Ways To Take Back Control When Ms Causes Bladder Dysfunction
Bladder problems are common in multiple sclerosis, but lifestyle changes, physical therapy, and medication can all help.
Bladder problems are very common in people with multiple sclerosis , affecting at least 80 percent of those who have it, according to the National Multiple Sclerosis Society . In some cases, bladder dysfunction is the first sign a person has MS.
Bladder dysfunction occurs when MS lesions areas of damage to the myelin sheath that normally protects nerve fibers block or delay nerve signals that control how the bladder and the muscles surrounding the bladder store or release urine, a condition called neurogenic bladder, says Kristi Epstein, an advanced practice registered nurse and a certified nurse practitioner who specializes in treating people with MS.
This disruption in the nerve signal can cause the bladder to be spastic or overactive, as well as retain urine or not empty correctly both bladder tone and sphincter control can be affected in MS patients, says Epstein.
In overactive bladder, the muscles controlling the bladder contract involuntarily and too frequently before the bladder actually fills with urine, according to the National MS Society. This can lead to symptoms such as:
- Urgency, an intense feeling that you need to urinate immediately
- Frequency, or taking trips to the bathroom more than eight times in 24 hours
- Nocturia, or waking up at night to urinate
- Incontinence, or loss of bladder control
What Is Botox For Ms
Botox is an injectable treatment approved to ease spasticity, a common symptom of multiple sclerosis . In spasticity, muscles are abnormally stiff and tight, and prone to involuntary spasms.
The therapy also is approved for neurogenic detrusor overactivity in MS, when nerve damage causes the muscle around the bladder to be overactive. This condition results in urinary incontinence and reduced quality of life.
Although Botox can ease these symptoms of MS, it does not alter the progression of the disease. The medication is marketed by Allergan, which is now part of AbbVie.
Social Emotional And Physical Consequences Of Bladder Dysfunction
Many people with MS arent aware that bladder dysfunction is an MS-related issue and dont bring it up with their doctors, says Tamara B. Kaplan, MD, a neurologist at Brigham and Womens Hospital in Boston.
Another big problem is that doctors dont always talk about bladder dysfunction with their patients. It is an embarrassing and uncomfortable situation and can have a major effect on quality of life, says Dr. Kaplan. Ive had patients who dont want to leave their home because they are afraid that they will have an accident. It can be emotionally and socially isolating.
Untreated bladder issues may also lead to loss of self-confidence and independence, according the National MS Society.
Left untreated, bladder dysfunction can lead to bladder infections or kidney damage, according to Cedars Sinai Health System. The excess moisture caused by urine leakage can also make irritation and yeast infections more likely, per MedlinePlus.
Bladder dysfunction can also lead to constipation, bowel urgency, and bowel incontinence, especially when people try to self-treat by not drinking enough water, says Kaplan.
Both bladder and bowel problems can also cause sexual dysfunction. You may be worried about having a bladder accident or feel uncomfortable because you are constipated, says Kaplan. When people have bladder incontinence, they may not emotionally feel they can engage in sexual activity, she adds.
Bladder dysfunction can also cause problems with sleep, says Epstein.
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Other Names: Dysport Xeomin
Botulinum toxin is a drug that is used to treat spasticity and spasms and bladder symptoms in multiple sclerosis.
Botulinum toxin is an extremely potent poison, made by the bacterium Clostridium botulinum. Its therapeutic use is now recognised in a range of symptoms, and it was first used to treat spasticity in MS in 1990. There are several different types of the toxin, with botulinum toxin A being the one most frequently used in MS.
What Is Botulinum Toxin Used For In Ms
In small, therapeutic doses injections of botulinum toxin can be used to treat several symptoms in MS. It can be injected into individual muscles to prevent the nerve messages that cause spasticity and spasms. It can be used to treat bladder symptoms when spasms in the muscle of the bladder wall cause urgency and incontinence. There is also some evidence to suggest that it may help with some types of tremor associated with MS.
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Bladder Botox: A Life
Mon 11, Sep 2017, Bridge Magazine
Botox Fast Facts
Suitable for all over active bladders
May cause urine retention
There is no bowel benefit
60-70% will need repeat treatment
If it fails, its recommended you wait 36 months for alternative treatment
Temporary 6-12 month effect
Not suitable for patients with neuromuscular disease
After ten years of sleepless nights and embarrassing bladder accidents, Michelle who lives with Multiple Sclerosis found a life changing treatment – Botox. She speaks to Jodie Harrison.
Botox, the paralysing drug, more commonly associated with ironing out facial wrinkles, has become a life-changer for tens of thousands of Australians who suffer from overactive bladder conditions.
Since 2014, Botox has been available on the Pharmaceutical Benefits Scheme up to twice a year for people who have more than 14 incontinence episodes per week and have failed more conventional treatments.
After more than a decade of embarrassing accidents, Michelle, a 47-year-old South Australian woman, told Bridge that Botox has changed her life.
Michelle has struggled with severe bladder incontinence since being diagnosed with Multiple Sclerosis 14 years ago.
I had always avoided caffeinated coffee and tea as it has a diuretic effect. It was also suggested that I avoid drinking fruit juice before leaving home as acidic juices are thought to aggravate the bladder.
What You Eat And Drink
It may seem illogical, but drinking more does tend to make bladder problems better. When you drink less, your urine becomes more concentrated. This can irritate your bladder, making it more likely to contract, and it can also make urinary tract infections more likely.
If you need to get used to drinking more, it is best to increase your intake gradually, for example on days when you are at home or when it is easy to get to a toilet.
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What Other Warnings Should I Know About
In addition to the boxed warning described above, Botox has other warnings. If any of the following medical conditions or other health factors apply to you, talk with your doctor before using Botox:
- if you have a history of side effects from any botulinum toxin product
- if you have a condition that affects your muscles or nerves, such as amyotrophic lateral sclerosis or myasthenia gravis
- if you currently have or have a history of breathing problems, such as asthma or emphysema
- if you currently have or have a history of problems with swallowing
- if you currently have or have a history of bleeding disorders
- if you have a urinary tract infection
- if you have trouble emptying your bladder on your own
- if you have surgery planned
- if youre pregnant or breastfeeding
- if youve had an allergic reaction to the drug or any of its ingredients
Botox injections may interact with other medications youre taking. Tell your doctor about all drugs youre using, including prescription and over-the-counter products.
Also, tell your doctor if you:
- have received other botulinum toxin products or injections in the past
- have recently received antibiotics by injection
- are taking an allergy or cold medication
- use sleep medication
What I Tried Before Botox
Ive tried a variety of different drugs for the bladder you know the ones that are advertised during the evening news that always end with pictures of smiling, active men and women. Those drugs helped in small ways, but the overall problem still existed. I tried bladder training, but that did little good because my problem is not a weak pelvic floor. Then I developed a string of UTIs because of retention, developed sepsis, and began doing intermittent self-catherization to be able to void completely and hopefully reduce the chance of further infections I like my kidneys being healthy and I want to keep them that way.
Even with all of these tools, I was still a slave to the restroom being in there a dozen or more times a day was tedious at best and a damn nuisance most of the time. Its hard to focus on a show or work or taking a walk when your bladder and brain are having their nonstop discussion and wont keep it to a whisper.
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What Are The Side Effects Of Botox
The lists below include some of the main side effects that have been reported in people using Botox. For information about other possible side effects of the drug, talk with your doctor or pharmacist.
You can also learn more about side effects from this in-depth Botox article or from the drugs medication guide.
Note: After the Food and Drug Administration approves a drug, it tracks and reviews side effects of the medication. If youd like to notify the FDA about a side effect youve had with Botox, visit MedWatch.
The Botox Treatment Procedure
Prior to the day of treatment, the patient will be given an antibiotic to reduce the chances of a urinary tract infection . Before treatment, a test will be completed to make sure the patient does not have a UTI. If they do have one, the treatment will be rescheduled.
At Urology Associates Botox is administered under general anesthesia or sedation in an ambulatory surgical center. The doctor performs a cystoscopy by inserting a cystoscope through the urethra, the opening where urine exits the body. Botox is given through the cystoscope by a series of quick injections into specific areas of the patients bladder muscle.It can take 24-72 hours before the Botox takes effect, but in rare cases it may take longer.
About 6 out of every 100 patients require a catheter after the treatment. If this is needed, the doctor will discuss the catheter process including cleaning prior to treatment. This is a smaller catheter than those found in hospitals and can be easily hidden.
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How Do I Take Botulinum Toxin
Botulinum toxin is injected. As the drug is so potent, and a misplaced application could lead to the loss of function or other complications, injections have to be delivered by a professional trained in the technique. As a treatment for MS, botulinum toxin is only available at specialist centres in the UK.
How Effective Is Botox
Botox has been shown to be an effective treatment option for bladder problems. In studies, people who received Botox injections for overactive bladder symptoms saw improvements in certain symptoms, such as frequent urination, in the 12 weeks after treatment. People also noticed an increase in the amount released during urination.
Another improvement that people using Botox for OAB symptoms noticed after receiving the injections was fewer episodes of urinary incontinence. In studies, these improvements lasted from 19 to 24 weeks.
In other studies of Botox used for OAB symptoms in adults, people reported improvements in their symptoms and in their quality of life.
Two studies looked at adults who had urinary incontinence with detrusor overactivity* linked with a neurological condition. These studies found that people who received Botox injections had fewer episodes of urinary incontinence. These improvements lasted 42 to 48 weeks for at least half the people in the study.
If you have questions about the results you can expect with this drug, talk with your doctor.
* This refers to overactivity of the detrusor muscle, which is the muscle that lines the bladder.
- overactive bladder symptoms in adults
- urinary incontinence with detrusor overactivity* linked with a neurological condition such as multiple sclerosis or a spinal cord injury, in adults and children ages 5 years and older
* This refers to overactivity of the detrusor muscle, which is the muscle that lines the bladder.
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Adjusting What And When You Drink
Your body needs six to eight cups of fluids daily, but you can modify what you drink and when. Limiting your consumption of coffee, tea, and soda may help, says Epstein.
There is no need to decrease your water intake overall this can lead to dehydration, which can lead to constipation, says Kaplan. She tells her patients to limit fluid intake after dinner to avoid nighttime urination.
How Does Botulinum Toxin Work
Botulinum toxin is injected into a muscle and works by blocking the electrical messages from a nerve being transmitted to a muscle. Therefore it causes muscle paralysis, weakness and relaxation.
The effects of an injection with botulinum toxin last for several months, exactly how long depends on where it has been injected and what symptom it is being used for. The effect wears off when the damaged nerve ends regrow and start sending messages again, at this point the injections can be repeated.
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Are There Any Long
In general, you may have side effects within the first week of receiving Botox injections. Most of the time, these side effects are temporary, but sometimes, side effects can last for several months or longer.
But possible long-term side effects of Botox can include:
Comparing Bladder Botox To Similar Treatments
Botox can have multiple benefits for overactive bladder or incontinence. This can be the ideal treatment for people of all ages. For older patients, this may be preferable to surgery since it will take less of a toll on the body.
Botox injections for the bladder are comparable in cost with most insurance coverages for oral medications, InterStim or percutaneous tibial nerve stimulation .
Below we highlight the pros and cons of Botox compared to other treatment options.
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What Are The Side Effects Of Botox When Injected In The Bladder For Treatment Of Bladder Control Problems
Large studies have shown that Botox, when injected in the urinary bladder for treatment of urinary symptoms including urinary urgency, frequent urination and for bladder control in patients with urinary incontinence, is a safe and effective treatment with few serious side effects.
While the warning label states that distant side effects of Botox are possible such as difficulty speaking/swallowing/breathing, they are apparently exceedingly rare when Botox is injected for treatment of OAB. No patients experienced distant side effects in randomized studies of Botox. In theory, the onabotulinumtoxinA can spread to other areas of the body but this would be an extremely rare occurrence following a relatively small dose of the medication which is given directly into the bladder.
Most common side effects from Botox administration in the bladder:
What The Treatment Involves:
Botox injection treatment is administered in the office under local anesthesia. Local anesthetic is placed via a catheter and allowed to remain in the bladder for 20-30 minutes to provide numbing of the lining of the bladder. After 20-30 minutes, a small scope which is connected to a camera is placed into your bladder through the urethra and a series of injections of Botox solution are done into the muscle of the bladder using a small needle that is passed through the scope. The actual injection procedure takes about 5 minutes or less.
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Botox For Overactive Bladder
Approved new use
Botox isnt just for wrinkles anymore. In 2013, the U.S. Food and Drug Administration expanded the use of Botox to include the treatment of overactive bladder .
Overactive bladder isnt a disease, but rather a group of symptoms related to the function of your bladder. If you arent sure whether you have OAB, ask yourself these questions:
- Do I often experience an urgent need to urinate right away?
- Do I need to urinate at least eight times during the day, or more than twice at night?
- Do I frequently leak urine?
If you answer yes to at least two of these questions, then you may have OAB.
Efficacy And Safety Assessments
The primary efficacy endpoint was the mean change from baseline at week 6 in UI episodes per day. Other endpoints included proportions of patients achieving 50% and 100% reduction in UI episodes per day, mean changes from baseline in urgency and micturition episodes, I-QOL total summary and subscale scores, and volume per void. Urodynamic assessments included changes from baseline in mean cystometric capacity , maximum detrusor pressure during the first IDC, and MDP during the storage phase. Duration of effect was also assessed.
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Gaining Control Of Ms
You should talk to your provider right away if you experience urinary symptoms so that the appropriate therapy can be prescribed, says Epstein. Early intervention leads to fewer complications and improved quality of life, she says.
Your doctor may refer you to a urologist a specialist in diseases of the urinary tract for a complete checkup, diagnosis, and treatment plan. A urologist may perform urodynamic testing, or urodynamics, which examines the lower urinary tract function, including pressure, volume, and how the bladder is storing and releasing urine, according to Stanford Health Care.
This can range from simple observation to precise measurements using sophisticated instruments to better measure how the bladder and urethra are working, says Kaplan.
Bladder problems can often be managed effectively with certain lifestyle adjustments, medication, physical therapy, or devices. The following are some treatment options.