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MS research update - How common is using a catheter among people with MS? - 07 October 2013

Summary

This study looked at how common it was for someone with MS to use a catheter. Out of 9,676 participants, just over one in ten (11%) people reported using a catheter at the time of the survey and another one in seven (15%) had used a catheter in the past bring the total to one in four (26%) who had used a catheter at some time.

Some people had used more than one type of catheter. Amongst catheter users, four out of five (81%) had used intermittent self-catheterisation (ISC), two out of five (43%) had used an indwelling urinary catheter and about one in twelve (8%) had used a suprapubic catheter.

A third (32%) of men but only a quarter of women (24%) used a catheter and men were more likely to use indwelling methods than women.

People with MS who used a catheter had, in general, been diagnosed for longer, experienced more physical disability, more overactive bladder symptoms and a lower quality of life.

Background

Bladder symptoms are common in MS. Different kinds of problems occur depending on where in the spinal cord or brain has been affected by the MS lesions. The bladder difficulties can be:

  • urgency - a desperate urge to go to the toilet with little or no warning
  • frequency - needing the toilet more than eight times a day
  • hesitancy - difficulty in emptying the bladder
  • retention - a feeling of incomplete bladder emptying

Many people experience a combination of these.

There has been considerable research into bladder symptoms and, as a result, many problems can now be managed well. Depending on the nature of the problem, treatment can involve medication, bladder retraining, using a catheter or finding ways to control the impact on day to day life.

This research looked at how common it was for someone with MS to use a catheter. They come in three types.

Firstly, intermittent self-catheterisation (ISC), also known as short-term catheterisation, which is when you insert a thin tube into the bladder through the urethra, the tube that connects the bladder to the outside of the body. Urine is drawn off through the tube and then the catheter is removed. It is called 'intermittent' because the catheter is not permanently in place and "self" because the person usually does the process themselves. ISC normally takes place several times a day using disposable catheters.

There are two kinds of long term catheter: indwelling urinary catheters and suprapubic catheters. Indwelling urinary catheters are inserted into the bladder through the urethra but they have an inflatable balloon at the bladder end which keeps the catheter in the correct position. The outside end of the catheter is attached to a collection bag worn on the leg or may have a valve so that urine can be emptied straight into the toilet periodically.

Suprapubic catheters may be used if a long-term catheter is needed as a permanent solution to bladder problems. A suprapubic catheter is a tube that is passed through the abdominal wall directly into the bladder, bypassing the urethra. This insertion is a surgical procedure. The collection of urine is the same as for an indwelling catheter.

More information about catheters is available at the bottom of this page.

How this study was carried out

The responses of 9,676 people with MS on the NARCOMS (North American Research Committee on Multiple Sclerosis) registry in 2005 were analysed. Participants had completed questionnaires about bladder problems and physical disability, including the Urogenital Distress Inventory (UDI-6), the Short Form-12 (SF-12), the Patient Determined Disease Steps measure of physical disability, as well as giving a history of any bladder symptoms.

What was found

Three quarters (75%) of the study participants were women, almost all (93%) were ethnically white and it was an average of 30 years since they had been diagnosed with MS.

Just over one in ten (11%) people reported using a catheter at the time of the survey and another one in seven (15%) had used a catheter in the past bring the total to one in four (26%) who had used a catheter at some time.

Amongst catheter users, four out of five (81%) had used intermittent self-catheterisation (ISC), two out of five (43%) had used an indwelling urinary catheter and about one in twelve (8%) had used a suprapubic catheter. Some people had used more than one type of catheter.

A third (32%) of men but only a quarter of women (24%) had used a catheter and men were more likely to use indwelling methods than women.

People with MS who used a catheter had, in general, been diagnosed for longer, experienced more physical disability, more overactive bladder symptoms and a lower quality of life.

What does it mean?

The authors conclude that this is the first study to show quite high (one in four) rates of catheter use in people with MS.

Mahajan ST, Frasure HE, Marrie RA.
The prevalence of urinary catheterization in women and men with multiple sclerosis..
J Spinal Cord Med. 2013 Apr 12. [Epub ahead of print]
abstract

More about bladder problems

Bladder problems can occur in the general population as a result of stress, childbirth, enlarged prostate (in men) and age. In addition, they can arise through acquired conditions including cerebral palsy, head injury, stroke and MS.

Bladder symptoms can be managed by a nurse or a specialist continence advisor. Depending on the nature of the problem, treatment can involve medication, bladder retraining including pelvic floor exercises, catheterisation or finding ways to control the effect of the symptom on day to day life such as reviewing fluid intake.

NICE has issued guidance on the management of urinary incontinence in people with neurological disease including MS. This makes recommendations on the assessment and most appropriate management techniques for the different kinds of bladder symptoms in MS.

If you have bladder symptoms you might like to read our book Managing your bladder for further information. Your MS nurse or GP may refer you to continence services for assessment.

NHS Choices has a range of information on relevant topics including urinary incontinence, catheters, a bladder self assessment questionnaire which can help you decide whether to seek professional advice, and pelvic floor exercises. Although not specific to MS, they may be helpful in providing general information.

There are other forms of support available including the National Key Scheme (previously administered by RADAR) that gives people with a disability access to many locked public toilets around the country.

The Bladder and Bowel Community is a charity which provides information and support for all types of bladder and bowel related problems for individuals, their families, carers and health professionals. They have free resources which have been created to help men and women who are concerned that they may have a bladder problem. They provide detailed information on different bladder control problems, as well as lifestyle tips, advice on speaking to your doctor, a 'Setting Goals' table and 'Bladder Diary' to fill in yourself.

The Bladder and Bowel Community have a confidential helpline staffed by health professionals. You can call them on 01926 357220. They also have a "Just can't wait" card that you can carry with you. It explains that the holder has a medical condition and needs to use the toilet quickly.

Bladder and bowel symptoms can be embarrassing and difficult to talk about and they may affect everyday life. This can make people reluctant to leave home unless they know that toilets will be available. However, good treatments are available so it can be worth exploring options with your health professionals.

Research by topic areas...

Disease modifying treatments

Oh J, Calabresi PA.
Emerging injectable therapies for multiple sclerosis.
Lancet Neurol. 2013 Sep 30. [Epub ahead of print]
abstract

Other treatments

Jawahar R, Oh U, Yang S, et al.
A systematic review of pharmacological pain management in multiple sclerosis.
Drugs. 2013 Oct 2. [Epub ahead of print]
abstract

Zecca C, Di Gesù GA, Robshaw P, et al.
Maintenance percutaneous posterior nerve stimulation for refractory lower urinary tract symptoms in patients with multiple sclerosis.
J Urol. 2013 Sep 24. [Epub ahead of print]
abstract

Quality of life

Reese JP, Wienemann G, John A, et al.
Preference-based Health status in a German outpatient cohort with multiple sclerosis.
Health Qual Life Outcomes. 2013 Oct 3;11(1):162. [Epub ahead of print]
abstract
Read the full text of this paper

Tepavcevic DK, Pekmezovic T, Stojsavljevic N, et al.
Change in quality of life and predictors of change among patients with multiple sclerosis: a prospective cohort study.
Qual Life Res. 2013 Oct 1. [Epub ahead of print]
abstract

Kohn CG, Baker WL, Sidovar MF, et al.
Walking speed and health-related quality of life in multiple sclerosis.
Patient. 2013 Sep 28. [Epub ahead of print]
abstract

Chen K, Fan Y, Hu R, et al.
Impact of depression, fatigue and disability on quality of life in Chinese patients with multiple sclerosis.
Stress Health. 2013 Apr;29(2):108-12.
abstract

Vitamin D

Koven NS, Cadden MH, Murali S, et al.
Vitamin D and long-term memory in multiple sclerosis.
Cogn Behav Neurol. 2013 Sep;26(3):155-60.
abstract

Genetics

Ratzer R, Søndergaard H, Christensen JR, et al.
Gene expression analysis of relapsing-remitting, primary progressive and secondary progressive multiple sclerosis.
Mult Scler. 2013 Oct 1. [Epub ahead of print]
abstract

International Multiple Sclerosis Genetics Consortium (IMSGC), Beecham AH, Patsopoulos NA, et al.
Analysis of immune-related loci identifies 48 new susceptibility variants for multiple sclerosis.
Nat Genet. 2013 Sep 29. [Epub ahead of print]
abstract

Prognosis

Cobo Calvo A, Mañé Martínez MA, Alentorn-Palau A, et al.
Idiopathic acute transverse myelitis: outcome and conversion to multiple sclerosis in a large series.
BMC Neurol. 2013 Oct 3;13(1):135. [Epub ahead of print]
abstract
Read the full text of this paper

Provision of care

Ytterberg C, Lundqvist S, Johansson S.
Use of health services in people with multiple sclerosis with and without depressive symptoms: a two-year prospective study.
BMC Health Serv Res. 2013 Sep 28;13(1):365. [Epub ahead of print]
abstract
Read the full text of this paper

Falls

Wajda DA, Motl RW, Sosnoff JJ.
Dual task cost of walking is related to fall risk in persons with multiple sclerosis.
J Neurol Sci. 2013 Sep 20. [Epub ahead of print]
abstract

Work

Shahrbanian S, Auais M, Duquette P, et al.
Does pain in individuals with multiple sclerosis affect employment? A systematic review and meta-analysis.
Pain Res Manag. 2013 September/October;18(5):e94-e100.
abstract

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