How are bladder problems treated in multiple sclerosis (MS)?

Bladder problems are not uncommon in multiple sclerosis (MS). The most common are frequency and urgency - the patient has to urinate too often and in a hurry. Three good medications relieve symptoms when present for more than a week or two - Pro-Banthine, Ditropan, and Tofranil.

Pro-Banthine and Ditropan are antispasmodics that help the bladder work normally by allowing it to fill up to a fuller level before it's ready to squeeze back down and empty. Tofranil is an antidepressant that also works to decrease spasms and bring the bladder back to normal in MS. It has an extra benefit in lifting the mood as well.

Some of the side effects of the medications include dry mouth, blurred vision, constipation, and sometimes too much urinary retention. Occasionally sweating is suppressed. The opposite bladder problem - urinary retention, or the inability to empty properly - is a rare occurrence.

When this is only partial, and the problem seems to be hesitation or slowness, a simple exercise can overcome it. The patient is trained to use the hands to push on the lower abdomen while sitting on the toilet. Any degree of urinary retention should be evaluated by a urologist; it can lead to repeated urinary tract infections that can aggravate MS itself by causing more frequent exacerbations.

If bladder problems do not respond to medication or exercise, a complete bladder-training program may be prescribed. This is very often effective, and only very rarely is it necessary to go further and use catheterization or surgery. A catheter is a device used, either intermittently or constantly, that takes over where bladder muscles fail.

Botox is also showing promise in the management of some urinary symptoms. Injected into the external urinary sphincter, Botox can help relieve urgency, frequency, dribbling, retention, and voiding problems. Botox A has been shown to reduce the need for some catheterizations.

A small study showed improved quality of life with no significant adverse effects. As FDA approval has not yet been sought by Allergan, the pharmaceutical company that owns the patent on Botox, the relatively high costs of the treatment are not covered by insurance. Bladder problems can probably be handled much more simply with a commonsense approach.

Empty the bladder before leaving the house. Avoid bladder stimulants such as caffeine drinks, beer, or other alcoholic beverages when not close to a bathroom. Avoid liquids close to bedtime if urgency occurs at night.

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