Under Treatment of Overactive Bladder Symptoms in Patients With Multiple Sclerosis: An Ancillary Analysis of the NARCOMS Patient Registry

Purpose

We describe the prevalence of overactive bladder symptoms in patients with multiple sclerosis as well as the rates of evaluation and treatment of urinary complaints.

Materials and Methods

Data from the fall 2005 North American Research Committee On Multiple Sclerosis survey were examined, including the Urogenital Distress Inventory plus a nocturia question, the SF-12, and inquiries regarding urological care and treatments. Data were analyzed using descriptive statistics, chi-square and Student's t tests, ANOVA and multivariable logistic regression.

Results

Of 16,858 surveys distributed 9,702 (58%) were completed. Participants with a surgically altered bladder were excluded from analysis (21). At least 1 moderate to severe urinary symptom (score of 2 or greater) was reported by 6,263 (65%) respondents. Increasing overactive bladder symptoms were correlated with longer disease duration (r = 0.135) and increasing physical disability (r = 0.291) (both p <0.001). Decreased quality of life was associated with increasing disability (p <0.001) and overactive bladder symptom score (p <0.001). Of patients with moderate to severe overactive bladder symptoms only 2,710 (43.3%) were evaluated by urology and 2,361 (51%) were treated with an anticholinergic medication. Treated patients more frequently reported leakage (p <0.001) and newer treatments were significantly underused (less than 10% total use). Catheter use was reported by 2,309 (36.8%) respondents, and was associated with greater disability, higher overactive bladder symptom score and reduced quality of life (all p <0.001).

Conclusions

This large scale study identified high rates of overactive bladder symptoms in patients with MS, and correlations with increasing disease duration and physical disability. Despite an increasing awareness of overactive bladder symptoms and the need for evaluation and treatment, many patients remain underserved.

Key Words: urinary bladder, overactive, multiple sclerosis, urinary incontinence, urge

Abbreviations and Acronyms: ISC, intermittent self-catheterization, MCS-12, Mental Component Score, MS, multiple sclerosis, NARCOMS, North American Research Committee On Multiple Sclerosis, OAB, overactive bladder, PCS-12, Physical Component Score, PDDS, Patient Determined Disease Steps, QOL, quality of life, SF-12, Medical Outcomes Study Short Form-12, SF-36, Medical Outcomes Study Short Form-36, SPC, suprapubic catheterization, TFC, transurethral Foley catheter, UDI-6, Urogenital Distress Inventory-Short Form