Overview of Incontinence Problems in Multiple Sclerosis

The British site[ MSTrust][1] came to our attention with a post  "Uro-Neurologist Professor Clare Fowler receives Honor. " According to that site,  Prof Fowler is managing continence problems in people with neurological problems, particularly people with MS. A quick way to get familiar with her work is to go to a Pdf  on line titled "A UK consensus on the management of the bladder in multiple sclerosis"

This is a nice work and in it is the chart below that we have extracted from the [MSTrust Pdf][2]

[![][3]][4]

MS progression and Incontinence (From MSTrust)

The chart is a bit scary because it almost implies that all MS patients will end up bed ridden, never mind the wheelchair. But it is a summary that draws all MS cases on the same time scale.  **_We have to be aware that the time scale is very different for all the gamut of MS types_** (Relapsing remitting, secondary progressive, primary progressive, and progressive relapsing, and probably more…)

Key advice from the leaflet is that patients who have more persistent  urine retention than 100 ml should be suggested self catheterization.  See our previous post, though, on the risk of Urinary Tract Infections [1]  associated with the use of catheters. See [2] for more details of this common problem.  If catheters are not not enough Professor Clare Fowler advises   _**antimuscarinics**_  drugs. Antimuscarinics are drugs acting on the central nervous system to control overactive bladder [3,4]. These drugs are also used against Parkinson's. Dr A. Athanasopoulos in [2] is see _antimuscarinics_ as a safe cornerstone of overactive bladder issues. Others see possible risks for men and advise caution [5]

_**Hope this helps in your talk to your Doctor.**_

References:

[1] [MediNewsDigest][5] ; "Status of treatments for Urinary Tract Infections With Emphasis On Wheelchair Users" ; 2011

[2] [Current Opinion of Infectious Disease][6] ; "Management of Catheter-Associated Urinary Tract Infection (CAUTI);  2010

[3] [British Journal of Pharmacology ][7]; "Muscarinic receptors: their distribution and function in body systems, and the implications for treating overactive bladder." 2006

[4][ Advanced Urology ][8]; "An Overview of the Clinical Use of Antimuscarinics in the Treatment of Overactive Bladder";  2011

[5] [Nature Reviews Urology][9] ; "Should an antimuscarinic agent be used for persistent LUTS after treatment with an α1-blocker?" 2009

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[1]: http://www.mstrust.org.uk/news/article.jsp?id=5194
[2]: http://www.mstrust.org.uk/downloads/bladder_consensus.pdf
[3]: http://www.medinewsdigest.com/wp-content/uploads/2012/01/MS-Progression-and-Incontinence.png (MS Progression and Incontinence)
[4]: http://www.medinewsdigest.com/wp-content/uploads/2012/01/MS-Progression-and-Incontinence.png
[5]: http://www.medinewsdigest.com/?p=3524
[6]: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2865895/
[7]: http://www.ncbi.nlm.nih.gov/pubmed/16398909
[8]: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114080/
[9]: http://www.nature.com/nrurol/journal/v6/n2/full/ncpuro1288.html
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