Over 50% of MS Patients Report Urinary Problems in Italian Study

Urinary problems, such as an urgency to urinate or a feeling of incomplete urination, are common among people with multiple sclerosis (MS), impacting more than half of patients, according to a large study in Italy.

The researchers noted that urinary disorders are often overlooked in MS compared with other disease symptoms — and that early therapeutic intervention is needed to avoid further problems and to improve patients’ lives.

Moreover, the study found that women and people with progressive disease are more likely to experience urinary problems.

“These disorders may severely affect quality of life and may cause future complications. Therefore, it is essential to have an early and correct characterization of the type of symptoms and an early and targeted therapeutic strategy,” the investigators wrote.

The study, “Lower urinary tract disorders in multiple sclerosis patients: prevalence, clinical features, and response to treatments,” was published in the journal Neurourology and Urodynamics.

A common non-motor symptom of MS is urinary tract difficulties. Symptoms can occur in up to 96% of patients, and appear, on average, six years after neurological symptoms. In about 10% of cases, such symptoms start at the onset of MS.

Overactive bladder symptoms, characterized by frequent urination or a sudden urge to urinate, are the most frequently reported by patients. According to scientists, the sudden urge to urinate is due to overactive detrusor muscles, which are smooth muscles found in the bladder wall.

Other symptoms, known as voiding malfunctions, include a hesitancy to urinate as well as interrupted or incomplete urination. In addition, altered coordination between bladder contraction and the relaxation of sphincter muscles surrounding the urethra can occur. 

The recommended treatments for urinary tract disorders are typically based on the specific type of problems experienced by patients. Still, data on the frequency of urinary problems and the effectiveness of therapies in people with MS are limited.

To answer these questions, scientists at the Università Cattolica del Sacro Cuore, in Italy, examined the medical records of 806 people with multiple sclerosis who visited a local MS center during 2018.

Participants were 45.8 years old, on average, and began having symptoms of MS at a mean age of 31.8. Most patients were female (68.1%) and their mean disease duration was 12.54 years. The majority of patients had relapsing-remitting MS (76.9%).

Additionally, 13.4% of participants had secondary progressive MS and 9.7% primary progressive MS.

Overall, urological disorders were present in 426 individuals, representing a frequency of 52.9%. That means that more than half of the study’s participants had urinary problems.

The most frequent disorder was an overactive bladder (54.2%), followed by a mix of urinary symptoms (25.4%), then voiding malfunction (20.4%). 

An urgency to urinate was the most common symptom, with a frequency of 59.4%. Following that was a sudden urge to urinate (41.5%), and a feeling of incomplete urination (28.9%), which was generally seen in patients with mixed symptoms rather than on its own.

Voiding malfunctions were significantly more common in patients with a younger age of onset, while overactive bladder was more common at an older age of disease onset and in women. 

The sudden urge to urinate was more frequent in women, in older participants, in those with a longer duration of disease, and in patients with a higher level of disability. Incomplete urination and urinary tract infections were more frequent in older patients and those with greater disability.

A total of 46 symptomatic participants (11%) underwent a urodynamic study, which assesses the function of the bladder and urethra in storing and releasing urine. 

The most frequent alterations were detrusor muscle overactivity, occuring in 60.9% of patients tested, and increased proprioception — which refers to brief urination caused by sneezing or coughing — in 43.5%.

A pressure/flow study showed lower activity in the detrusor muscles in 10 patients (21.7%), while in 12 (26.1%) the urination pattern suggested a lack of detrusor-sphincter coordination. 

Participants with symptomatic urinary problems had higher disability scores, were older at disease onset, had a longer duration of disease, and a greater mean age at the time of evaluation than those who were asymptomatic.

In addition, urinary disorders were found more often in patients with progressive forms of MS and among women.

“Unlike other works, which have documented the same prevalence of urinary disorders between the two sexes, in our case series a significantly higher frequency has emerged in women,” the investigator wrote. They noted that the difference could be tied to a greater degree of disability among female patients in this study or to a lower reporting of mild problems by male patients.

Out of all assessed, 178 symptomatic participants (41.8%) were treated for a urological disorder, with high adherence (91.6%). Of these, 145 (81.5%) reported improved symptoms.

The most commonly prescribed treatments were antimuscarinic therapies — used by 42.7% of patients to treat overactive bladder — and alpha-blocking medicines, used for voiding malfunction in 34.8% of patients.

Some patients also required a catheter placement or pelvic floor rehabilitation, in which a physical therapist manipulates pelvic floor muscles to enhance strength and function.

There were no statistically significant differences in clinical and demographic variables between participants who responded to treatment and those who did not. Likewise, no differences were seen in response to treatment based on the type of urinary disorder, nor in the kind of assessment. 

“Urinary disorders in patients with MS have a high prevalence,” the scientists wrote. “An early and correct characterization of types of symptoms and an early and targeted therapeutic strategy are essential to improve the patient’s quality of life and avoid future complications.”

“Further studies are needed to better define clinical and therapeutic aspects of lower urinary tract disorders in patients with MS, which are often overlooked compared to other aspects of the disease,” they added.