SX17 Urinary Symptoms Assessment and Management Among Patients With MS

Thursday, May 30, 2013
Kristin M Khalaf, PharmD, MS , College of Pharmacy, University of Arizona, Tucson, AZ
Karin Coyne, PhD, MPH , Health Economics and Outcomes Research, United Biosource Corporation, Bethesday, MD
Denise Globe, PhD , Global Health Outcomes, Allergan, Irvine, CA
Edward Armstrong, PharmD , College of Pharmacy, University of Arizona, Tucson, AZ
Daniel Malone, RPh, PhD , College of Pharmacy, University of Arizona, Tucson, AZ
Jack Burks, MD , Florida International University, Reno, NV

Background: Lower urinary tract dysfunction is a common symptom of MS that may be overlooked by health care providers, thereby limiting appropriate management of symptoms. 

Objectives: The objective of this research was to assess the self-reported prevalence, bother, and management of lower urinary tract symptoms (LUTS) in a sample of US patients with MS. 

Methods: An online, cross-sectional survey was administered to a convenience sample of US-residing participants with self-reported MS recruited through patient advocacy groups. The presence and bother of LUTS among the entire sample were assessed. Patients experiencing LUTS were asked additional questions related to severity, management, and treatment satisfaction with current therapies. 

Results: A total of 1052 participants completed the survey. The mean age was 48 years (SD=10.6) and 81% of the sample was female. Ninety-two percent (n=966) reported at least one LUTS,  the most common being post-micturition dribble (64.9%), followed by urinary urgency (61.7%) and incomplete emptying (60.7%). The most common type of urinary incontinence (UI) reported was urgency urinary incontinence (UUI, 52.6%), followed by stress incontinence (45.3%). Mixed UI (stress UI and UUI) was present in 297 patients (28%).   Patients with UUI most commonly reported experiencing UUI a few times per week (35%), and most (56%) reported that UUI bothered them “Quite a bit” or “A great deal,” compared to 40% for stress UI and 48% for other types of UI. Patients with UUI were 3.5 times more likely to report being “Quite a bit” or “A great deal” bothered by incontinence compared to patients with only other types of incontinence (p<0.001). Among those “Quite a bit” or “A great deal” bothered by any type of UI (n=441), 46% had not discussed their symptoms with their healthcare professional (HCP) within the past year, and 35% had never tried any treatments for UI.  Of patients who had discussed any LUTS with their HCP at any time (n=680, 70%), 204 (38%) patients reported currently engaging in pelvic exercises/bladder training (PE), 154 (23%) using oral anticholinergics (OAC), 17 (3%) using botulinum toxin type A (BTX), and 13 (2%) using neural stimulation (NS) devices. The majority of patients were very or somewhat satisfied with their current LUTS treatment, but a proportion (8-19%) indicated they would probably not or definitely not continue treatment except for BTX patients, who were all very or somewhat satisfied and would definitely or probably continue treatment.

Conclusions: LUTS are commonly experienced, highly bothersome, and often not treated among patients with MS. Proper LUTS assessment and work-up is warranted in the MS population.