Bladder function is complex. Emptying the bladder is the result of three parts of the bladder functioning in sequence. To empty the urine from the bladder effectively, the bladder wall (the detrusor muscle) has to contract. When the pressure in the bladder has reached the right level, and only then, the bladder neck will normally relax and then the internal sphincter will relax. If the external sphincter is relaxed, voiding will occur. Sometimes, early in the course of MS, the bladder may not contract normally, and the sphincter does not relax, thus preventing the bladder from emptying. This is a so-called hyporeflexic bladder. However, most bladders are hyperreflexic, and the patient feels the urge to urinate frequently, sometimes with a feeling of great urgency. At times, the bladder uncontrollably empties unexpectedly or prematurely, resulting in urinary incontinence.
Anticholinergic drugs that block the effect of the hormone acetylcholine in the body and are called anticholinergic drugs.
removal of urine from the bladder by means of a urinary catheter (tube).
Treatment of bladder dysfunction is usually directed at relieving symptoms and reducing the risk of infection. Ditropan and other anticholinergic drugs are the mainstay of the treatment of urinary frequency and urgency. Unfortunately, these drugs tend to produce dryness of the mouth. Often, patients prefer to use the drugs only at night to reduce wakening and risk of incontinence. These drugs can be useful when patients with urinary frequency and urgency have to leave their homes. Urinary catheterization is sometimes necessary to achieve bladder emptying and can help prevent recurrent bladder infections and complicating kidney damage. If catheterization is recommended, it should be done regularly. All patients with such problems should be seen by a urologist who is familiar with MS.
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