Bladder Symptoms Among Registry Participants
Olympia Hadjimichael, MPH, Coordinator , NARCOMS Project, Yale Center for Multiple Sclerosis Treatment and Research , Yale University School of Medicine and VA Connecticut Healthcare System , West Haven , CT
Bladder symptoms are very common among people with multiple sclerosis (MS), because MS can affect the nerves responsible for urinary control. In the previous issue of MSQR, Dr. Harris Foster, a urologist, discussed current research on bladder problems experienced by those with MS and discussed available treatments. This article will review the extent to which bladder problems can interfere with daily activities among NARCOMS participants.
We have analyzed responses from the Bladder/Bowel section of the Performance Scales in the Registry questionnaires. The following is a description of the levels of disability that the scale me sures:
Normal Bladder/Bowel
Functionally normal; no limitations on activity or lifestyle. I have not noticed any problems with my bladder or bowel control.
Minimal Bladder/Bowel Disability
I have some problems with bladder or bowel control (e.g., urinary frequency, urgency, or hesitancy), but it does not interfere with my activities. I am aware of needing to control my bladder and bowel, and I do not have any problem with wetting or soiling.
Mild Bladder/Bowel Disability
Bladder or bowel control problems occasionally affect some of my activities (e.g., once a week or less). I have trouble controlling my bladder or bowel once a week or less (e.g., dribbling).
Moderate Bladder/Bowel Disability
Bladder or bowel control problems frequently affect some of my activities (e.g., several times a week). I have trouble controlling my bladder or bowel several times a week (e.g., wet or soil).
Severe Bladder/Bowel Disability
Every day, bladder or bowel control problems force me to modify my daily activities.
Total Bladder/Bowel Disability
Every day, bladder or bowel control problems prevent me from doing my daily activities.
Table 1 shows that 84% of participants report that they experience some bladder problems, from minimal to very severe. One third of the participants report that they have bladder symptoms that are moderate, severe, or total, which frequently affect their lives, and force them to modify and even prevent some of their daily activities. Older and male participants are more likely to experience higher levels of bladder disability. Severe bladder symptoms are associated with very low employment and with being disabled due to MS.
Figure 1 shows that participants who have relapsing - worsening type of MS are more likely to have moderate and very severe bladder problems, while those with relapsing-stable MS report mostly minimal symptoms. Fewer participants with primary progressive MS report bladder symptoms than those with relapsing-worsening MS.
Age at time of symptoms or of MS diagnosis does not appear to be related to the development of bladder disability. However, those with more disabling bladder symptoms are more likely to have frequent relapses.
Figure 2 shows that the frequency and severity of bladder symptoms increases as the level of overall MS disability increases. Specifically, those with more severe mobility and spasticity problems are more likely to have frequent bladder symptoms as well. Since, on the average, MS symptoms increase over time, it is not surprising that bladder problems also increase with time. After an average of 10 years with MS, participants are likely to have at least moderate bladder symptoms.
There are a number of medications available to ease bladder symptoms. When the problem is persistent, or the medication not effective, many patients choose catheterization. We do not collect information on how many participants use catheterization, but we can report on how many use medications.
Table 2 shows that the more severe the symptoms, the higher the percent of participants who use bladder control medication. It also shows the most commonly used medications by the Registry participants.
If you would like to refresh your memory on bladder problems due to MS, please read Dr. Foster’s article in the Spring 2002 issue of MSQR.