Overactive Bladder Symptoms in Patients With Multiple Sclerosis Go Untreated

Fran Lowry

September 25, 2009

September 25, 2009 (Hollywood, Florida) — Most patients with multiple sclerosis (MS) have moderate to severe overactive bladder (OAB) symptoms but they are not receiving appropriate evaluation or treatment, despite the fact that the condition is easily managed with current medications, Sangeeta T. Mahajan, MD, from University Hospitals Case Medical Center in Cleveland, Ohio, reported here at the American Urogynecologic Society 30th Annual Scientific Meeting.

"Something can be done for these patients, absolutely. Overactive bladder is very treatable and we have many medication choices. We can treat them with botox, we can treat them potentially with other medications, but unfortunately we're not really doing a good job," Dr. Mahajan told Medscape Ob/Gyn & Women's Health.

The statistics for MS and urinary symptoms are sobering, she said. Of the 400,000 Americans with the disease, 75% report urinary incontinence, and 50% to 80% have voiding dysfunction. One tenth of patients with MS, which affects women twice as often as it does men, present with urinary retention as their first symptom.

Dr. Mahajan presented results from a survey that was sent out to 16,585 patients as part of the North American Research Committee on Multiple Sclerosis (NARCOMS) Project in the fall of 2005. In total, 9702 individuals with MS (7312 females and 2390 males; 58%) responded.

The survey included questions about quality of life and history of urinary and urologic evaluation and treatments. Questions specific to urinary dysfunction asked about frequent urination, urgency, urine leakage related to the feeling of urgency, and getting up at night to pass urine. All questions were scored on a scale of 0 to 3, and an OAB score was calculated from the responses.

Moderate to severe OAB symptoms were common in this population. Of the respondents, 4,606 (65%) had an OAB score of 5 or more; the median OAB score was 5.1. In addition, 46% had urinary frequency, 43% had urgency, 25% had urge leakage, and 48% had nocturia.

As OAB scores increased, so did disability. A longer duration of MS was associated with a higher prevalence of OAB symptoms. Intermittent catheter use was reported by 25% of patients, 10.8% used a Foley catheter, and 1.3% used a suprapubic catheter

The survey showed that less than half (47%) of patients had ever undergone a urologic evaluation. Only half the patients (51%) with moderate to severe OAB had ever been treated with anticholinergic medication. New medications, such as solifenacin, darifenacin, and botox, were used in only 4.6%, 2.9%, and 2.1% of respondents, respectively.

There has been a major push in neurology to address urinary symptoms in MS patients, but the message is still not getting across, Dr. Mahajan told Medscape Ob/Gyn & Women's Health.

"Neurologists are asking more frequently about bladder symptoms, but still not as much as they should. And the patients who do get asked are not being treated with the up-to-date medications we give everyone else in the population who go to see a urologist or a urogynecologist," she said.

For Mikio A. Nihira, MD, MPH, from the University of Oklahoma Health Sciences Center in Oklahoma City, who comoderated the session, even treatment with an older medication would be worthwhile in these patients.

Dr. Nihira told Medscape Ob/Gyn & Women's Health that "people have criticized the use of simple oxybutynin as opposed to a newer drug. But one thing that I have observed in taking care of these patients is that they tolerate dry mouth much better than patients who do not have MS. I think it's unfortunate, but it's my guess that they deal with such a harder life. These patients are usually so debilitated, so if you have a hard time walking, wearing pads and having dry mouth may be more acceptable. I think it's a very interesting study."

Comoderator Gretchen Lentz, MD, from the University of Washington at Seattle, added that the study was particularly significant because of its size.

"We downplay the level of evidence for a survey type study, but even though it is a survey, it had a large population and a very high response rate of 58%. The significant finding is that these people have moderate to severe incontinence and have not been treated. So there's a lot of room for improvement in the care of these patients."

Dr. Mahajan disclosed that she is a member of the speaker's bureau for Pfizer, which manufactures Toviaz (fesoterodine fumarate) and Detrol (tolterodine tartrate). Dr. Nihira and Dr. Lentz have disclosed no relevant financial relationships.

American Urogynecologic Society (AUGS) 30th Annual Scientific Meeting. Presented September 24, 2009.

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