Symptomatic Treatment of MS - European Multiple Sclerosis Platform

RECOMMENDATIONS
� Exclusion of bladder infection; treatment with appropriate antibiotics if infection is present.
� Evaluation with micturition diary, clinical examination, sonographic evaluation of residual volume
and uroflowmetry in case of obstruction, creatinine; creatinine clearance and sonography of the
abdomen if necessary.
� Counselling for adaequate fluid intake; information on incontinence devices, acidification of urine
with methionine or cranberry extract.
� In uncomplicated urgency, low disability status and with absent urological side effects pelvic floor
training, toilet training in patients with at least partially maintained sphincter control are useful;
drugs to diminish detrusor overactivity include trospiumchloride or tolterodine, oxybutynin,
propiverine, solifenacin, darifenacin; electrostimulation at S3 root level.
� If obstruction with or without urgency is present, urodynamometry, initiation of treatment is recommended
in cooperation with an urologist. In most cases: treatment with anticholinergic drugs
combined with intermittent sterile catheterisation may be of some value.
� In detrusor overactivity resistant to oral anticholinergic drug treatment injection of botulinum
toxin type A seems to be effective and safe.
� Recurrent bladder infections: Counselling on specific causes, optimisation of symptomatic treatment,
methionine, in severe cases combined with methenamine; avoidance of chronic antibiotic
treatment.
� Severe nocturia: desmopressin 20 µg intranasally.
� Long-term catheterization and surgery is recommended only in treatment-resistant cases because
of its irreversibility, late complications and unpredictable course of the disease.
19 EMSP, Symptomatic Treatment of Multiple Sclerosis, December 2006 - revised in April 2008