Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 6834 msfocusmagazine.org options, including: • Acupuncture • Botox injections • Tibial nerve stimulation • Pelvic floor muscle training • Medical marijuana Botox injections can improve urodynamic function; however, it is important to note that a side effect of Botox injection may include urinary retention. Botox injections can be repeated every three to four months if it is successful in managing urinary incontinence. Tibial nerve stimulation involves the insertion of an electrode needle into the lower leg. Then, electrical signals are sent up through the leg. The procedure is often done once a week for 12 weeks, and has proven to be an effective alternate to medications. Pelvic floormuscle training involves doing exercises that will strengthen the muscles that support your bladder and urinary tract. Kegel exercises are the most common form of training and can be done discreetly at any time. Studies suggest that cannabis mayalleviate lower urinary tract symptoms. This treatment may help decrease urinary urgency, number of incontinence occurrences, and incidents of nocturia, when you wake up from sleep with an urgency to urinate. Other options If these treatments do not show improve- ment in incontinence symptoms, others are available, but are not often recommended until all other options have been exhausted. There are several, partially invasive nerve stimulation therapies available. Intravaginal neuromuscular electrical stimulation, which involves placement of an electrode on or into the vagina, may strengthen vaginal muscle by electrical stimulation to allow greater con- trol of the vaginal wall and improve urinary incontinence. Sacral neuro modification (known as InterStim® therapy) sends electrical stimulation through the bladder nerves, which can improve bladder hyperactivity and urinary leakage. However, with these procedures, a neurologist will not be able to monitor MS progress with MRIs because of metal implants in the body. Clean self-intermittent catheterization (known as CIC) can be performed for urinary retention bythe patient, if they retain dexterity in their arms, or by their caregiver after propertraining.Catheterization involves inserting a tube into the urethra for the purpose of drainingurinefromthebladder. Several surgical options also exist. A urethral sling can be surgically implanted to assist with CIC. Suprapubic cystotomy with closure of the urethra to drain urine from the bladder is also a surgical option to explore. Augmentation cystoplasty is a procedure designed to increase bladder capacity in patientswith small bladdercapacitysecondary to MS. Permanent urinary diversion is a surgical procedure (called ileal loop) to control urinaryincontinenceandprotectrenalfunction that may be considered for last stages of urinary issues in patients with end stage bladder disease secondary to MS. Ileal loop “Finding a suitable treatment option is important, because urinary incontinence can lead to several serious conditions in addition to the discomfort and embarrassment you may experience.” Symptom Management