms interfere with self-catheterization, your provider may recommend the use of an indwelling (Foley) catheter.  An indwelling catheter consists of a flexible rubber tube that remains in the bladder to allow urine to flow into an external drainage bag.  A small balloon, which inflates after insertion, holds the catheter in place.  




Compliments of:

Multiple Sclerosis Society of Canada




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