Sunday, 15 March 2015

ClinicSpeak: lower urinary tract infections

How bad are your bladder problems? Do you need help? #ClinicSpeak #MSBlog #MSResearch

"The elephant in the room; bladder problems. Urinary problems, in particular urinary tract infections (UTIs) are a major cause of comorbidity in MSers and significantly impact on quality of life. The axons subserving bladder function are very long and liable to be impacted early in the course of MS. Most MSers have bladder problems. This causes anxiety; will there be a toilet close by in case I need to go urgently? I rather not go to the movies; my urinary frequency makes the whole experience unpleasant. I keep waking up at night to go to toilet; I never get a good night's sleep and feel terrible in the morning. My daytime fatigue is almost certainly made worse by not sleeping at night. I can't stand these anti-cholinergics my continence advisor has given me. My mouth is always dry and my constipations is so much worse. I have just read on this blog that anticholinergics slows cognition and increases my chance of developing dementia. What should I do? I have had several infections this year and I am worried that things are getting worse. I believe there is research showing that MSers with recurrent infections do worse than those without infections. The last time I saw my continence advisor I was told that I needed to start intermittent self-catheterisation; my residual volume after emptying my bladder was 180ml. I don't want to use catheters. My GP is reluctant to give me urinary antiseptics to prevent more UITs; he says they will select for bacteria that are resistant to antibiotics and make it difficult to treat my next urinary tract infection. What should I do? You can read the previous ClinicSpeak post on managing your bladder problems."
"We have an active research programme focusing on bladder function and recurrent UTIs. We hope with your help to develop a ClinicSpeak app to deal with some of the issues highlighted above. If you have bladder problems don't ignore them; let your neurologist or nurse know about them. Get help!"


Khalaf et al. Lower urinary tract symptom prevalence and management among patients with multiple sclerosis. Int J MS Care. 2015 17(1):14-25. doi: 10.7224/1537-2073.2013-040.

BACKGROUND: This study was conducted to assess self-reported prevalence and management of lower urinary tract symptoms (LUTS), along with drivers of treatment seeking, among MSers.

METHODS: An online, cross-sectional survey was administered to US-residing participants with self-reported MS to assess presence of LUTS, including urinary incontinence (UI). Participants experiencing LUTS were asked additional questions related to management and current therapies. Multivariate logistic regression identified drivers of treatment-seeking behavior.

RESULTS: A total of 1052 participants completed the survey; 1047 were included in the analysis. Nine hundred sixty-six participants (92%) reported at least one LUTS, the most common being post-micturition dribble (64.9%), urinary urgency (61.7%), and a feeling of incomplete emptying (60.7%). Eight hundred twenty-six (79%) reported having some type of UI. Of those with any type of LUTS, 70% (n = 680) had previously discussed urinary symptoms with a health-care provider (HCP), while only 32% (n = 311) had seen an HCP in the past year. Logistic regression found urgency (odds ratio [OR] 1.20 [95% confidence interval (CI), 1.00-1.44]), intermittent urine stream (OR 1.40 [95% CI, 1.15-1.69]), and urgency UI (OR 1.78 [95% CI, 1.22-2.60]) to be significant predictors of seeking treatment. Of those who had discussed LUTS with an HCP, 480 (70.6%) were currently receiving at least one LUTS treatment; the most common treatments were reducing fluid intake, pelvic exercises, oral anticholinergic medications, and avoiding certain foods/alcohol.

CONCLUSIONS: LUTS are commonly experienced among people with MS but are largely untreated. Proper LUTS assessment and work-up is warranted in MSers.

8 comments:

  1. Drink a lot and pee a lot helps combat UTIs - but causes more problems if you have urgency and volume problems and thus limits how far you can be from quick access to a loo. It doesn't help if you have retention problems either. Damned if you do, and damned if you don't (drink a lot, that is...)

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  2. Apparently if women do the correct pelvic floor exercises every day for six months this will cure 60-70% of stress incontinence. It is important to do the correct pelvic floor exercises. The stress incontinence can be due to aging, approaching or during menopause, childbirth and pregnancy, prolapase or surgery, active sport.

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  3. I was told by an MS nurse who had previously been a continence nurse that the best preventative technique is regular Pilates, because ALL their exercises strengthen the pelvic floor in some way. As with the comments posted on the importance of neuro teams in promoting exercise as a therapy, shouldn't they also be strongly promoting Pilates for bladder issues? As with exercise generally, this would need neuro teams to signpost it as an integral part of therapy (IMO).

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    1. If someone has no feeling, it is a bit difficult to do exercises.

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  4. Have had bladder problems resembling UTIs, but no evidence of infection was ever found. I found that nettle tea fixes it. (I'm female.)

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    1. I've had similar problems and it has ben suggested that it is Interstitial Cystitis. Still undergoing tests and am considering Botox or nerve block.

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  5. I agree this is a huge elephant in the room. I have come to accept it, live with it. The drugs do make my mouth dry. I do use catheters for intermittent self catheterisation.I do use pads when ever I'm going to be out for quite a while even though I have catheters with me. Is there anything that I can we do to reduce the irritation to the bladder?

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  6. After 3-4 UTIs last summer my doctor prescribed Hiprex tablets (Methenamin Hippurat) that make the urin very acid. One tablet in the morning, one before bedtime. No UTIs after that. Highly recommended!

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