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| MS in focus Issue
1
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2003
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By Professor Dirk De Ridder, MS Urologist, Department of Urology, Universitaire Ziekenhuizen, Leuven, Belgium |
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BLADDER PROBLEMS AND MULTIPLE SCLEROSIS
It is important that the urologist evaluates the individual and carefully explains the options
Once diagnosed accurately, bladder problems in MS are often effectively managed using medication and intermittent catheterisation. Occasionally these strategies are only partially successful and the overall health and well-being of the person is put at risk. For example, intermittent catheterisation may not be possible if the person with MS has significant spasticity of the legs, making it impossible to separate the legs enough to perform the technique. In these cases the urologist must evaluate, together with the individual, other more invasive, permanent ways of managing these problems.
In addition to the various evaluations and tests mentioned in previous articles, there are a number of additional tests that can help the urologist identify the exact cause of the bladder symptoms (see table on page 16). These tests are not always performed on every individual with bladder problems but their necessity is indicated by the person’s history, post-void residual urine measurement and the judgement of the urologist.
Urodynamics
Although the term urodynamics has a wide meaning, including any measure of the function of the urinary tract, it is often used as a synonym for cystometry. The purpose is to determine whether or not there is bladder over-activity. Urodynamic testing involves filling the bladder with saline through a transurethral catheter, which allows a number of different measurements to be obtained, including the capacity of the bladder (maximum volume tolerated by the patient), bladder sensation, involuntary detrusor contractions, the amount of pressure on the inner abdomen and detrusor, and the amount of pressure within the bladder. Also, bladder-emptying ability is evaluated by measuring urine flow (‘uroflow’) and detrusor pressure during emptying.
Surgical options
All of the procedures described are considered permanent and, obviously, not appropriate for everyone with MS experiencing bladder problems. It is important that the urologist evaluates the individual and explains carefully the options available to someone who may need to consider a surgical intervention for effectively managing bladder symptoms.
A supra pubic catheter may be appropriate for a person who has a urethra that is too narrow for a regular catheter or some other problem that creates an obstacle at the level of the urethra. A catheter is inserted directly into the bladder through a small abdominal incision above the pubic area to allow for continual emptying of the bladder. A tube connects the catheter within the bladder to an external bag that collects the urine.
The urologist may recommend a catheterisable stoma as an alternative to a supra pubic catheter because of the complications associated with a supra pubic catheter, especially infection. With this procedure a small hole is made surgically in the abdomen which is then connected to the bladder with a tube that is constructed from the patient’s own tissue. Urine can then be drained by passing intermittently urinary catheters. through the stoma.
Another surgical option is bladder augmentation to enlarge a very small bladder. It involves the addition of a piece of the patient’s tissue (frequently the intestine) to the bladder to increase the bladder size.
When there is excess tissue where the bladder and urethra meet or the bladder outlet is obstructed, a urinary diversion procedure may be necessary. This procedure is rare and more often an option for men with MS than women.
Conclusion
Successful management of bladder problems is not always possible with non-invasive techniques. Surgical interventions must be carefully considered following an extensive evaluation. When determined appropriate, a surgical intervention can help in managing difficult bladder problems and may help in avoiding serious health complications associated with a poorly managed MS bladder.
‘One aspect of MS which is extremely frustrating is the lack of urinary control, as it sets one’s agenda and timetables. I cannot, or dare not go on a long distance journey unless I have been to the bathroom or know that I will have fairly immediate access to such a facility’.
Boris
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| | Test | Purpose |
| Ultrasound (also called sonogram) | Helps to rule out structural abnormalities that of bladder and kidneys cause bladder symptoms, such as blockages |
| Intravenous urogram (also called intravenous pyelogram) | Outlines urinary passages and tests kidney functioning |
| Urodynamic studies | Evaluates how well the bladder is functioning |
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