Treatment Options for Urinary Urgency in Multiple Sclerosis

First-Line Treatment: Behavioral Therapies

The American Urological Association recommends bladder training as the initial treatment for patients with Multiple Sclerosis (MS) experiencing urinary urgency, as it improves urinary symptoms and quality of life 1, 2
Pelvic floor muscle training (PFMT) is particularly effective for MS patients with urinary urgency and has been shown to decrease urine leakage and neurogenic bladder symptoms 1
For patients with mixed urinary symptoms, PFMT combined with bladder training is recommended, as suggested by the American College of Physicians 3, 4

The American College of Physicians recommends antimuscarinic medications (e.g., oxybutynin, tolterodine, darifenacin, solifenacin, fesoterodine, and trospium) for urgency urinary incontinence and have shown efficacy in increasing continence rates 3, 4
When choosing between medications, consider that tolterodine causes fewer adverse effects than oxybutynin with similar efficacy, as recommended by the American College of Physicians 5, 2
Solifenacin has the lowest risk for discontinuation due to adverse effects, according to the American College of Physicians 5
Oxybutynin is associated with the highest risk for discontinuation due to adverse effects, as noted by the American College of Physicians 5

For MS patients with urinary retention in addition to urgency, intermittent catheterization should be recommended rather than indwelling catheters, as suggested by the American Urological Association 1
Intermittent catheterization has lower rates of UTI and urethral trauma compared to indwelling catheters, according to the American Urological Association 1

The American College of Physicians recommends weight loss and exercise for obese patients with urinary urgency 5, 2
Avoiding bladder irritants in diet, such as caffeine and alcohol, can help reduce symptoms, as recommended by the American Urological Association 2
Treatment of constipation is essential as it can exacerbate urinary symptoms, according to the American Gastroenterological Association 2

Failing to identify medications that may cause or worsen urinary incontinence, as noted by the American College of Physicians 2
Overlooking conditions that may cause urinary symptoms, such as urinary tract infections and metabolic disorders, according to the American College of Physicians 2
Underdiagnosing urinary issues, as at least half of women with urinary incontinence do not report the issue to their physicians, as recommended by the American College of Obstetricians and Gynecologists 2