Bladder symptoms due to multiple sclerosis

Urgency (due to detrusor overactivity) is the most common bladder symptom in patients with multiple sclerosis (MS). However, always consider the possibility of infection or residual urine (readily measured with ultrasound). If the problem is not urgency, or if the residual urine volume is more than 100 mL, refer the patient for expert advice and urodynamic testing. Possible expert treatments include intradetrusor injections of botulinum toxin type A and sacral neuromodulation.

Relatively mild symptoms (ie urinary urgency and frequency) usually respond to taking an anticholinergic drug and emptying the bladder frequently. Use:

1 oxybutynin 2.5 to 5 mg orally, 2 or 3 times daily urinary urgency (multiple sclerosis) oxybutynin    

OR

1 oxybutynin 3.9 mg transdermally, twice weekly oxybutynin    

OR

2 darifenacin modified-release 7.5 to 15 mg orally, daily urinary urgency (multiple sclerosis)    

OR

2 solifenacin 5 to 10 mg orally, daily urinary urgency (multiple sclerosis)    

OR

2 tolterodine 1 to 2 mg orally, twice daily. urinary urgency (multiple sclerosis)    

Anticholinergic drugs can exacerbate cognitive dysfunction. Newer drugs (eg mirabegron) may have fewer cognitive adverse effects—refer for expert advice.

If the patient has high residual urine volumes, and has sufficient dexterity, the expert may teach them to perform clean intermittent self-catheterisation. If not, a permanent indwelling suprapubic or urethral catheter must be considered.