Therapy Insight: bladder dysfunction associated with multiple sclerosis


Bladder dysfunction is a common problem for patients with multiple sclerosis. The severity of symptoms often correlate with the degree of spinal cord involvement and, hence, the patient's general level of disability. The emphasis of management is now mainly medical and is increasingly offered by nonurologists. Treatments can be highly effective, relieving patients of what are otherwise very troublesome symptoms that would compound their neurological disability. This article gives an overview of the neural control of the bladder, followed by an explanation of the pathophysiology of detrusor overactivity secondary to neurological disease. A review of methods available for treating bladder dysfunction in multiple sclerosis then follows. The treatment options for this disorder are largely medical and include established first-line measures such as anticholinergics, clean intermittent self-catheterization and the use of desmopressin, as well as potential second-line agents, such as cannabinoids, intravesical vanilloids and intradetrusor botulinum neurotoxin type A. The diminishing role of surgical intervention is also discussed.

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Figure 1: Illustration of the pathways involved in micturition.
Figure 2
Figure 3: Algorithm for the management of neurogenic incontinence.
Figure 4: The bladder symptoms in multiple sclerosis become increasingly difficult to manage with progression of spinal cord disease.
Figure 5: Injection sites using the minimally invasive outpatient technique.


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Correspondence to Clare J Fowler.

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Kalsi, V., Fowler, C. Therapy Insight: bladder dysfunction associated with multiple sclerosis. Nat Rev Urol 2, 492–501 (2005).

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