Friday, 4 December 2015

ClinicSpeak: infections and bladder problems; common sense?

Do you have bladder problems? Please don't ignore them. #MSBlog #MSResearch #ClinicSpeak

"This small descriptive study reminds us what a burden bladder problems are for pwMS. In this relatively young cohort of pwMS (average age 37 years) over half already had urinary problems with a quarter having problems with incontinence. More sinister are observations from other studies that early bladder problems are a poor prognostic factor and indicate underlying structural damage to the long fibre tracts in the spinal cord and brainstem; in short pwMS with early bladder problems do worse than MSers without bladder problems."

"Not surprisingly bladder problems were associated with bladder infection. Why? The main driver of this is incomplete bladder emptying; urine left behind in the bladder acts as a reservoir for bacteria to grow in. Another problem is reduced fluid intake to control urinary frequency and urgency. When you do this you flush your bladder less frequently allowing bacteria more time to cause an infection. Please don't manage your bladder problems by restricting your fluid intake."

"There is also evidence that pwMS who have multiple infections tend to progress more rapidly. Why? The inflammatory mediators from systemic infections activate innate immune mechanisms within the brain and spinal cord that drive neurodegeneration. When it comes to the holistic management of MS it is a good idea to try and prevent recurrent urinary tract infections. This is easier said than done, which is why our group has a programme of research targeting better control of bladder problems with the aim of reducing urinary tract infections."

"Again I dream of a world when all MSers are treated early and effectively enough so that they never develop bladder symptoms. Wouldn't that be wonderful?"


Nikseresht et al. Association Between Urinary Symptoms and Urinary Tract Infection in Patients With Multiple Sclerosis.Glob J Health Sci. 2015 Sep 28;8(4):48574.

BACKGROUND & OBJECTIVE: Urinary dysfunctions occur in the majority of MS patients and these patients are at higher risks of developing UTI due to multiple reasons. We determined to study the association between different urinary symptoms and UTI in MS patients.


MATERIAL & METHOD: Eighty seven MS patients that referred to our medical care center with an acute attack of the disease, from November 2012 to April 2014, were included in the study. Patients were classified into two groups based on their urine culture results: UTI positive and non-UTI patients. The prevalence of different types of urinary symptoms was then compared among the two groups.

RESULT: The mean age of our patients was 36.8 years old. From the total 87 patients, 83 (95.4%) were female. Overall 56.3% of patients displayed urinary symptoms. The most prevalent urinary problems were urinary incontinence and frequency (25.3% and 24.1%, respectively). A positive urinary culture was seen in 71.3% of the patients. The prevalence of urinary problems was significantly higher in UTI patients in comparison to non-UTI patients (64.5% and 40% in UTI and non-UTI patients, respectively; p=0.036). Separately none of the different urinary symptoms displayed a significant difference between UTI and non-UTI patients (p>0.05).

CONCLUSION: Not a single symptom can be diagnostic of UTI, but MS patient with urinary tract infections do present more urinary symptoms and this can be an indication for further urine analysis and screening measures for MS patients who display more urinary symptoms.

15 comments:

  1. I have bladder problems. These were my first MS symptoms even before my first relapse. They are manageable. On can you use ISC to do full emptying. Try it, not painful and very good from the psychological point of view (take back the control over you bladder!). The only downside is that ISC can cause urinary infection (stupid isn't it?), and can cause some discomfort (urgency). I had no full blown infection but a discomfort between ISC at the beginning. I want to insist I never had any bladder infection whatsoever. And I strongly agree with the doc, do NOT drink less. Drink MORE and I would add TAKE cranberry extract, it protects you from infection and make me pee easier.

    ReplyDelete
  2. THC-based medecines can help with bladder problems (see cannabis for spasticity blog post). Any comment on that? The response to the comment I put in this post was a deafening silence.

    ReplyDelete
    Replies
    1. In answer to your query, there have been a few studies showing efficacy of THC-based medicines for bladder problems such as urgency.
      http://www.ncbi.nlm.nih.gov/pubmed/12617376
      http://www.ncbi.nlm.nih.gov/pubmed/15327041
      http://www.ncbi.nlm.nih.gov/pubmed/26608223
      http://www.ncbi.nlm.nih.gov/pubmed/24778283

      Delete
    2. Thank you very much. So If I understand correctly there are multiple evidences demonstrating a positive effect of THC on bladder symptoms. The obvious thing to do is to not advertise that and to not say to patient with bladder problems that these kind of medicine could help.

      Delete
    3. We are not doctors and cannabinoids are not licenced for the treatment of bladder problems

      Delete
    4. Sorry, the pseudo MouseDoctor and your comments on medical research made me think that you had a medical training. Thank you about the reminder on cannabinoids, luckily like most MSers I have also spasticity problems. So cannabinoids are an off-label drug for bladder problem, you mean like Cladibrine? Or Rituximab?

      Delete
  3. Hindsight now tells me that my first MS symptoms were balance problems and weakness in my legs. The next one to join my personal symptom collection was bladder problems, which I attributed to menopause, seeing as how I was at that age. Unfortunately it was another few years before I was diagnosed (no relapses to trigger investigations), and by then it was too late - several large spinal lesions already in residence. Bladder problems remain, and continue to slowly get worse. Bladder urgency problems can be so restrictive on both your social and work life, and they have certainly impacted on mine.

    Early treatment cannot occur without early diagnosis. There needs to be a greater awareness amongst GPs about the need to take various neurological symptoms more seriously and consider MS as a possibility when there are no clearly defined acute relapses.

    ReplyDelete
    Replies
    1. Thank you for sharing. The lesion on my spine were the first indicator. It was noticed in a private clinic with a private MRI, the NHS never proposed to look at my spine. Save spine? I am a bit bias I love my spine almost as much as my brain.

      Delete
    2. Given that MS runs in my family I have always run a self test frequently. When I got on the DLR or tube and in more recent years on the subway, I would always test my vision by reading the car numbers - I would also regularly balance test by standing on one foot too. Given that MS affects more women than men could these basic tests be built into visits to the GYN?

      Delete
  4. I have suffered bladder problems since the early 70's and was not dignosed with MS until 1994. When I started ISC in 2005 I was given one type of catheter and told to get on with it.

    I have since discovered that there are a range of catheter makes, each one is different. Maybe I was unlucky, I did not get to know about the different types until several years later

    I would have benefitted from knowing that there is quite a wide range of catheters available. I now use a different make catheter and this was only after trying several different ones which I found out about by chance after getting a very serious UTI when the catheter tore my urethra

    ReplyDelete
  5. Thank you for sharing even if your comment is frightening. The incontinence
    nurse never told me about urethra damages. She is incompetent (no knowledge of
    MS and she had nothing to test urine!), but still. You cannot say something that
    frightening without details. How did this happen? How to prevent it? Mouse
    doctors please tell me that it is a very rare thing and only happened with old
    versions of catheters.

    ReplyDelete
  6. Much more needs to be done to raise awareness of the problems of UTIs in MS our recent report has show that UTI's are a top cause of emergency admission to hospital in England with some £43 million a year being spent on hospital admissions - more proactive care is needed. The money spent on these crisis admissions could be reinvested in more MS nurses and continence nurse specialists http://www.nhis.com/commissioning-excellence/ms-report

    ReplyDelete
  7. I had urinary incontinence nearly from the time I was diagnosed. It so freaked me out since I had been going to college to become an registered nurse before MS hit me (long story) that I did not even want leave my home.

    I discovered low dose naltrexone through a forum and figured what do I have to loose?

    Within a week or so the incontinence completely disappeared. That was 8 years ago and it has not come back.

    ReplyDelete
  8. "Again I dream of a world when all MSers are treated early and effectively enough so that they never develop bladder symptoms. Wouldn't that be wonderful?".

    Indeed it would. Have there been any studies showing that early treatment with DMDs reduces subsequent bladder problems? Or other MS symptoms? Or reduces spinal lesions? Focus of DMD research seems to have been (and continues to be) relapse prevention and brain lesions. Seems like a study that could be done retrospectively by looking at medical records.

    ReplyDelete

Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.