Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies.

Area of Science:

• Neurology
• Urology
• Gastroenterology
• Sexual Health

Background:

• Multiple sclerosis (MS) frequently impacts bladder, bowel, and sexual function, often overlooked in patient care.
• Bladder dysfunction, including overactivity and incomplete emptying, affects up to 75% of MS patients, manifesting as urgency, frequency, and incontinence.
• Sexual dysfunction and bowel issues like incontinence and constipation are also prevalent, affecting up to 50% of individuals with MS.

Purpose of the Study:

• To review current management strategies and recent pharmacological advancements for bladder, bowel, and sexual dysfunction in patients with multiple sclerosis.
• To highlight progress in treating neurogenic bladder overactivity and male sexual dysfunction.
• To address the need for further research and treatment development for female sexual dysfunction and bowel disorders in MS.

Main Methods:

• Review of existing literature on pharmacological treatments for MS-related dysfunction.
• Analysis of recent advancements in drug therapies for bladder overactivity, sexual dysfunction, and bowel disorders.
• Discussion of emerging treatments including vanilloids, botulinum toxin, cannabinoids, sildenafil citrate, and phosphodiesterase 5 inhibitors.

Main Results:

• Anticholinergic medications remain a primary treatment for neurogenic bladder overactivity, with intravesical treatments and cannabinoids as alternatives.
• Significant progress has been made in treating male erectile dysfunction with agents like sildenafil citrate.
• Research into female sexual dysfunction is advancing, with classification systems emerging; however, treatments for MS-specific bowel dysfunction remain limited.

Conclusions:

• While treatments for bladder and male sexual dysfunction in MS have advanced, further research is crucial for female sexual dysfunction and bowel disorders.
• Pharmacological interventions offer promising avenues for managing the diverse functional impairments associated with multiple sclerosis.
• A comprehensive approach addressing bladder, bowel, and sexual health is essential for improving the quality of life for MS patients.