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Bladder, Bowel and Sexual Dysfunction in Multiple Sclerosis

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Abstract

Although patients with multiple sclerosis (MS) are likely to have problems with bladder, bowel and sexual function, these problems have often been neglected in the past. Bladder dysfunction produces symptoms of urgency, frequency and urge incontinence (due to bladder overactivity and incomplete emptying), and is found in up to 75% of patients with MS. The mainstay of drug treatment for neurogenic bladder overactivity is anticholinergic medication, although intravesical treatments have also been proposed, such as the vanilloids and botulinum toxin, as well as sublingual cannibanoids. There has been much progress with pro-erectile agents in recent years, notably the use of sildenafil citrate, which has been shown to be particularly efficacious in these patients. Other agents include apomorphine hydrochloride and newer phosphodiesterase 5 inhibitors; however, the efficacy of these drugs in patients with MS remains to be proven. Research in female sexual dysfunction is also progressing, although this aspect of patient well being has only recently been addressed; the reported development of a classification system for the condition is likely to help categorise future treatments. Unlike bladder and sexual dysfunction, there have been rather limited advances in the treatment of faecal incontinence and constipation specifically for patients with MS, despite a prevalence of up to 50%. This review highlights the strategies for these types dysfunction commonly seen in patients with MS, with report of recent pharmacological developments.

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References

  1. Betts CD. Bladder and sexual dysfunction in multiple sclerosis. In: Fowler CJ, editor. Neurology of bladder, bowel and sexual dysfunction. Boston (MA): Butterworth Heinemann, 1999: 289–308

    Google Scholar 

  2. Betts CD, D’Mellow MT, Fowler CJ. Urinary symptoms and the neurological features of bladder dysfunction in multiple sclerosis. J Neurol Neurosurg Psychiatry 1993; 56(3): 245–50

    Article  PubMed  CAS  Google Scholar 

  3. Betts CD, D’Mellow MT, Fowler CJ. Erectile dysfunction in multiple sclerosis: associated neurological and neurophysiological deficits, and treatment of the condition. Brain 1994; 117: 1303–10

    Article  PubMed  Google Scholar 

  4. Nortvedt MW, Riise T, Myhr KM, et al. Reduced quality of life among multiple sclerosis patients with sexual disturbance and bladder dysfunction. Mult Scler 2001; 7(4): 231–5

    PubMed  CAS  Google Scholar 

  5. Chappie CR. Muscarinic receptor antagonists in the treatment of overactive bladder [see comments]. Urology 2000; 55 (5A Suppl.): 33–46

    Article  Google Scholar 

  6. Appell RA, Sand P, Dmochowski R, et al. Prospective randomized controlled trial of extended-release oxybutynin chloride and tolterodine tartrate in the treatment of overactive bladder: results of the OBJECT Study. Mayo Clin Proc 2001; 76(4): 358–63

    PubMed  CAS  Google Scholar 

  7. Abrams P, Freeman R, Anderstrom C, et al. Tolterodine, a new antimuscarinic agent: as effective but better tolerated than oxybutynin in patients with an overactive bladder. Br J Urol 1998; 81(6): 801–10

    Article  PubMed  CAS  Google Scholar 

  8. Appell RA. Clinical efficacy and safety of tolterodine in the treatment of overactive bladder: a pooled analysis. Urology 1997; 50 (6A Suppl.): 90–6

    Article  PubMed  CAS  Google Scholar 

  9. Chancellor M, Freedman S, Mitcheson HD, et al. Tolterodine, an effective and well tolerated treatment for urge incontinence and other overactive bladder symptoms. Clin Drug Invest 2000; 19(2): 83–91

    Article  CAS  Google Scholar 

  10. Madersbacher H, Halaska M. A placebo-controlled, multicentre study comparing the tolerability and efficacy of propiverine and oxybutynin in patients with urgency and urge incontinence. BJU Int 1999; 84(6): 646–51

    Article  PubMed  CAS  Google Scholar 

  11. Madersbacher H, Stohrer M, Richter R, et al. Trospium chloride versus oxybutynin: a randomised, double-blind, multicentre trial in the treatment of detrusor hyperreflexia. BJU Int 1995; 75: 452–6

    Article  CAS  Google Scholar 

  12. Fowler CJ. Intravesical treatment of the overactive bladder. Urology 2000; 55 (5A): 60–4

    Article  PubMed  CAS  Google Scholar 

  13. Glickman S, Tsokkos N, Shah P. Intravesical atropine and suppression of detrusor hypercontractility in the neuropathic bladder. Paraplegia 1995; 33: 36

    Article  PubMed  CAS  Google Scholar 

  14. Deaney C, Glickman S, Gluck T, et al. Intravescial atropine suppression of detrusor hyperreflexia in multiple sclerosis. J Neurol Neurosurg Psychiatry 1998; 65: 957–8

    Article  PubMed  CAS  Google Scholar 

  15. Fowler C, Beck RO, Gerrard S, et al. Intravesical capsaicin for treatment of detrusor hyperreflexia. J Neurol Neurosurg Psychiatry 1994; 57: 169–73

    Article  PubMed  CAS  Google Scholar 

  16. Lazzeri M, Spinelli M, Beneforti P, et al. Intravesical resiniferatoxin for the treatment of detrusor hyperreflexia refractory to capsaicin in patients with chronic spinal cord diseases. Scand J Urol Nephrol 1998; 32(5): 331–4

    Article  PubMed  CAS  Google Scholar 

  17. Silva C, Rio ME, Cruz F. Desensitization of bladder sensory fibers by intravesical resiniferatoxin, a capsaicin analog: long-term results for the treatment of detrusor hyperreflexia. Eur Urol 2000; 38(4): 444–52

    Article  PubMed  CAS  Google Scholar 

  18. Schurch B, Stohrer M, Kramer G, et al. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol 2000; 164 (3 Pt 1): 692–7

    Article  PubMed  CAS  Google Scholar 

  19. Brady CM, DasGupta R, Wiseman OJ, et al. The effect of cannabis based medicinal extract on lower urinary tract dysfunction in advanced multiple sclerosis: preliminary results. J Neurol Neurosurg Psychiatry 2002; 72: 139

    Google Scholar 

  20. Hassouna MM, Siegel SW, Nyeholt AA, et al. Sacral neuromodulation in the treatment of urgency-frequency symptoms: a multicenter study on efficacy and safety. J Urol 2000; 163(6): 1849–54

    Article  PubMed  CAS  Google Scholar 

  21. Weil EH, Ruiz-Cerda JL, Eerdmans PH, et al. Sacral root neuromodulation in the treatment of refractory urinary urge incontinence: a prospective randomized clinical trial. Eur Urol 2000; 37(2): 161–71

    Article  PubMed  CAS  Google Scholar 

  22. Zorzon M, Zivadinov R, Bosco A, et al. Sexual dysfunction in multiple sclerosis: a case-control study. I. Frequency and comparison of groups. Mult Scler 1999; 5: 418–27

    CAS  Google Scholar 

  23. Miller H, Simpson DCA, Yeates WF. Bladder dysfunction in multiple sclerosis. BMJ 1965; 1: 1265–9

    Article  PubMed  CAS  Google Scholar 

  24. Vas CJ. Sexual impotence and some autonomic disturbances in men with multiple sclerosis. Acta Neurol Scand 1969; 45: 166–84

    Article  PubMed  CAS  Google Scholar 

  25. Minderhoud JM, Leemhuis JG, Kremer J, et al. Sexual disturbances arising from multiple sclerosis. Acta Neurol Scand 1984; 70: 299–306

    Article  PubMed  CAS  Google Scholar 

  26. Kirkeby HJ, Poulsen EU, Petersen T, et al. Erectile dysfunction in multiple sclerosis. Neurology 1988; 38: 1366–71

    Article  PubMed  CAS  Google Scholar 

  27. Valleroy ML, Kraft GK. Sexual dysfunction in multiple sclerosis. Arch Phys Rehab 1984; 65: 125–8

    CAS  Google Scholar 

  28. Rosen R, Riley A, Wagner G, et al. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49(6): 822–30

    Article  PubMed  CAS  Google Scholar 

  29. Ghezzi A, Malvestiti GM, Baldini S, et al. Erectile impotence in multiple sclerosis: a neurophysiological study. J Neurol 1995; 242: 123–6

    Article  PubMed  CAS  Google Scholar 

  30. Salinas Casado J, Virseda Chamorro M, Sambias Garcia R, et al. Neurobiology of erectile dysfunction in multiple sclerosis. Arch Esp Urol 1998; 51: 167–70

    PubMed  CAS  Google Scholar 

  31. El-Galley R, Rutland H, Talic R, et al. Long-term efficacy of sildenafil and tachyphylaxis effect. J Urol 2001; 166: 927–31

    Article  PubMed  CAS  Google Scholar 

  32. Fowler C, Miller J, Sharief M. Viagra (Sildenafil Citrate) for the treatment of erectile dysfunction in men with multiple sclerosis. Ann Neurol 1999; 46(3): 497

    Google Scholar 

  33. Miller J, Fowler C, Sharief M. Effect of sildenafil citrate (Viagra) on quality of life in men with erectile dysfunction and multiple sclerosis. Ann Neurol 1999; 46(3): 496–7

    Google Scholar 

  34. Porst H, Rosen R, Padma-Nathan H, et al. Vardenafil, a new highly selective PDE5 inhibitor, improves erectile function irrespective of the baseline severity and etiology of ED or age of patient [abstract]. Eur Urol 2001; 39 Suppl. 5: 17

    Google Scholar 

  35. Anglin G. On-demand administration of IC351 is effective and well tolerated in men with mild-to-severe erectile dysfunction. Int J Impot Res 2001; 13 Suppl. 1: 36

    Google Scholar 

  36. Bukofzer S, Livesey N. Safety and tolerability of apomorphine SL (Uprima). Int J Impot Res 2001; 13 Suppl. 3: S40–4

    Article  PubMed  Google Scholar 

  37. Teloken C, Rhoden EL, Sogari P, et al. Therapeutic effects of high dose yohimbine hydrochloride on organic erectile dysfunction. J Urol 1998; 159: 122–4

    Article  PubMed  CAS  Google Scholar 

  38. Morales A, Heaton JP, Johnston B, et al. Oral and topical treatment of erectile dysfunction: present and future. Urol Clin North Am 1995; 22: 879–86

    PubMed  CAS  Google Scholar 

  39. Basile G, Goldstein I. Medical treatment of neurogenic impotence. Sex Dis 1994; 12: 81–94

    Article  Google Scholar 

  40. Hatzichristou DG, Payton T, Goldstein I. Intracavernous injection therapy for impotence. In: Nagler HM, Whitehead ED, editors. Management of impotence and infertility. Philadelphia (PA): Lippincott, 1994: 12–26

    Google Scholar 

  41. Padma-Nathan H, Hellstron WJ, Kaiser FE, et al. Treatment of men with erectile dysfunction with transurethral alprostadil. N Engl J Med 1997; 336: 1–7

    Article  PubMed  CAS  Google Scholar 

  42. Ganem JP, Lucey DT, Janosko EO, et al. Unusual complications of the vacuum erection device. Urology 1998; 51: 627–31

    Article  PubMed  CAS  Google Scholar 

  43. Rees RW, Ziessen T, Ralph DJ, et al. Human and rabbit cavernosal smooth muscle cells express Rho-kinase. Int J Impot Res 2002; 14(1): 1–7

    Article  PubMed  CAS  Google Scholar 

  44. Giuliano F, Argiolas A, Bernabe J, et al. Comparison of the proerectile effect of two hexarelin analogues, EP80661 and EP91072, with apomorphne after intravenous or intraparaventricular nucleus delivery in anaesthetised rats. Int J Impot Res 2001; 13 (4 Suppl.): 15–6

    Google Scholar 

  45. Lillius H, Valtonen C, Wilkstrom J. Sexual problems in patients suffering from multiple sclerosis. J Chron Dis 1976; 19: 643–7

    Article  Google Scholar 

  46. Laumann EO, Paik A, Rosen R. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281 (6): 537–44

    Article  Google Scholar 

  47. Basson R, Berman J, Burnett A, et al. Report of the International Consensus development conference on female sexual dysfunction: definitions and classifications. J Urol 2000; 163: 888–93

    Article  PubMed  CAS  Google Scholar 

  48. Basson R. Female sexual response: the role of drugs in the management of sexual dysfunction. Obstet Gynaecol 2001; 98(2): 350–3

    Article  CAS  Google Scholar 

  49. Sipski ML, Alexander C. Sexual activities, response and satisfaction in women pre- and post-spinal cord injury. Arch Phys Med Rehab 1993; 74: 1025–9

    Article  CAS  Google Scholar 

  50. Sipski M, Alexander C, Rosen R. Sexual arousal and orgasm in women: effects of spinal cord injury. Ann Neurol 2001; 49: 35–44

    Article  PubMed  CAS  Google Scholar 

  51. McKenna KE. The neural control of female sexual function. Neurorehabilitation 2000; 15: 133–43

    PubMed  Google Scholar 

  52. Sommer F, Caspers HP, Esders K, et al. Measurement of vaginal and minor labial oxygen tension for the evaluation of female sexual function. J Urol 2001; 165(4): 1181–4

    Article  PubMed  CAS  Google Scholar 

  53. Gruenwald I, Miller A, Gartman I, et al., Evaluation of genital sensation and associated sexual dysfunction in females with multiple sclerosis and spinal cord involvement. Int J Imp Res 2001; 13 Suppl. 4: 30–1

    Google Scholar 

  54. Laan E, van Lunsen RH, Everaerd W. The effects of tibolone on vaginal blood flow, sexual desire and arousability in postmenopausal women. Climacteric 2001; 4(1): 28–41

    PubMed  CAS  Google Scholar 

  55. Kaplan S, Reis RB, Kohn IJ, et al. Safety and efficacy of sildenafil in potmenopausal women with sexual dysfunction. Urology 1999; 53(3): 481–6

    Article  PubMed  CAS  Google Scholar 

  56. Caruso S, Intelisano G, Lupo L, et al. Premenopausal women affected by sexual arousal disorder treated with sildenafil: a double-blind, cross-over, placebo-controlled study. Br J Obstet Gynaecol 2001; 108: 623–8

    Article  CAS  Google Scholar 

  57. Chia YW, Fowler CJ, Kramm MA, et al., Prevalence of bowel dysfunction in patients with multiple sclerosis and bladder dysfunction. J Neurol 1995; 242(2): 105–8

    Article  PubMed  CAS  Google Scholar 

  58. Hinds JP, Eidelman BH, Wald A. Prevalence of bowel dysfunction in multiple sclerosis: a population survey. Gastroenterology 1990; 98(6): 1538–42

    PubMed  CAS  Google Scholar 

  59. Sullivan S, Ebers G. Gastrointestinal dysfunction in multiple sclerosis. Gastroenterology 1983; 84: 1640–6

    PubMed  CAS  Google Scholar 

  60. Hennessey A, Robertson NP, Swingler R, et al., Urinary, faecal and sexual dysfunction in patients with multiple sclerosis. J Neurol 1999; 246(11): 1027–32

    Article  PubMed  CAS  Google Scholar 

  61. Kamm MA. Faecal incontinence. BMJ 1998; 316: 528–32

    Article  PubMed  CAS  Google Scholar 

  62. Fowler CJ. Neurological disorders of micturition and their treatment. Brain 1999; 122: 1213–31

    Article  PubMed  Google Scholar 

  63. Nordenbo AM, Anderson JR, Anderson JT. Disturbances of ano-rectal function in multiple sclerosis. J Neurol 1996; 243: 445–51

    Article  PubMed  CAS  Google Scholar 

  64. Sorensen M, Lorentzen M, Petersen J. Anorectal dysfunction in patients with urologic disturbance due to multiple sclerosis. Dis Colon Rectum 1991; 34: 136–9

    Article  PubMed  CAS  Google Scholar 

  65. Waldron D, Horgan PG, Patel FR, et al., Multiple sclerosis assessment of colonic and anorectal function in the presence of faecal incontinence. Int J Colorectal Dis 1993; 8: 220–4

    Article  PubMed  CAS  Google Scholar 

  66. Wiesel PH, Norton C, Glickman S, et al., Pathophysiology and management of bowel dysfunction in multiple sclerosis. Eur J Gastroenterol Hepatol 2001; 13(4): 441–8

    Article  PubMed  CAS  Google Scholar 

  67. Muller-Lissner SA. Effect of wheat bran on weight of stool and gastrointestinal transit time: a meta analysis. Br Med J (Clin Res Ed) 1988; 296(6622): 615–7

    Article  CAS  Google Scholar 

  68. Brady C. Constipation and fecal incontinence. In: Munsat TL, editor. Neurologic bladder, bowel and sexual dysfunction. Amsterdam: Elsevier, 2001: 27–37

    Google Scholar 

  69. Geders J, Gaing A, Bauman WA, et al. The effect of cisapride on segmentai colonie transit time in patients with spinal cord injury. Am J Gastroenterol 1995; 90: 285–9

    PubMed  CAS  Google Scholar 

  70. Fowler C, Henry M. Bowel dysfunction in multiple sclerosis. In: Fowler CJ, editor. Neurology of bladder, bowel, and sexual dysfunction. vol. 23. Blue Books of Practical Neurology. Boston: Butterworth Heinemann, 1999: 309–13

    Google Scholar 

  71. Gill K, Chia YW, Henry MM, et al. Defecography in multiple sclerosis patients with severe constipation. Radiology 1994; 191: 553–6

    PubMed  CAS  Google Scholar 

  72. Wiesel PH, Norton C, Roy AJ, et al. Gut-focused behavioural treatment (biofeedback) for contipation and faecal incontinence in multiple sclerosis. J Neurol Neurosurg Psychiatry 2000; 69: 240–3

    Article  PubMed  CAS  Google Scholar 

  73. Roberts JP, Moon S, Malone PS. Treatment of neuropathic urinary and faecal incontinence with synchronous bladder reconstruction and the Antegrade Continence Enema. Br J Urol 1995; 75: 386–9

    Article  PubMed  CAS  Google Scholar 

  74. Krogh KP, Christensen P, Laurberg S. Colorectal symptoms in patients with neurological diseases. Acta Neurol Scand 2001; 103(6): 335–43

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    Ranan DasGupta & Clare J. Fowler

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  1. Ranan DasGupta
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DasGupta, R., Fowler, C.J. Bladder, Bowel and Sexual Dysfunction in Multiple Sclerosis. Drugs 63, 153–166 (2003). https://doi.org/10.2165/00003495-200363020-00003

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