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Saturday, August 13, 2016

Bladder Issues in MS


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Don’t underestimate the importance of early diagnosis of UTI and bladder dysfunction in MS patients—or the impact on QOL.

By Brett Moskowitz
Reviewed by Aaron Miller, MD, Professor of Neurology, Icahn School of Medicine at Mount Sinai and Medical Director at the Corinne Goldsmith Dickinson Center for Multiple Sclerosis, New York, NY

Bladder dysfunction, associated urinary tract colonization (UTC), and urinary tract infections (UTIs) are among the many common complications associated with multiple sclerosis (MS).1 The level of spinal cord involvement and general severity of MS-related disability has a direct impact on the severity of bladder dysfunction.2
As many as 75% of MS patients have neurogenic detrusor overactivity (NDO), which causes symptoms of urinary urgency, frequency, and/or incontinence.2,3 Bladder dysfunction tends to worsen as the disease progresses. Eventually, patients may require pelvic floor exercises, intermittent self-catheterization, or a permanent catheter. Recurrent UTIs become common in these patients as a result of urinary stasis or the use of a catheter and, when left undiagnosed and untreated, can cause systemic infection and sepsis.1
Further, UTIs, respiratory infections, and other infections commonly cause or exacerbate acute relapses in MS patients and have a significant impact on quality of life. Activation of the immune system in response to UTIs or other infections is commonly believed to exacerbate MS symptoms. Conversely, corticosteroid treatments used during MS exacerbations can “unmask” an infection in a patient with UTC. The mechanisms by which infections increase risk of relapse and, potentially, disease progression aren’t well understood.1

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