Tuesday, March 26, 2013

Bladder Dysfunction Associated With Multiple Sclerosis

Multiple Sclerosis symptoms have traditionally been divided into three main categories:
-Primary symptoms of Multiple Sclerosis that occur as a result of current demyelination in the central nervous system;
-Secondary symptoms of Multiple Sclerosis are derived from primary symptoms, for example. This symptoms will lead to bladder dysfunction, urinary tract infections, and so on;
-Tertiary symptoms of Multiple Sclerosis are those that are caused by psychological reactions to stress associated with chronic disease (vocational problems, personal or marital).

In this article we chose a different approach. Some symptoms of Multiple Sclerosis are easily treated, some are harder and some are very difficult to treat. This classification can be used when it is discussing about the treatment of various symptoms of Multiple Sclerosis disease.

"Instruments" used to treat these symptoms generally are divided into three main categories:
    Rehabilitation
    Pharmacological treatment
    Procedural

It is important to understand that none of these techniques is not necessarily used in isolation, unless it is sufficient to fix certain symptoms / problems. However, usually requires a combination of this instruments to achieve an improvement of the various symptoms of Multiple Sclerosis.

Secondary urinary bladder dysfunction problems are very common in multiple sclerosis.
(1) Symptoms of urgency, frequency, urinary retention and incontinence indicate a nerve tract dysfunction of spinal cord from the brain until the sacral segments. Location of lesions in this case is not practical or even impossible.

(2) Small bladder, hypertonic, with "storage deficit" may have the same symptoms as a large bladder, hypotonic, with "empty gap".

(3) The treatment is very different. For a proper treatment, the doctor is obliged to determine what type of bladder dysfunction is present in a patient with multiple sclerosis. It is necessary to exclude any infection involved in this dysfunction. Upper urinary tract infections (kidney and ureter) are surprisingly rare in multiple sclerosis, while bladder infections are very common.

(4) A control of the bladder function before the infection is practically impossible, so if it will be detect it will primarily require antibiotic therapy and other techniques for bladder acidification. After that, residual volume measurement will elucidate whether the bladder is small and big hypertonic or overfill (both situations will create a very similar symptoms). Measurement of residual urine in a patient with multiple sclerosis can be done by catheterization or by ultrasound. Bladder rehabilitation therapists experienced in patients with overactive bladder can train to help reduce the frequency and urgency of urination.

(5) It is necessary to have a skilled professional and highly motivated patient to take full advantage of these techniques, but it certainly is possible. If the bladder is detected to be small (with a small residual volume), anticholinergic treatment will reduce the frequency and urgency of the call.

(6) There are many anticholinergic agents, varying according to region (eg. Oxibutina, tolteridina, tartrate , solifenacin, darifenacin and hyoscyamine). Dose increases until it will reach maximum effect, it is to note that anticholinergic treatment reduces sweating, it caused an increase in body temperature and a worsening of initial symptoms. If residual volume is high (> 150 cm3), it seems logical to use agents that will increase the flow of urine. Alpha-adrenergic blockers and preparations used in the treatment of prostate adenoma (tamsulosin, terazosin and prazosin) are frequently used in such patients with multiple sclerosis but with little success.

(7)Catheterization techniques can be useful, if they were correctly executed. If the person with MS has retained sensitivity and coordination will practice hands intermittent self-catheterization. It is clean (not sterile) and by reducing residual urine volume, will reduce the frequency of infectious complications.

(8) If necessary, will assign a hypokinetic anticholinergic drug to reduce the frequency of catheterization. otherwise (upper limb coordination disorders) will make use of Foley catheter with continuous drainage. If infection rate may be increased to a certain extent with this catheter should not ignore an improvement in the quality of life of patients with multiple sclerosis.
There are situations when patients with multiple sclerosis bladder sphincter to contract even when bladder contraction. This causes dissinergie ischiurie, calling compelling and urinary retention.

(9) dissinergie degree can be measured by urodynamic testing in case if it fails an improvement in bladder function by the methods mentioned above, this test can give us an answer. Disinergia is very important in men with multiple sclerosis, once increased pressure causes urinary reflux into the ureters and renal calicele. Even though it can be a problem for women, because of the anatomical its probability is much lower.

The urologists often do not attract much attention in multiple sclerosis bladder given that few treatment strategies that are available to help in this case. However, if an overactive bladders unresponsive to oral agents, botulinum toxin injected into the bladder wall can help reduce bladder overactivity status in patients with multiple sclerosis.
(10) Electrical stimulation of the bladder sphincter can be useful in some situations problematic, but this technique remains experimental bladder dysfunction in multiple sclerosis.

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