A UK Consensus On The Management Of The Bladder In Multiple Sclerosis

Main Category: Multiple Sclerosis
Also Included In: Neurology / Neuroscience;  Urology / Nephrology
Article Date: 23 Apr 2009 - 2:00 PDT

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Bladder problems are a common and distressing aspect of multiple sclerosis. Their management is currently erratic in the UK, although the problems are highly amenable to treatment.

In order to provide guidance on the management of bladder problems a multi-disciplinary expert group has assessed all the current evidence and has published in the British Journal of Neurology, Neurosurgery and Psychiatry a consensus statement of best practice.

Prof Clare Fowler, from the Uro-Neurology Department at the National Hospital for Neurology and Neurosurgery, coordinated the work of the group. She said "Having worked with people with MS over many years I was concerned that simple, straightforward management options were not being made widely available because of a belief by healthcare professionals that complex invasive investigations were necessary before treatment could be started. With this consensus we have agreed in the UK who should see MS patients at different stages of their condition and what investigations and treatments should be made available. Many people with MS stand to benefit if these recommendations are widely adopted.

Urinary incontinence is one of the worst symptoms of MS often leading to people being forced to give up work, or feeling trapped in their homes. We have good management options which should be more freely available and the use of Botulinum toxin A bladder injections and intermittent self catheterization means that we now have a highly effective treatment if first line measures are not enough. Proper management of bladder symptoms at each stage of this variably progressive condition can dramatically improve peoples' quality of life."

Jill Lovell lives with MS and said "Exciting discoveries regarding possible cures for MS in the future, such as stem cell treatment are, of course very important, but the reality of living day to day with MS also needs to be addressed. That's why I'm pleased to support today's publication commending a consensus on bladder management. Of course it's embarrassing to have to admit to needing to use catheters and pads but that isn't as embarrassing as being caught short. Far worse, I think is when people stop going out at all. I lead as fulfilling a life as I can within the limits of my MS symptoms. Good bladder management and of course, the provision of accessible public toilets contribute to my ability to do this."

Nicola Russell, Director of Services MS Trust said "Data from the recent MS audit we did with the Royal College of Physicians shows categorically that continence management is very patchy across the UK. We are grateful to all the experts who gave their time so freely to make this consensus statement a reality and hope that the principles outlined in the paper will be adopted across the UK"

MS affects about 100,000 people in the UK and two thirds of these are women. MS is most often diagnosed when people are in their 20s and 30s and is the most common neurological condition affecting young people.

In MS, damage or scarring occurs to the myelin sheath - a layer of fatty protein that protects the nerves in the same way that insulating material protects an electric wire. This damage disrupts the way in which nerve impulses are carried to and from the brain and leads to a range of symptoms, including fatigue, bladder and bowel problems, difficulties with walking and pain or abnormal sensations.

MS is a complex and unpredictable condition, which varies from person to person and does not follow a set pattern. Symptoms can come and go from day to day but there can also be relapses followed by periods of complete or partial remission.

Source
MS Trust

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