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Monday, October 23, 2017

Managing Urinary Retention in Multiple Sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system, resulting in a variety of nonspecific neurologic symptoms.Bladder problems are one of the many primary symptoms of the disease and are highly prevalent among MS patients.1,2 According to results of the 2005 North American Research Committee on Multiple Sclerosis survey, 65% of MS patients have experienced at least one urinary symptom described as moderate to severe in severity.2 Additionally, analysis of the survey found that approximately 25% of MS patients perform intermittent catheterization, which significantly impacts their quality of life.
When discussing the pathophysiology of urinary retention in MS patients, it is important to consider the role of the bladder detrusor.2 The detrusor muscle is comprised of three overlapping layers of smooth muscle as well as a surrounding extracellular matrix that acts as a support. Sympathetic nervous system stimulation of alpha- and beta- adrenergic receptors relax the detrusor muscle, allowing for bladder filling and storage. Conversely, parasympathetic stimulation of muscarinic cholinergic receptors contract the muscle, causing emptying of the bladder. In patients with MS, urinary retention can be due to an underactive detrusor muscle and/or an obstruction of the bladder outlet due to detrusor sphincter dyssynergia (DSD). Both imaging and data obtained from previous studies indicate that these causes actually occur due to disruptions in neurologic signaling rather than from primary detrusor failure.
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