A New Approach to Bladder Health

Many of us balk at the idea of talking about bladder issues because it can feel embarrassing or uncomfortable. And yet, it is an important topic to address, especially in the MS community. This is because 70 to 80 percent of patients experience bladder symptoms—called neurogenic bladder—that often appear between the ages of 20 and 40. Neurogenic bladder occurs when individuals lack bladder control due to brain, spinal cord, or nerve injury. Symptoms may vary, but generally include:

  • Overactive bladder, which includes having to urinate too often in small amounts; problems emptying all the urine from the bladder; or loss of bladder control
  • Underactive bladder, which is when the bladder becomes too full and an individual may leak urine; the inability to tell when the bladder is full; problems starting to urinate or emptying all the urine from the bladder; or urinary retention
  • Urinary tract infections (UTIs)

Such symptoms can negatively impact the quality of individuals’ social, occupational and sexual lives, and they may develop coping behaviors and strategies that include avoiding activities and social encounters. UTIs can also cause ‘pseudo-relapses,’ during which symptoms may mimic an MS exacerbation, when in fact the UTI is the sole problem.

Treating bladder difficulties is therefore critical. As such, it may come as a surprise that there are no current guidelines on how to diagnose and treat such symptoms—although they affect such a large percentage of people with MS.

The gap in this area is what inspired Dr. Augusto Miravalle, a neuro-immunologist at the Rocky Mountain MS Center at Anschutz Medical Campus, to pursue a project that will help develop a systematic approach—that may be adopted worldwide—for the assessment and diagnosis of neurogenic bladder.

“Patients often do not seek medical attention for this specific problem, as they may be too embarrassed. Equally, health care providers often fail to discuss urinary symptoms as well. We have the opportunity to monitor a patient's health just by having them answer a few validated questions, which is very exciting,” said Dr. Miravalle.

After receiving the necessary approvals, Dr. Miravalle recently began screening patients with bladder issues, treating them, and collecting self-reported questionnaires to determine their health-related quality of life. From this study, he hopes to improve health care outcomes for all MS patients—and make talking about bladder issues a normalized part of care. This is the first in a series of outcomes studies at the Rocky Mountain MS Center at Anschutz Medical Campus that will focus on self-reported questionnaires from patients. Dr. Miravalle and his colleagues hope that each study will prove to be an additional resource in improving patient care and thereby quality of life.