Multiple Sclerosis is characterized by a number of different
symptoms ranging from mild sensory symptoms such as tingling,
burning and itching to major symptoms such as weakness, paralysis,
and bladder and bowel control. Learning how to live with these
symptoms is an important part of managing the condition and living
an active life with MS.
Many people with MS experience bladder control issues due to
problems with the muscles that help hold or release urine. Urinary
incontinence in among the most common types of bladder control
conditions. Incontinence effects women two times more often than men
and is treatable.
Urinary incontinence refers to the involuntary passage of
urine, or loss of bladder control. The body stores urine in the
bladder, which is a balloon-like organ. Urine leaves the body
through the urethra, a tube connected to the bladder. During
urination, bladder muscles contract, forcing urine into the urethra.
Urine flows out of the body when the sphincter muscles surrounding
the urethra relax. Incontinence occurs when the bladder muscles
contract suddenly or when the urethra muscles relax suddenly.
Stress Incontinence vs. Urge Incontinence
People who experience incontinence when they laugh, sneeze,
cough or perform other movements that put pressure on the bladder
are experiencing "stress incontinence." Physical changes such as
pregnancy and childbirth can lead to stress incontinence. Stress
incontinence occurs due to the weakening of pelvic floor muscles
that support the bladder. When weakened, the bladder tends to move
down preventing the muscles that shut the urethra from squeezing as
tight as they should. The week before a womanís menstrual cycle can
also lead to stress incontinence due to lowered estrogen levels
which in turn lowers muscle pressure around the urethra causing
"Urge incontinence" is marked by the loss of urine while
suddenly feeling the need to urinate. This is caused by
inappropriate bladder contractions. Urge incontinence is also
referred to as "spastic bladder", "unstable bladder", or "overactive
bladder." People who experience urge incontinence can lose urine
during sleep, after drinking a small amount of water, when they
touch water or when they hear water running. These involuntary
actions of the bladder muscles occur due to damage to the nerves of
the bladder, to the nervous system or to the bladder muscles
themselves. MS patients are especially susceptible, as are people
who have Parkinsonís disease and Alzheimerís disease.
Urinary incontinence can be treated with exercises called
Kegel exercises. These strengthen the pelvic floor muscles and
sphincter muscles and take just a few minutes a day. A health care
professional can teach these exercises. Electrical stimulation works
in the same way as exercises by strengthening the muscles in the
lower pelvis. Electrodes placed in the vagina or rectum stimulate
the muscles and can correct stress incontinence and urge
Biofeedback and timed voiding or bladder training are
treatments that work together. Biofeedback involves the use of
electrical measuring devices to track when bladder and urethral
muscles contract, allowing the patient to gain better control. Timed
voiding and bladder training (also known as muscle conditioning)
rely on biodfeedback. During timed voiding, a patient fills in a
chart of voiding and leaking episodes. Patterns indicate when a
patient should empty the bladder to avoid incontinence. Biofeedback
and bladder training are used to alter the bladderís schedule for
storing and eliminating urine.
Medications can be effective in treating incontinence.
Medications can work by inhibiting the contractions of an overactive
bladder or by relaxing the muscles allowing for complete bladder
emptying during urination. Other medications work by tightening the
muscles at the bladder neck or urethra, preventing leakage. Some
medications have proved to have side effects when used over a long
period of time. Patients should be aware of the risks and long-term
effects of medications for incontinence.
All incontinence conditions are treatable. While many
patients find urinary incontinence embarrassing, overcoming the
embarrassment and talking to a healthcare provider is the first step
in solving the problems.
WHOCI: Extended-Release Oxybutynin Safe, Effective in
Treating Overactive Bladder in Patients with Multiple Sclerosis and
Spinal Cord Injuries
PARIS, FRANCE -- July 2, 2001 -- Results of two studies
evaluating the safety and efficacy of extended-release oxybutynin
(Ditropan XL) to treat overactive bladder in patients with spinal
cord injury (SCI) and multiple sclerosis (MS) were presented today
at the World Health Organization Second International Consultation
on Incontinence in Paris, France.
Michael B. Chancellor,
M.D., professor of urology and director of neuro-urology at the
University of Pittsburgh Medical Center, served as author and lead
investigator for the studies.
These are the first reported
results of the drug's efficacy in MS and SCI patients. "Results of
these studies show that extended-release oxybutynin can safely and
effectively treat patients diagnosed with MS or SCI that experience
symptoms of overactive bladder or neurogenic bladder," said Dr.
Chancellor. "Through these studies physicians should be encouraged
that treating overactive bladder as a secondary condition is an
effective measure in improving quality of life for these
Conditions in which the bladder becomes overactive
due to lesions on the nervous system, or due to damage to the
nervous system are referred to as neurogenic bladder. Extended
release oxybutynin is one of the leading medications for overactive
bladder, reducing incontinence episodes and frequency of urination,
with minimal side effects. Both studies were conducted by
researchers at the University of Pittsburgh Medical Center and led
by Dr. Michael Chancellor.
Dr. Chancellor, et. al., presented
data on an investigational study designed to evaluate the
effectiveness of extended-release oxybutynin, inpatients who
experienced detrusor hyperrerflexia (DH) or overactive bladder and
had some type of SCI.
It was found that up to 30mg of
extended-release oxybutynin greatly reduced their frequency of
urination or catheterization by an average of two episodes per day.
"Patients who are diagnosed with SCI already have difficult
challenges in every day life," said Dr. Chancellor. "By treating
their overactive bladder symptoms effectively with extended-release
oxybutynin, we are allowing them increased freedom, as
catheterization and trips to the bathroom decrease."
results were based on an ongoing 12-week study in which 14 patients
with complete or incomplete SCI were enrolled. Eighty percent of the
patients were women and the mean age of the patients was
approximately 38 years.
The dosing was initiated at 10
milligrams of extended-release oxybutynin per day, and was adjusted
weekly by five milligrams, up to 30 milligrams per day. All 4
patients had a dosing regimen over 10 milligrams per day, with six
patients using 30 milligrams per day. At one week, a decrease of two
voids or catheterizations per day was recorded.
experienced serious adverse events during the study, nor was there a
relationship between dosing quantity and severity of side effects,
such as dry mouth.
Results of a study involving 40 adult MS
patients with neurogenic bladder and a mean age of approximately 43
years indicated that high doses of extended-release oxybutynin can
greatly reduce frequency of urination and incontinence episodes in
patients with MS. "This study demonstrates that extended-release
oxybutynin is safe and effective in decreasing frequency of
urination and incontinence episodes, without significantly
increasing residual urine volume," said Dr. Chancellor." This is
important to MS patients as not only does this treatment increase
their quality of life but it does so without compromising their
overall bladder health, as increased volume could lead to urinary
In the 12-week study, patients were started with
10 milligrams per day of extended-release oxybutynin. Dosing was
increased weekly by five milligrams, up to 30 milligrams per day.
More than 80 percent of patients had a final dosing regimen of over
10 milligrams per day, with 20 percent at 30 milligrams per day. At
one week, a decrease of two voids or catheterizations per day was
No patient experienced serious adverse events
during the study, nor was there a relationship between dosing
quantity and severity of side effects such as dry mouth.
medical condition known as overactive bladder affects approximately
17 million Americans, making it more prevalent than many commonly
discussed conditions, such as diabetes (seven million) and
Alzheimer's disease (four million). With symptoms of urinary urge
incontinence, involuntary loss of bladder control; urgency, urgent
need to urinate; and micturition frequency, urinating more than
eight times a day, overactive bladder is one of the most
under-diagnosed and under-treated conditions in the United
SOURCE: ALZA Pharmaceuticals
Botulinum Toxin Improves Urinary
Continence in Multiple Sclerosis Patients with Overactive Bladder
By Ed Susman
Special to DG News
ORLANDO, FL -- May 28, 2002 -- Botulinum
toxin injection appears to return bladder control to patients with
urinary incontinence secondary to multiple sclerosis, according to
"Botulinum toxin injections are an
effective and promising treatment for patients with incontinence due
to problems in controlling their bladder," said Michael Chancellor,
MD, professor of urology, University of Pittsburgh School of Medicine,
Pittsburgh, Pennsylvania. He presented the results of two studies here
Monday at the 97th
annual meeting of the American Urological Association (AUA).
Dr. Chancellor described his use of
botulinum toxin-commonly known as Botox-in 25 patients with multiple
sclerosis and 50 patients with overactive bladder. He said patients
with multiple sclerosis frequently suffer urinary problems because
nerve damage caused by the disease prevents signals from reaching the
external sphincter muscle. Injection of botulinum relaxed the external
sphincter, and the internal sphincter at the neck of the bladder
prevented unwanted leakage of urine.
For patients with overactive bladder, Dr.
Chancellor located the bladder through a fiber optic scope and
injected the bladder with 100 to 300 units of botulinum toxin, which
calmed the bladder spasms.
"People with these conditions have to
wear diapers[or] are fitted with catheters and urine bags," he said.
"Some of these people are almost hopeless."
Dr. Chancellor said about two-thirds of
the study patients experienced enough relief to discard their
catheters and diapers, and many were able to discontinue medicine used
to control overactive bladder.
The injections are effective for about
six months, but the treatments are not curative and must be repeated.
"I haven't seen any unwanted side effects
with the treatment," he said.
"The use of botulinum for treating
overactive bladder sounds reasonable," said Thomas Brady, MD, head of
the AUA's media committee and a faculty member at the University of
Nevada, Reno. "The treatment is quite feasible as well. We can get
needles into the bladder to make all kinds of injections, so this
would not require any greater amount of expertise that doctors already
Dr. Chancellor said the downside of the
treatment is its cost. A vial of botulinum toxin costs about $400 for
100 units of the drug. A single bladder procedure can use one to three
vials. And while the treatment may be the only thing that works for
these patients, insurance companies often will not pay for the
injections because botulinum toxin does not have FDA approval for this
Dr. Chancellor said he has urged the
manufacturers of botulinum toxin to fund a study to prove its worth as
a treatment for incontinence, but so far the companies have not
The studies were institutionally