Bladder symptoms in multiple sclerosis: a review of pathophysiology and management.
BACKGROUND
The use of anticholinergic medication in bladder dysfunction such as overactive bladder syndrome (OAB) is widespread. However, the benefits and risks of anticholinergics in multiple sclerosis (MS) are unclear because in MS the damage to normal urinary function is both more diffuse and increases with disease progression, and the risk of CNS side effects is higher.


METHODS
The pathophysiology of urinary dysfunction in MS and the efficacy and side effects of anticholinergics is assessed. The review analyzed randomized controlled trials and observational studies using anticholinergics involving persons with a confirmed diagnosis of MS having urinary symptoms. Finally a pragmatic approach to managing urinary symptoms in MS is discussed.


RESULTS
The published data provide limited evidence for the efficacy of anticholinergics in MS. The complexity of treating urinary symptoms in the context of other therapies and the changing neurological background seen in MS is comprehensively analyzed.


CONCLUSIONS
Anticholinergics could be helpful in particular phases of MS. However, there is inadequate evidence currently available on the use of anticholinergics in MS, and further research on the management of the MS neuropathic bladder is warranted.
Nicholas
Richard
R
Imperial College Healthcare NHS Trust, Charing Cross Hospital, Department of Neurosciences, London, UK. richard.nicholas@btinternet.com
Young
Carolyn
C
Friede
Tim
T
D002493:Central Nervous System Diseases / Q000150:complications; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018450:Disease Progression; D016503:Drug Delivery Systems; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications*; D016032:Randomized Controlled Trials as Topic; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D014570:Urologic Diseases / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*
D018680:Cholinergic Antagonists