Anticholinergics ineffective for urinary symptoms in multiple sclerosis

Clinical question: 
How effective are anticholinergic agents for urinary symptoms in people with multiple sclerosis (MS)?
Bottom line: 
In 1 trial, methantheline bromide, flavoxate chloride and meladrazine tartrate were compared to no treatment for 14 days each. Median volume measurements at the first bladder contraction were statistically significant at a 5% level for methantheline bromide only compared to no treatment. A prospective parallel group randomised study compared 6-8 weeks oxybutynin with propantheline. For frequency, nocturia, urgency and urge incontinence, differences in symptom grade in favour of oxybutynin were found. However, the difference was statistically significant at a 5% level for frequency only. A double-blind crossover trial comparing oral oxybutynin with intravesical atropine for 14 days showed no significant difference in any efficacy outcome measure. Side effects and quality of life scores showed significant differences in favour of atropine. The authors concluded that they could not advocate the use of anticholinergics in MS.
Caveat: 
There was a high rate of adverse side effects, with more than 1 in 5 trial participants having to withdraw from oral treatment. This may reflect a high risk of drug adverse effects in people with CNS damage from MS.
Context: 
MS is the commonest physically disabling chronic neurological disease affecting young people. Urinary symptoms (frequency, urgency and urinary incontinence) are present in about 68% of people with MS but their basis has a number of potential aetiologies that can change with time. Anticholinergics may benefit individuals with overactive bladder syndrome due to their muscle relaxant action, and have therefore been used in patients with MS.
Review CD#: 
CD004193
PEARLS No: 
155
Date: 
April, 2009
Authored by: 
Brian R McAvoy