Multiple Factors Influence the Prevalence of Lower Urinary Tract Symptoms in MS Patients, Study Indicates

Age, gender, disease subtype, degree of disability, and more factors affect lower urinary tract symptoms (LUTS) among patients with multiple sclerosis (MS). Also, the epidemiology of LUTS must be better understood and promptly detected and treated to improve patients’ quality of life.

Those findings are detailed in a new study, “The prevalence of lower urinary tract symptoms based on individual and clinical parameters in patients with multiple sclerosis,” which was published recently in the peer-reviewed journal BMC Neurology.

Patients with MS experience higher rates of lower urinary tract symptoms, which significantly affect their quality of life. Symptoms include the frequent need to urinate, incontinence, urinary leakage without cause at all times, including during sex, and the sensation of incomplete bladder emptying.

LUTS occur frequently with MS, emerging as the first symptom of the disease in 2%–14 % of patients. With few studies on the topic, however, clinicians have little information regarding the differences in LUTS between men and women, or between MS subtypes.

A better understanding of LUTS and its role in the emergence of MS may help doctors diagnose MS earlier, and better control possible complications. It also would provide greater insight into MS’ complicated pathophysiology.

In order to determine the prevalence of LUTS among MS patients, researchers at the Isfahan University of Medical Sciences, in Iran, analyzed 602 MS patients with varying degrees of disease severity who were referred to two neurology clinics affiliated with Isfahan University. Patients were queried about their past experiences with LUTS.

Results showed that men and women reported having experienced LUTS at similar rates, 85.9% and 88.2%, respectively.

The most common symptoms reported by respondents were nocturnal polyuria (the production of too much urine overnight, 59.3%) and urgency (57.1%) in the storage phase, urinary hesitancy (39.7%), intermittent urine flow (36.0%) in the emptying phase, and feeling of incomplete emptying in the post-emptying phase (43.2%).

Although these symptoms were common to all respondents, men and women reported differences in the prevalence of some of them. In particular, stress urinary incontinence (SUI), intermittent urine flow, hesitancy, straining, and dribbling varied significantly by gender.

The team also found that the severity of LUTS varied with age. Mild cases declined with age, while moderate and severe cases increased with age.

MS subtype also showed a strong effect on the prevalence and severity of LUTS. Mild symptoms were more prevalent in those with clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS), while moderate symptoms were found in slightly more than half of the progressive forms of MS.

Progressive MS subtypes also saw the highest frequency of severe symptoms (16.4% in patients with primary or secondary progressive MS), while no severe symptoms were reported among those with CIS, and in 7% in those with RRMS.

Socioeconomic factors also affected LUTS prevalence. Divorced and widowed respondents experienced higher rates of moderate and severe symptoms than their married counterparts. Those with a high school degree or higher experienced a lower rate of LUTS and less severe symptoms, than those with a secondary school degree or lower.

Finally, the rate and severity of LUTS appeared to be affected by the duration and clinical course of an individual’s MS, and by the severity of disability. The rate and severity of LUTS were found to be generally correlated with the duration and severity of a patient’s MS.

At least one previous study, however, suggested that LUTS were unrelated to the duration of MS and to the degree of disability, despite LUTS incidence increasing with disease progression.

According to the research team, in general, the results of this study sometimes complement and sometimes conflict with results of other studies, highlighting the need for more research about this subject.

Overall, the team concluded “A high prevalence of LUTS was found among patients with MS. There was a higher probability of a urinary tract problem among patients with MS and a high EDSS score [a disability score].”

“Therefore, it is recommended that the health system take the necessary measures regarding timely detection and treatment of LUTS among these patients, in order to prevent secondary outcomes and improve the quality of life (QOL) of patients with MS,” the researchers stated.