Bladder Dysfunction in Multiple Sclerosis

Abstract

Estimates of the prevalence of bladder dysfunction in multiple sclerosis vary considerably because of differing case selection. Current views on normal bladder function are described, and the nature of its disturbance in multiple sclerosis is discussed. Bladder dysfunction in this disease differs from that in other conditions because of the preponderance of females, the tendency to remission, the presence of multiple neurological lesions, and the frequent weakness of the abdominal wall. Bladder sensation is often retained to a late stage, A study is described in which bladder dysfunction was evaluated in a representative sample of patients with multiple sclerosis in Northumberland and Durham. Bladder disturbance had occurred at some time in 78%, and was persistent in 52%; it was the sole initial symptom in 2%, and one feature of the initial attack of multiple sclerosis in 12%. The severity of bladder symptoms was more clearly related to the severity of clinical disablement than to any other factor, though patients. with severe spasticity as well as profound impairment of vibration sense are sometimes entirely free of bladder symptoms. Sixty-four per cent, of patients had combinations of different symptoms, 60% had urgency, 50% frequency, 36% urge incontinence, 33% hesitancy, and 10% “unconscious” incontinence. Only 2% suffered from repeated episodes of urinary retention. Constipation occurred in 39%, and urgency of defaecation in 10%. Impotence was present in 44% of males. The management of bladder disturbances in multiple sclerosis is discussed in terms of drug therapy, surgical reduction of urethral resistance, bladder reconstruction, and diversion of urine. Electrical stimulation of the bladder and sphincters may afford therapeutic possibilities for the future. © 1965, British Medical Journal Publishing Group. All rights reserved.