Sphincter and bladder dysfonction

Symptomatic bladder dysfunction occurs at some time in most patients with m ultiple sclerosis. Detrusor hypereflexia and sphincter dyssynergia are the main dysfunctions. Anticholinergic medication is currently the most effecti ve and the most common treatment of overactive bladder with reduced bladder capacity and uninhibited detrusor contractions. Desmopressin, surgery, per manent indwelling catheter or external device are used in some cases. Never theless essential to bladder management is understanding to what extent the patient has incomplete emptying while complaining predominantly of symptom s of detrusor overactivity: frequency and urgency, with or without urge inc ontinence. Intravesical capsaicin and botulinum toxin injected into the det rusor seems promising means of treating intractable bladder hyperreflexia. If the post-micturition residual volume is raised, intermittent self-cathet erization is the most adequate method to achieve bladder emptying of patien ts with MS. Physical and cognitive disability as well as patients motivatio n can reduce their ability to perform catheterization. In such situation, a lphablockers show moderate efficacy and botulinum toxin urethral sphincter injection or surgical solution may be discussed. Disturbed anorectal physio logy is common in MS, but there are as yet few specific treatments. The eff icacy of oral sildenafil for treatment of neurogenic erectile failure incre ases the range of treatment available for men with sexual dysfunction. in w omen, mechanical remedies, treatment of motor and sensory loss are effectiv e for dyspareunia. Patients of both sexes are likely to welcome to discuss their problem, and counselling or psychotherapy may be of use.