Nearly 80 percent of MS patients experience some type of bladder dysfunction, which may include problems with urine storage (more common) or with emptying urine.

Bladder problems are caused by nerve lesions (demyelination), which block or delay brain signals to control the bladder muscles.

Urine storage dysfunctions include a feeling of your bladder being filled too early; an urgency to urinate (inability to hold urine); urinary frequency (the tendency to urinate often); nocturia (urinating often during the night); and incontinency (loss of bladder control causing urine leakage).

Emptying dysfunctions include impaired bladder emptying and interrupted urine flow. As a result, residual urine is left in the bladder that may result in urinary tract infections.

Managing bladder dysfunction in MS

Bladder symptoms can be managed with lifestyle changes, medications, physical therapy, and nerve stimulations.

Medications that relax the detrusor muscle (a smooth muscle lining the bladder wall) may be used for the treatment of storage dysfunctions. These include the most commonly prescribed anticholinergic drugs. The major side effects of these medications are dry mouth, constipation, drowsiness, and memory problems.

Detrol (tolterodine) is an FDA-approved antimuscarinic drug (it inhibits the action of the neurotransmitter acetylcholine) that is used to treat bladder spasms responsible for urinary frequency, urgency or incontinence.

Ditropan (oxybutynin) is an antispasmodic/anticholinergic medication that relaxes the bladder muscle spasms and the frequent urge to urinate.

Ditropan XL (oxybutynin chloride) is an extended-release version on Ditropan.

Enablex (darefenacin) is an extended-release antispasmodic/antimuscarinic medication that relaxes the bladder muscles to prevent urgent, frequent, or uncontrolled urination.

Oxytrol (oxybutynin) is a skin patch that delivers the active ingredient oxybutynin through the skin into the bloodstream. It decreases the bladder muscle spasms, relieving the frequent urge to urinate.

Propantheline is an antispasmodic/anticholinergic medication that relieves muscle spasms of the bladder to control urination.

Sanctura (trospium chloride) is an FDA-approved antispasmodic/anticholinergic medication that relaxes the bladder muscles to prevent urgent, frequent, or uncontrolled urination.

Tofranil (imipramine) is an antidepressant but has an anticholinergic effect that benefits bladder frequency at night. It is also prescribed to manage pain in MS.

Vesicare (solifenacin succinate) is an antimuscarinic medication that is used to treat an overactive bladder and the associated symptoms such as frequency, urgency, and incontinence.

Occasionally, other medications may also be prescribed such as DDAVP nasal spray, Flomax, Hytrin, and Minipress (see below).

DDAVP nasal spray (desmopressin acetate) is an antidiuretic (it prevents the production of urine) hormone used as a nasal spray. The hormone works on the kidneys to control urine volume and frequent urination.

Flomax (tamsulosin) is an FDA-approved drug for the treatment of benign prostate enlargement. It blocks the alpha-adrenergic receptor on the bladder muscle, causing it to relax. Flomax is approved for use in men with MS to promote urine flow. It is not approved for women and children.

Hytrin (terazosin) is an anti-hypertensive drug that reduces blood pressure. It also blocks the alpha-adrenergic receptor and relaxes the bladder muscle and promotes urine flow in MS patients.

Minipress (prazosin) is an anti-hypertensive drug that is used off-label to promote urine flow. It is a quinazoline derivative that relaxes the bladder muscles.

Another alternative for an overactive bladder is Myrbetriq (mirabegron), which belongs to a class of drugs called β3-adrenoreceptor agonists that activate a receptor on the detrusor muscle, causing it to relax. This increases the capacity of the bladder to hold more urine for a longer period of time, preventing urgent, frequent or uncontrolled urination. The most common side effects of Myrbetriq are increased blood pressure, common cold-like symptoms, urinary tract infections, and headaches.

If treatment with any of these medications does not manage overactive bladder, doctors may recommend treatment with Botox (botulinum toxin A). It is a powerful nerve toxin that is approved by the FDA to treat incontinence. It relaxes the overactive bladder muscle in temporarily, lasting for about three months. The drug is injected into the bladder muscle. The most common side effects include urinary tract infections and urinary retention. Other side effects include the spread of the toxin to other areas in the body causing problems with swallowing, speaking or breathing.

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