Lower Urinary Tract Dysfunction in Multiple Sclerosis

Multiple sclerosis is commonly associated with bladder dysfunction, which is frequently reported to be the worst aspect of the disease. Patients may experience bothersome bladder symptoms early in the course, and this should be explored. If necessary, a formal evaluation of the lower urinary tract should be offered. The type of bladder dysfunction may also change with time, which highlights the need for continual follow-up assessments. Anticipated problems are incomplete bladder emptying and disorders with urine storage, which may occur simultaneously. This may lead to symptoms of overactive bladder and recurrent urinary tract infections. Conservative measures for management should be used initially while other sinister pathology is excluded. Newer treatments such as botulinum toxin A and neural stimulation techniques are replacing more invasive surgical procedures. Treatment approaches have been described and should be offered by teams who are familiar with patients having uro-neurological complaints.