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Postgrad Med J 2009;85:552-559 doi:10.1136/jnnp.2008.159178
  • Review

A UK consensus on the management of the bladder in multiple sclerosis

  1. C J Fowler1,
  2. J N Panicker1,
  3. M Drake2,
  4. C Harris3,
  5. S C W Harrison4,
  6. M Kirby5,
  7. M Lucas6,
  8. N Macleod7,
  9. J Mangnall8,
  10. A North9,
  11. B Porter10,
  12. S Reid11,
  13. N Russell9,
  14. K Watkiss12,
  15. M Wells13
  1. 1
    Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK
  2. 2
    Bristol Urological Institute, Southmead Hospital, Bristol, UK
  3. 3
    Borders General Hospital, Melrose, UK
  4. 4
    Department of Urology, Pinderfields Hospital, Wakefield, UK
  5. 5
    Faculty of Health and Human Sciences, Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
  6. 6
    Morriston Hospital, Swansea, UK
  7. 7
    Western General Hospital, Edinburgh, UK
  8. 8
    Continence Clinic, Doncaster Gate Hospital, Rotherham, UK
  9. 9
    MS Trust, Letchworth Garden City, Hertfordshire, UK
  10. 10
    National Hospital for Neurology and Neurosurgery, London, UK
  11. 11
    Princess Royal Spinal Injuries Unit, Northern General Hospital, Sheffield, UK
  12. 12
    Shrewsbury and Telford Hospitals, Telford, UK
  13. 13
    Integrated Bladder and Bowel Care, Devon PCT, Exeter, UK
  1. Correspondence to Professor C J Fowler, Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; c.fowler{at}ion.ucl.ac.uk
  • Received 25 July 2008
  • Revised 20 October 2008
  • Accepted 12 November 2008

Abstract

Bladder symptoms in multiple sclerosis (MS) are common and distressing but also highly amenable to treatment. A meeting of stakeholders involved in patients’ continence care, including neurologists, urologists, primary care, MS nurses and nursing groups was recently convened to formulate a UK consensus for management. National Institute for Health and Clinical Excellence (NICE) criteria were used for producing recommendations based on a review of the literature and expert opinion. It was agreed that in the majority of cases, successful management could be based on a simple algorithm which includes using reagent sticks to test for urine infection and measurement of the post micturition residual urine volume. This is in contrast with published guidelines from other countries which recommend cystometry. Throughout the course of their disease, patients should be offered appropriate management options for treatment of incontinence, the mainstay of which is antimuscarinic medications, in combination, if necessary, with clean intermittent self-catheterisation. The evidence for other measures, including physiotherapy, alternative strategies aimed at improving bladder emptying, other medications and detrusor injections of botulinum toxin A was reviewed. The management of urinary tract infections as well as the bladder problems as part of severe disability were discussed and recommendations agreed.

Footnotes

  • This is a reprint of a paper that appeared in the Journal of Neurology, Neurosurgery, and Psychiatry, May 2009, volume 80, pages 470–7. Reproduced with kind permission of the author and publisher.

  • Competing interests None.

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