The Waterworks in Multiple Sclerosis
Jalesh N. Panicker MD,DM,FRCP
Department of Uro-Neurology
National Hospital for Neurology and
Neurosurgery
Queen Square, London
UCLP MS Research Day 14.6.2014
Overview
• Why happens to the waterworks in
MS?
• What can be done about it?
Why talk about the bladder?
T L. Hemmett et al., QJM 2004
The waterworks in MS
• 90% of people have bladder symptoms if
MS > 10 years
• First symptoms usually 6 years into MS
• Bladder troubles in 10% of people at first
diagnosis of MS
• Bladder problems related to duration of
MS and leg weakness/spasticity
What happens during the
assessment?
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Ask a few questions
Keep a diary of visits to the toilet
Test the urine for an infection
See if the bladder is emptying after urination
Urodynamics?
Talk about treatments
Storage
symptoms
•Hesitancy
•Straining
•Interrupted stream
•Double voiding
•Urgency
•Frequency
•Nocturia
•Incontinence
Voiding
symptoms
Measuring the post void residual
Figure courtesy Mrs. Collette Haslam, Department of Uro-Neurology
First line treatment: Antimuscarinics
Trospium
Oxybutynin
Tolterodine
Propiverine
Which one?
Propantheline
Oxybutynin
transdermal
patch
Darifenacin
Solifenacin
Fesoterodine
Oxybutynin
Trospium
Tolterodine
Propiverine
Propantheline
Oxybutynin
transdermal
patch
Darifenacin
Solifenacin
Fesoterodine
Botox for the bladder
• Flexible or rigid cystoscopy
• 300 units in 30 sites
• Duration < 15 minutes
• Discomfort score 3.4 (0.5 – 9)
• Effect lasts 9-13 months
Percutaneous Tibial Nerve
Stimulation (PTNS)
Courtesy Uroplasty
Figure courtesy Mrs. Collette Haslam, Department of Uro-Neurology
Figure courtesy Mrs. Collette Haslam, Department of Uro-Neurology
Urinary tract infections
• Urinary tract infections- may lead to
worsening symptoms/relapse
• Is there a cause for infections?
• Cranberry
• Probiotic yogurts
• Preventive antibiotics
To recap
• The waterworks are often affected in MS
• Check to see if the bladder is emptying or not
• TreatmentsFluids
Exercise
Tablets- antimuscarinics (anticholinergics)
Botox
Electrical stimulation of nerves (PTNS)
Get in touch
• Bowel and bladder foundation
01536533255
• MS society, MS Trust
• Primary care- community continence team
• Hospital- speak to your MS doctor or nurse
• Uroneurology department- we are here to
help