Diagnosis and treatment
As can be seen from these descriptions of MS-related bladder dysfunctions, some of the same symptoms can result from very different types of problems. In fact, it is never possible to know from symptoms alone exactly what type of bladder dysfunction a person is experiencing. Further testing is required to identify the problem – and determine the appropriate treatment. Clearly, it is very important to report any bladder changes to the physician or other health-care professional who manages your MS. (In some settings it is the physician who manages urinary symptoms; in others, a nurse, nurse-practitioner, or physician's assistant (PA) is the primary contact person. The term “provider” will be used for the remainder of the booklet.)
Your provider will do the necessary tests and recommend a treatment regimen that is designed to relieve the symptoms, prevent unnecessary complications, and allow you to be more comfortable and confident in your daily life. There is no need to feel any embarrassment about discussing these problems with your provider. Most people with MS will experience urinary symptoms at one time or another. Prompt, open discussions with your provider are the fastest, safest, and most effective way to manage urinary dysfunction, prevent complications, and regain comfort and confidence.
Your recommended strategy is to report any changes in urinary function – either positive or negative – at every visit to your provider.
Steps to diagnosis
Once you have described your symptoms to your provider, he or she is likely to take the following steps:
Screen
Screen for a urinary tract infection (UTI), since any or all of the symptoms listed above could be caused by a UTI and UTIs are common in MS. The methods used to screen for a UTI are:
Culture & Sensitivity (C&S)
- drops of urine, collected from a sterile urine sample, are placed in a culture medium in the laboratory to allow the bacteria to grow for 48 hours. The bacteria are identified and tested against several antibiotics to determine which would be the most effective. If a specific treatment is indicated, you will probably be given a 7 to 14 day course of medication. If the symptoms subside, no further action will be taken.
Urinalysis
- a microscopic study of a sample of urine
Dipstick
- a quick and convenient test; the paper stick changes colour in response to various indicators of infection in a urine sample. The dipstick technique is slightly less reliable than microscopic urinalysis.
If positive
If the screening test is positive (i.e., detects evidence of infection), your provider will probably take the following steps:
Prescribe an antibiotic to treat the infection. The type and duration of treatment will differ depending on your symptoms, history, and prior use of catheterization (intermittent or indwelling catheters. Regardless of the specific antibiotic that is prescribed for you, it is essential to take the full amount prescribed even if your symptoms subside. Stopping the medication prematurely is likely to result in a recurrence of the symptoms because the infection has not been fully treated. If the symptoms subside, no further action will be taken.
If the symptoms persist, the provider will initiate tests to identify what type of ongoing bladder dysfunction might be causing the infection to persist. If the tests indicate that bladder function is normal, but the symptoms of UTI continue, your provider will refer you for further testing by a urologist – a physician who specializes in the study and treatment of the urinary system. The urologist will do further testing to identify the source of the problem.
If negative
If the screening test is negative, indicating that no infection is present, your provider will initiate testing to determine which type of bladder dysfunction is causing your symptoms. The most important question to be answered is whether you are retaining urine in your bladder after attempting to empty it completely. Urine left in the bladder (post-void residual urine) can cause any of the symptoms described above.
Postvoid residual (PVR) testing is usually done in one of two ways:
Diagnostic catheterization
- Immediately after you have voided, your provider will pass a thin, hollow tube, called a catheter, through the meatus into the urethra. This will drain the remaining urine out of the bladder so it can be measured. Although people dislike the idea of catheterization, most find it to be a quick and easy procedure that causes little discomfort.
Bladder ultrasound
- After you have urinated, the provider will apply a conductive jelly to your lower abdomen and slide a small instrument over the area to obtain an image that can be analyzed to measure residual urine. With either method, a residual amount of less than 100ml is normal.
Compliments of:
Multiple Sclerosis Society of Canada