Multiple sclerosis (MS) is a chronic autoimmune condition characterized by the immune system attacking the myelin sheath, a protective covering of nerve fibers in the central nervous system. This leads to disruptions in communication between the brain and the rest of the body, resulting in a wide range of symptoms that can affect various bodily functions. One common area of impairment in men with MS is the urinary system.

Urinary problems in men with multiple sclerosis can significantly impact their quality of life and daily functioning. These issues often arise due to damage to the nerves that control bladder function, leading to difficulties in storage and emptying of urine. Understanding the nature of urinary problems in men with MS is crucial for effective management and improving overall well-being.

Urinary problems in patients with MS

Urinary problems in men with multiple sclerosis (MS) can manifest in various ways due to disruptions in nerve signaling between the brain and the bladder. Some of the common urinary problems seen in men with MS include:

• Urinary urgency: Men with MS may experience a sudden and compelling need to urinate, often with little warning. This urgency can be difficult to control and may lead to accidents if the individual is unable to reach a restroom in time.
• Urinary frequency: MS can cause an increase in the frequency of urination, with men needing to empty their bladder more often than usual. This frequent urge to urinate can disrupt daily activities and sleep patterns.
• Urinary hesitancy: Some men with MS may have difficulty initiating urination despite feeling the urge to do so. This hesitancy can be frustrating and may require straining to start the flow of urine.
• Urinary retention: In contrast to hesitancy, urinary retention involves the inability to completely empty the bladder. Men with MS may experience incomplete voiding, leading to a sensation of residual urine in the bladder.
• Nocturia: Nocturia refers to the need to urinate frequently during the night, disrupting sleep patterns. Men with MS may experience nocturia due to increased bladder activity or reduced bladder capacity.
• Urinary incontinence: MS-related bladder dysfunction can result in urinary incontinence, where men may experience leakage of urine involuntarily. This can occur during activities such as coughing, sneezing, or lifting heavy objects (stress incontinence), or it may happen suddenly and unpredictably (urge incontinence).
• Urinary tract infections (UTIs): Men with MS are at an increased risk of developing urinary tract infections due to bladder dysfunction and incomplete emptying. UTIs can cause symptoms such as burning during urination, increased urgency, and cloudy or foul-smelling urine.

Causes of urinary problems in MS

Urinary problems in men secondary to multiple sclerosis (MS) primarily result from damage to the nerves that control bladder function. The exact cause of MS is not fully understood, but it is believed to involve a combination of genetic, environmental, and immune system factors. In MS, the body’s immune system mistakenly attacks the myelin sheath, a protective covering of nerve fibers in the central nervous system, leading to inflammation, demyelination, and nerve damage. This disruption in nerve signaling can affect various bodily functions, including bladder control.

Specific causes of urinary problems in men with MS include:

• Neurogenic bladder: MS can cause dysfunction of the nerves that control bladder function, resulting in a neurogenic bladder. This condition can lead to a range of urinary symptoms, including urinary urgency, frequency, hesitancy, retention, and incontinence.
• Detrusor-sphincter dyssynergia: In some cases of MS-related neurogenic bladder, there may be a discoordination between the detrusor muscle (which contracts to expel urine from the bladder) and the urinary sphincter muscles (which control the release of urine from the bladder). This dyssynergia can lead to difficulties in voiding urine effectively.
• Bladder sphincter dysfunction: MS-related damage to the nerves controlling the urinary sphincter muscles can result in problems with urinary continence, leading to urinary leakage or incontinence.
• Bladder storage dysfunction: MS can affect the ability of the bladder to store urine properly, resulting in symptoms such as urinary urgency, frequency, and nocturia. This may be due to abnormalities in bladder sensation or decreased bladder capacity.
• Spinal cord lesions: MS lesions in the spinal cord can disrupt the neural pathways involved in bladder control, exacerbating urinary symptoms. Lesions in specific regions of the spinal cord may contribute to specific bladder dysfunction patterns.
• Secondary complications: Urinary problems in men with MS can lead to secondary complications such as urinary tract infections (UTIs), bladder stones, and kidney damage. These complications can further exacerbate urinary symptoms and impact overall health.

Treatment of urinary problems in patients with MS

The treatment of urinary problems in men secondary to multiple sclerosis (MS) typically involves a multidisciplinary approach aimed at managing symptoms, improving bladder function, and preventing complications. The treatment plan may vary depending on the specific symptoms experienced by each individual, and it often includes a combination of medical interventions, lifestyle modifications, and behavioral therapies. Here are some common strategies used in the management of urinary problems in men with MS:

Medications:

• Anticholinergic medications: These drugs help relax the bladder muscles and reduce urinary urgency, frequency, and incontinence.
  • Alpha-blockers: Alpha-adrenergic blockers may be prescribed to improve bladder emptying by relaxing the muscles around the urethra.
  • Botulinum toxin injections: In cases of severe overactive bladder or detrusor-sphincter dyssynergia, injections of botulinum toxin into the bladder wall can help relax the muscles and improve bladder function.

Bladder training:

• Bladder training techniques involve scheduled voiding, gradually increasing the time between bathroom visits to improve bladder capacity and control.
  • Prompted voiding: Caregivers or family members remind the individual to empty their bladder at regular intervals to prevent accidents and improve bladder function.

Pelvic floor exercises:

• Pelvic floor muscle exercises, also known as Kegel exercises, can strengthen the muscles that control bladder function and improve urinary continence.
  • Biofeedback therapy may be used to assist in learning how to properly perform pelvic floor exercises and monitor muscle activity.

Catheterization:

• Intermittent catheterization: This involves inserting a catheter into the bladder at regular intervals to empty urine completely, particularly in cases of urinary retention.
  • Indwelling catheter: In some cases of severe bladder dysfunction, a catheter may be left in place continuously to drain urine.

Surgical interventions:

• Sacral neuromodulation: This involves implanting a device near the sacral nerves to modulate bladder function and improve urinary symptoms.
  • Augmentation cystoplasty: In cases of severe bladder dysfunction and intractable symptoms, surgery to increase bladder capacity and reduce pressure may be considered.

Lifestyle modifications:

• Limiting fluid intake before bedtime to reduce nocturia.
  • Avoiding caffeine and alcohol, which can irritate the bladder and worsen urinary symptoms.
  • Maintaining a healthy weight and engaging in regular physical activity to improve overall bladder function.

Management of complications:

• Treating urinary tract infections promptly with appropriate antibiotics.
  • Monitoring kidney function regularly to detect any signs of kidney damage.

Summary

Urinary problems are common in patients with multiple sclerosis (MS), stemming from damage to the nerves that control the bladder. These issues can include urinary urgency, frequency, incontinence, and retention. Management typically involves a combination of lifestyle modifications, medications, and occasionally procedures to help regulate bladder function and improve quality of life for MS patients.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE