Bladder problems

Urinary tract symptoms are common in people with MS. In a population-based sample in the USA, 25% of people with MS had intermittent or constant catheterisation for bladder dysfunction262 and in a second American survey 59% had some bladder disturbance.278 A study in South Wales suggested that 14% of all people with MS had an indwelling urethral catheter and 44% of the remainder had bladder dysfunction.279 In the Southampton survey of people with MS, 33% suffered urinary incontinence.280 In the Oxfordshire audit6 bladder problems were the most common presenting problem affecting 39/226 patients on 78 occasions over ten months, and they were the fifth most common problem in terms of prevalence.

Bladder dysfunction can be very disabling and may have many adverse consequences, including great emotional distress, curtailed social activities, and disturbed sleep. Incontinence also increases the risk of pressure ulcers. Its effects may be compounded by reduced mobility. Unfortunately matters are worsened by the reluctance of people with MS, their families and professional staff to discuss the problems.

While it is likely that disturbed bladder control is the commonest general cause of bladder symptoms, some bladder symptoms may be indicative of infection, and infection not only causes pyrexia (high temperature) and malaise but can also cause general exacerbation of all impairments, especially spasticity. Urinary tract infection (UTI) may also, rarely, cause pyelonephritis and septicaemia. The frequency of actual UTI is unknown and so, although the potential importance of urinary tract infection is great, its actual medical importance is unknown.

This section will first cover the assessment and management of disturbed bladder control leading to urinary frequency, nocturia, urgency of micturition, and incontinence. Then the specific issues of UTI will be covered. Many of the issues are not specific to people with MS, being similar to those faced by other people with neurogenic bladder disturbance and so some recommendations are based on generic evidence. The main issues to be covered are:

• detection and diagnosis of disturbed bladder physiology

• management of disruptive bladder function

• diagnosis and treatment of UTIs

• management of intractable incontinence.

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