Lower urinary tract dysfunction in patients with multiple sclerosis

Lower urinary tract (LUT) dysfunction is common in multiple sclerosis (MS), and has a considerable impact on quality of life. It most often results from involvement of the spinal cord, which results in detrusor overactivity and detrusor sphincter dyssynergia. LUT symptoms may change with time, paralleling the dynamic course of MS, and therefore the need for regular follow-up assessments is essential. A formal evaluation includes history taking, measurement of the postvoid residual volume (PVR), testing for urinary tract infections and urodynamic studies in select cases. If the PVR is elevated, incomplete bladder emptying is best managed by intermittent self-catheterization. Several options exist for managing the overactive bladder, including antimuscarinics, desmopressin, tibial nerve stimulation, and botulinum toxin A. A stepwise approach is adopted for managing LUT dysfunction in MS.