Neurogenic detrusor overactivity and MS
Reviewed by Neurogenic detrusor overactivity, or NDO, is a bladder issue that often occurs in people with multiple sclerosis (MS). It develops when disrupted communication between the spinal cord and bladder causes involuntary bladder muscle contractions during the bladder-filling phase. These contractions can lead to urinary urgency, frequent urination, nocturia (waking up one or more times in the night to urinate), and urinary incontinence.
The disrupted communication causes the detrusor muscles in the bladder to become overreactive, resulting in uncontrolled and sporadic contractions. This causes pressure to build in the bladder and decreases the volume of urine the bladder can hold, leading to leakages.
NDO occurs due to neurological conditions, such as a spinal injury or diseases such as MS. In people with MS, NDO is driven by lesions developing on the brain or spinal cord as the disease progresses.
The impact of NDO on daily life and quality of life
Urinary incontinence, often an issue for people with MS, can have a significant social impact when it comes to quality of life.
It may:
- discourage people from engaging in outdoor activities
- affect a person’s ability to work
- leave people feeling isolated from others
While the symptom can be caused by urinary tract infections (UTIs), which are common in MS, urinary incontinence can also be the result of NDO.
Doctors treat NDO differently to UTIs, so if you are experiencing urinary incontinence, it is important to work out what the cause is. A doctor will analyze a urine sample to identify if a UTI is present.
Lifestyle modifications and management
A doctor may suggest the following management techniques for NDO:
- scheduled bathroom breaks
- bladder training
- setting verbal reminders to use the toilet
- pelvic floor exercises
- pelvic floor physiotherapy
- physical therapy for the pelvic muscles
- requesting workplace accommodations, if needed
- requesting air travel accommodations, if needed
Tracking how often you need to urinate and how frequently you are experiencing incontinence can also help you and your doctor see what kind of effects these techniques might have.
You may also find it helpful to limit caffeine, alcohol, and soft drinks, including diet sodas, as these may increase urinary frequency and urgency. Wearing incontinence pads and using waterproof mattress protectors may also help you feel more confident and less anxious throughout the day and night.
Medical treatments
If such management techniques are not enough to relieve incontinence due to NDO, doctors may recommend a type of drug called an anticholinergic medication. These medicines are considered first-line therapy by the medical community.
Anticholinergic medicines can reduce involuntary muscle movement, helping to decrease the detrusor muscle activation. You can take these medications as pills or liquids, or they can be absorbed through the skin.
Examples include:
- oxybutynin
- trospium
- darifenacin
The risks and benefits of each medication need to be discussed with your prescriber. Treatment decisions may vary from patient to patient. Because the medications do not specifically target the bladder muscle, they can cause side effects in other parts of the body.
These may include:
- constipation
- dry mouth
- confusion
- a strong desire to sleep
- short-term memory problems
- eye problems
- gastric problems
- decreased sweating
Decreased sweating may be a concern because it can lower the body’s ability to cool naturally. This increases the chances of overheating among people with MS who may already experience heat intolerance.
If these medications are not working to alleviate your symptoms or are causing unpleasant side effects, you can reach out to your doctor to discuss alternative medicines.
Botox for NDO and MS
If medications are not effective at controlling NDO symptoms, your prescriber may refer you to a urologist to discuss other treatment options. One option is injecting botulinum toxin into the detrusor muscle to help relax the bladder.
Of the different types of botulinum toxin, Botox (onabotulinumtoxinA) is typically used to treat NDO.
One common side effect is difficulty with completely emptying the bladder, although this seems to be temporary. Until your bladder functions normally, you will likely need to use a catheter. This can last for two to six weeks.
It is important to note that the effects wear off after six to nine months, so you will need to repeat this treatment.
It can also cause UTIs or blood in the urine. If this occurs, you should contact your doctor.
Botulinum toxin injections can lead to significant improvements in bladder control, which can improve life quality for those with MS.
The aim of the treatment is to reduce:
- urinary incontinence
- feelings of urinary urgency
- the number of times you need to urinate during the night and day
- the need for wearing incontinence pads
As with any procedure, there is a risk of side effects. According to a 2024 systematic review and meta-analysis, there can be some safety concerns with botulinum toxin injections for NDO. Alongside a risk of UTIs, some people may also experience nausea and muscle weakness. It is important to discuss the possible risks with your doctor and ask your care team about any signs or symptoms you may need to watch for.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
