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Bladder symptoms in multiple sclerosis: a review of pathophysiology and management

Importance of the field: The use of anticholinergic medication in bladder dysfunction such as overactive bladder syndrome (OAB) is widespread. However, the benefits and risks of anticholinergics in multiple sclerosis (MS) are unclear because in MS the damage to normal urinary function is both more diffuse and increases with disease progression, and the risk of CNS side effects is higher. Areas covered in this review: The pathophysiology of urinary dysfunction in MS and the efficacy and side effects of anticholinergics is assessed. The review analyzed randomized controlled trials and observational studies using anticholinergics involving persons with a confirmed diagnosis of MS having urinary symptoms. Finally a pragmatic approach to managing urinary symptoms in MS is discussed. What the reader will gain: The published data provide limited evidence for the efficacy of anticholinergics in MS. The complexity of treating urinary symptoms in the context of other therapies and the changing neurological background seen in MS is comprehensively analyzed. Take home message: Anticholinergics could be helpful in particular phases of MS. However, there is inadequate evidence currently available on the use of anticholinergics in MS, and further research on the management of the MS neuropathic bladder is warranted.