Chapter 14 - Multiple sclerosis and other non-compressive myelopathies

Summary

Estimates of the proportion of patients with Multiple sclerosis (MS) who have lower urinary tract symptoms (LUTS) vary according to the severity of the neurological disability in the group under study, but a figure of about 75% is frequently cited. There are a number of therapeutic interventions which can be of benefit to patients with overactive bladder symptoms. Combined rapid tests of urine, dipstick tests, using reagent strips for urinalysis, are advisable for all patients with MS presenting with new bladder symptoms. The post-micturition residual urine should be measured as a part of initial assessment and preferably before antimuscarinic treatment is started. Pelvic organ dysfunction may occur in several other inflammatory and/or demyelinating neurological conditions, such as acute demyelinating encephalomyelitis (ADEM), central pontine myelinolysis, leucodystrophies, Devic's disease, transverse myelitis and B12 deficiency. Bladder dysfunction has been evaluated in many of these conditions and the results of urodynamic studies are summarized.