PURPOSE: The purpose of this study was to determine the prevalence of stress urinary incontinence (SUI) in women MSers and to what degree these women are bothered by their SUI, since there is a paucity of literature regarding the nature of SUI in this unique population of women.
“SUI is the passing of urine when coughing or straining; in general SUI is not due to MS, but another problem.”
METHODS: Women scheduled for outpatient follow-up appointments at a dedicated MS centre were asked to complete a questionnaire regarding urinary incontinence. Urgency urinary incontinence (UUI) and SUI were defined as an answer of slightly, moderately or greatly to the Urogenital Distress Inventory (UDI-6) question #2 and question #3, respectively. Impact of SUI on physical activity was determined by Incontinence Impact Questionnaire (IIQ-7) question #2.
RESULTS: A total of 55.9% (80/143) women had SUI, 70.6% (101/143) women had UUI, and 44.8% (64/143) women had mixed urinary incontinence. The mean age was 45.8 years old (range, 20 to 72 years). Women with SUI were significantly older (mean, 47.2 vs. 41.9; P=0.023) and there was a trend towards a greater body mass index (mean, 29.3 vs. 26.5; P=0.057). Women with SUI had significantly higher IIQ-7 scores compared to women without SUI (P<0.001). Impact of urinary incontinence on physical activity was also found to be significantly greater in women with SUI (mean IIQ-7 question #2, 0.96 vs. 0.35; P<0.001).
CONCLUSIONS: The prevalence of SUI in women with MS is 55.9% and the presence of SUI has a significant impact on their quality of life. A comprehensive urologic evaluation of a woman with MS should include assessment of SUI.
“This is figure is unbelievable; I ask most, if not all, of the MSers who see in clinic about incontinence and I have never seen figures of stress incontinence that were this high. May be I am wrong. I will need to run an audit about this!”
“I am beginning to believe that bladder problems are the indicator symptoms from which a lot of MSers problems start, in other words it is the first domino in the impairment and disability cascade. Once you have moderate bladder problems, frequency, urgency, urgency incontinence and/or hesitancy with incomplete emptying it has a major impact on your QoL and then the course of your MS.”
“MSers with bladder problems have difficulty with sleep; they have to get up frequently to go to the toilet. This results in day-time fatigue that then prevents them functioning properly in the day. Bladder problems causes severe anxiety! Were is the next toilet? Will I make it to the toilet? Should I go out? This often leads to MSers becoming socially isolated; they avoid going out because of their bladder problems. This has implications for work.”
“Once there is incomplete bladder emptying there is the risk of recurrent infections. There is mounting evidence that recurrent infections may speed up MS disease progression.”
“Drugs we use for treating bladder problems have side effects; the older ones that enter the brain make cognition worse, they all make constipation worse and they cause dryness of the mouth. Once there is incomplete emptying MSers have to generally start using intermittent self-catheterising; most MSers don’t like doing this – another negative.”
“Bladder problems increase health-care utilisation; more doctor appointments more interventions, etc.”
“I think one of the quality indicators that should be used for assessing the quality of the MS Services in the UK is how well we judge our management of MS-related bladder dysfunction. What do you think?”