Approximately 80% of patients
with MS experience some type of bladder dysfunction. The primary problems are
failure to store urine in the bladder and inability to empty the bladder normally.
Symptoms of failure to store urine in the bladder include urinary urgency, frequency,
incontinence, and nocturia. Symptoms associated with failure to empty the bladder
include urgency, hesitancy, and a sensation of incomplete bladder emptying.
Being unable to control bladder function poses significant psychosocial implications.
For example, the patient may avoid drinking liquids, may experience anxiety
over loss of bladder control, may become homebound due to fear of not being
close to a bathroom, may fear incontinence during sexual activities, and experience
increased fatigue due to interrupted sleep.
and pharmacological interventions can be used to help bladder dysfunction. Patients
should be advised to avoid using substances such as caffeine and alcohol that
have a diuretic effect. Bladder modification techniques, such as timed or scheduled
voiding, may also be used. Some patients empty their bladders regularly using
intermittent catheterization. Using this technique, the patient or a caregiver
inserts a straight catheter into the bladder every few hours to drain urine
and prevent urinary retention. Medications that can improve bladder dysfunction
include oxybutynin (Ditropan ®), hyoscyamine sulfate, propantheline bromide
(Banthine ®), and tolterodine (Detrol ®).
Bowel dysfunction occurs
in approximately 60% of patients with MS. The most common bowel complaint is
constipation; the most distressing is involuntary bowel emptying. Slow colon
transit times, pelvic floor spasticity, and poor perianal sensation cause constipation,
fecal impaction, flatulence, and paralytic ileus. Diarrhea may occur as a result
of bowel impaction. Bowel dysfunction creates embarrassment, and anxiety about
leaving home and interferes with participation in normal social activities.
Interventions for constipation
include increasing daily fluid intake to 1.5 to 2 liters, adding fresh fruits
and vegetables to the diet, increasing bulk and fiber in the diet by adding
bran and whole grain breads, and increasing physical exercise. Bulk forming
agents, stool softeners, mild laxatives, anticholinergic drugs, and suppositories
or mini-enemas can also be used to help treat constipation.
Cognitive dysfunction is
common in persons with MS. It is estimated that up to 60% of patients with MS
demonstrate abnormalities on mental status examinations. Symptoms of cognitive
Cognitive impairment can
have a profound effect on quality of life for the person with MS. The individual
with symptoms of cognitive dysfunction often experiences anxiety, loss of self-esteem,
depression, and impaired ability to perform self-care activities. On an interpersonal
level, cognitive dysfunction may produce family and marital strain, impaired
communication, and role shifts within the family. Cognitive impairment is a
major cause of the high unemployment rate among people with MS. Cognitive problems
may also affect the patients ability to communicate with his or her healthcare
providers and may have a negative impact on treatment compliance.
Cognitive rehabilitation shows promise as an approach to help patients with cognitive impairment. A restorative approach to cognitive rehabilitation focuses on restoring impaired function through direct retraining exercises. A compensatory approach helps to improve cognitive function by using specific strategies and tools to substitute for the impaired functions. This approach teaches patients how to substitute specific strategies and tools for the impaired cognitive functions. For example, memory books, and electronic reminders can help an individual with cognitive impairment with daily living skills. Denepezil hydrochloride (Aricept ®), a drug currently approved for use in Alzheimers disease, may be used to treat cognitive dysfunction in MS patients. There is also some evidence that treatment with disease modifying agents may play a modest role in the treatment of cognitive impairment.