Intermittent Self Catheterisation - The White Elephant In The Room For People With MS

Background:

Voiding dysfunction (VD) can be characterised by urinary frequency, urgency, hesitancy, straining, poor flow, incomplete bladder emptying, incomplete bladder emptying, UTI or incontinence, and is generally underreported by people with MS. VD with urinary retention has been safely treated by intermittent self-catheterisation (ISC) for over 40 years, and is associated with improved quality of life. Although many studies report improved symptoms and positive patient perceptions others report negative aspects. Non-adherence to ISC can cause complications of the urinary and renal tracts. Current knowledge about ISC in MS is scant, ISC practices amongst patients are highly variable, and inconsistent ISC patient instruction and follow up may contribute to ISC non adherence. 

Objectives:

Identify the nature and extent of voiding dysfunction, need for ISC and ISC adherence in an Australian cohort of MS patients.

Methods:

A newly developed continence-screening tool taking 5-10 minutes to administer, identifed the nature and extent of bladder and bowel dysfunction. MS patients were either referred for screening to the Continence Nurse working in the Unit by the MS team or seen in clinic. Patients identified with symptoms were offered intervention including ISC.

Results:

146 patients screened

Referred:34%

Non-Referred:66%

Voiding dysfunction:44%

Requiring ISC:27%

Degree of symptom impact & burden very high

None of the ISC patients were adherent to recommended treatment regimen

 

Conclusions:

This author has observed very strong ISC resistance and non-adherence even though degree of symptom impact and burden are high. People with chronic illness do not want to be seen as diminished, and in the face of constant loss and change, cling to an ever-changing sense of self and identity. ISC may be confronting and challenging for people with MS. As clinicians, we need to better understand our patient’s health belief system and ability for self management as they relate to ISC. Doing so may help to understand behaviours associated with non adherence.