Multiple Sclerosis with the Consequence of Incontinence 

This essay will discuss the long term neurological condition that is Multiple Sclerosis – also known as MS. MS is a disease of the central nervous system. It involves the brain, spinal cord and nerves of the eye. According to the MS society there is approximately 100,000 people in the UK living with Multiple Sclerosis with a higher proportion of females being diagnosed. One consequence that comes with having MS is the risk of incontinence. Urinary incontinence is the involuntary loss of urine. This essay will discuss the importance of managing incontinence, the nursing care and the impact that incontinence can have on individuals living with MS. Being incontinent can majorly affect an individual’s quality of life. Many people will struggle to cope with the initial diagnosis of MS and will find it difficult to adjust to the potential consequences that come with it. Bladder and bowel problems can be one of the more distressing side effects that come with MS, so it is important as a nurse to provide the appropriate care to help the patient overcome and deal with the consequence that is incontinence.

A holistic and patient-centred assessment is required to establish the presence and nature of bladder dysfunction which can lead to urinary incontinence and any contributing factors. An initial assessment should include a detailed symptom history, a focused physical examination, where required and appropriate and laboratory testing such as urinalysis and blood tests in order to establish a working diagnosis and to exclude underlying related conditions that may require attention. As well as considering the patients general health and their past medical history, key components to assess when taking a continence history can include diet and fluid intake, drug history, history of incontinence and urinary symptoms, bowel habit, functional ability and cognitive ability. It is important to use a person-centred approach to care and this is why the assessment stage is vital, not only to get background information regarding the patients continence issues, but to understand what approach they would like to take when dealing with this and to help them set goals for themselves in their care. Studies have shown that at least 75% of patients with MS develop urinary symptoms at some stage of their disease process. The severity of the bladder symptoms are usually to do with the degree of spinal cord involvement and the level of the patients general disability. In patients with MS and marked neurological dysfunction in their lower limbs, the urinary symptoms tend to be severe.

There are many factors to consider when determining the best management of the urinary symptoms in a patient with MS. It is important to know about the patients’ level of neurological disability, their home circumstances, work and daily routine. With consent, the patients’ family and carers should be involved in the evaluation process. It is important to obtain detailed information about the nature and severity of the urinary symptoms. The most important neurogenic bladder symptoms would be urgency, frequency, urge incontinence, stress leakage, interrupted flow and feeling of incomplete emptying. Incontinence can have a huge impact on a person’s quality of life. Many people are embarrassed to be in public or to carry out their usual daily tasks as they have the fear that they will have an episode of incontinence while being out in public. This can cause patients to become isolated and not want to socialise. As a nurse it is important to ensure that the appropriate care is being carried out to manage the patients incontinence. Bladder dysfunction increases the risk of urinary tract infections which can be recurrent and disabling, therefore, it is important on initial assessment to test the patients urine to ensure that there is no urinary tract infection. UTI’s can often lead to patients becoming incontinent, confused and delirious so it is important to rule out this factor as early as possible.

The nervous system control of the bladder filling and emptying is complex and it is quite common for people with neurological conditions to develop urinary incontinence. It is important that when caring for patients with neurological disorders to have an understanding of the types of urinary incontinence that can be caused by a range of different neurological conditions. Neurological disorders, such as MS, often result in lower urinary tract dysfunction. The majority of patients diagnosed with MS will experience some sort of bladder dysfunction. Most people with neurological disorders will present with problems of storage which can lead to incontinence, problems of emptying which can lead to urinary retention or a combination of the two. The most common type of bladder dysfunction in MS results from a small spastic bladder which results from demyelination of the spinal cord pathways between the voiding reflex centre and the brain.

In MS, treatment of the bladder dysfunction is aimed at reducing the severity of the symptoms with the least possible inconvenience for the patient. Bladder management is the same for inpatients as it is for patients in the community setting. However, the management plan should be take into account the wishes of the patient, their level of disability, the severity of the urinary symptoms, the patient’s cognitive function and the considerations of the relatives and carers. The likelihood MS will progress is high and this must be considered when deciding on the best management of bladder dysfunction. The mainstay of treatment includes lifestyle advice, anticholinergic medication and intermittent self-catheterisation (ISC). This is advised when there is incomplete bladder emptying. It involves inserting a small tube into the bladder, allowing all urine to flow out, then removing the catheter. This technique can be repeated several times a day, and has proved to be one of the most effective and practical means of facilitating bladder emptying. Its use has increased in recent years because intra-detrusor injections of botulinum toxin A have been used to help control overactive bladder symptoms, which often means patients have to use ISC because their ability to void can be reduced. Although ISC proves to be affective, it also comes with the risk of urinary tract infections, which is the most frequent complication in patients using ISC, this can result from poor catheterisation technique.

For patients with MS, it is important to be able to find a suitable method of managing their continence issues. For some patients it may be a simple are providing continence pads, whereas for others it may be the option of catheterisation. It is important to ensure that each patient feels comfortable with the method of managing provided. For patients with MS going out in public places can prove to be challenging if they are struggling with continence issues as they may fear being unable to access disabled toilets when needs be. Without access to a disabled toilet, the chance of becoming incontinent can occur and leave the patient sitting in their own urine in their wheelchair, which can cause discomfort and embarrassment. Depending on the situation, a patient could be left sitting in their own urine for hours if they didn’t have access to a disabled toilet in a public area and this can lead to their skin becoming irritated and possibly breaking which could lead to infection.

There are different ways to improve bladder control such as, pelvic floor muscle training, bladder training programmes, pharmacological interventions such as anti-muscarinics, tricyclic anti-depressants, surgical interventions such as botulinum toxin-A and augmentation cystoplasty. Pelvic floor muscle training is one of the most common physical therapies used with women for the treatment of urinary incontinence. Pelvic floor muscle training involves repetitive, selective voluntary contraction and relaxation of the pelvic floor muscles. The aim of treatment is to improve both the strength and the coordination of these muscles, which are important in supporting the structures of the pelvis and promoting continence. Bladder training is most commonly used to treat urge urinary incontinence. The main aim for bladder training is to increase the time interval between voids. Bladder training involves the patient being encouraged to resist the urge to void for a period of time, gradually increasing the time interval between voids, and can take several weeks or months to be effective. Bladder training requires a large amount of motivation, therefore, it may prove to be difficult for some patients and will require a large amount of support from family, friends and healthcare professionals. A toileting routine should be determined by the carer, based either on the schedule of the care provider or on the pattern of voiding of the individual patient. The aim for this method is to avoid incontinence episodes by taking the patient to the toilet in the hope that they will use it, rather than to promote continence.

Urinary incontinence and associated symptoms can sometimes be cured and can almost always be better managed. Many patients who experience episodes of urinary incontinence will resort to using some sort of product for containment to protect their clothes or dignity and there are a number of different products to choose from. These products may be used in the short term, while the incontinence is treated using another intervention, or in the long term; they may be worn day and night or only occasionally, for example, when going out. It is important, therefore, that healthcare professionals are aware of the products available and able to support their patients in choosing the most appropriate products to meet their needs. With healthcare professionals being away of the products and the different methods that can be used to treat urinary incontinence, it allows for the patients who may be struggling to feel that they will be able to overcome the consequence that comes with MS that is incontinence.

In conclusion, MS is a neurological disease that can result in a patient becoming incontinent. This essay discusses the different methods and approaches to caring for patients dealing with the consequence of incontinence and how to further manage it. Through research it was evident that there were multiple different approaches to caring for a patient who is suffering with the consequence of being incontinent, the most common approaches being pelvic floor muscle training for women, bladder training, altering medications and intermittent self-catheterisation for those who are able. In many cases incontinence is able to be better managed by the help of healthcare professionals and by the help of products that are there to support struggling patients. Throughout this essay it is evident that if incontinence is poorly managed, or not managed at all that is can impact on a patients quality of life negatively, causing patients to sometimes become isolated and being afraid to go out in public on their own in fear of not being able to manage. This essay highlights the importance of caring for each patient as an individual in their journey through MS and how to help better manage the consequence that is incontinence.