Posted by: Thixia | April 8, 2008

Urinary Dysfunction and MS 5 of 6

Treatment of combined dysfunction 

 

For those who experience problems with both the emptying and storage, a combination of strategies is usually recommended that includes intermittent catheterization to remove the residual urine, and an anticholinergic or antimuscarinic medication to relax the bladder’s detrusor muscle. 

 

Occasionally, other medications may also be prescribed, including: 

  1. Antispasticity agents to relax the sphincter muscle:

·     oxybutynin (Ditropan)

·     baclofen (Lioresal®)

·     tizanidine hydrochloride (Zanaflex®)

 

  1. Alpha-adrenergic blocking agents to promote the flow of urine through the sphincter:

·     prazosin (Minipress®)

·     terazosin (Hytrin®)

·     tamsulosin (Flomax®) 

 

On the very rare occasions when none of the medications or self-care strategies are sufficient to manage MS-related bladder symptoms, a surgical procedure called suprapubic cystostomy can be performed.  A tube is inserted into the bladder through an opening in the lower abdomen, to allow the urine to drain into an external collection bag.

 

 

Treatment horizons 

 

Some clinicians have added still other strategies to manage bladder dysfunction.  They include injections of botulinum toxin (Botox®) into the external sphincter or detrusor, and electrical stimulation of the sacral nerve which requires a surgically implanted stimulator.  While the data concerning these interventions are still quite limited, you may want to discuss them with your physician. 

 

 

Additional diagnostic measures

 

Should your bladder problems persist despite standard medications and self-care techniques, you should be referred to a urologist (a physician who specializes in problems of the urinary tract) for further testing to rule out other problems.  

 

 

Possible tests include: 

 

Urodynamic studies

– This test, in which the bladder is filled with sterile fluid, measures the pressure within the bladder and assesses the function of the external sphincter.  The person lies on an examining table and the physician or nurse inserts a small urinary catheter and a rectal probe for the duration of the procedure.

 

Cystoscopy

– By passing a thin tube with a light and a magnifier through the urethra into the bladder, the doctor is able to examine the interior of the bladder for inflammation, polyps, and other abnormalities that might cause urinary symptoms.  

 

Ultrasound

– This test allows the kidneys and urinary bladder to be visualized in order to check for blockage or stones. 

 

Radioisotope renal scan

– This test assesses kidney function.  A short-acting radioisotope, that allows the entire urinary system to be visualized, is injected into a vein and excreted by the kidneys.  Residual urine is measured by noting the amount of radioisotope remaining in the bladder after urination.  

 

Intravenous pyelogram (IVP)

– This test is similar to the radioisotope study in that it requires an injection of special dye and provides a picture of the entire urinary system.  It differs, however, in that it is an X-ray that requires an empty bowel in order for the urinary system to be visible.  The IVP is therefore used less frequently because it requires the use of enemas and/or laxatives before the examination.  

 

The impact of other factors on bladder function

 

Mobility problems

 

Safe and comfortable self-care activities require adequate mobility, which in turn depends upon: strength; balance; coordination; flexibility; absence of pain; adequate sensory input to feet, legs, arms, and hands; and an accessible environment. 

 

In addition to diagnosing and treating the bladder dysfunction you may be experiencing, the provider will be assessing your ability to move easily and comfortably in an environment that is accessible and safe (mobility assessment).  

 

 

Other medical considerations 

 

Occasionally, bladder problems in a person with MS may be related to other MS symptoms, to medications that the person is taking, or to diseases other than the MS.  People may have difficulty with bladder management because of fatigue, constipation, cognitive problems, or other MS-related changes.  These will need to be assessed and treated in order for bladder management to improve.  

 

Bladder problems can also result from medical conditions unrelated to MS, such as pregnancy, diabetes, prolapsed bladder or uterus, enlarged prostate, arthritis, or the postmenopause period.  Various medications, especially those for hypertension, can affect urinary function.  

 

 

Strategies to improve mobility 

 

  1. Medical or surgical interventions to manage spasticity
  2. Rehabilitation, including physical and occupational therapies, to provide:
  • Home exercise program to enhance flexibility, strength, endurance
  • Energy management strategies to conserve energy and minimize fatigue
  • Balance and mobility training to improve walking
  • Assistance with activities of daily living
  • Adaptive equipment to conserve energy, promote safety, and enhance mobility and productivity
  • Adaptive clothing for ease and convenience
  • Home/office modifications to improve bathroom access and safety

 

It is very important for your MS-care provider to know all the medications you are taking-prescription, non-prescription, and dietary supplements such as vitamins and herbs – regardless of the condition for which you are taking them (see Appendix 1).  

 

 

 

 

 

Compliments of:

Multiple Sclerosis Society of Canada

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