b'There are many options when it comes to that are available (anticholinergics and beta 3managing these symptoms. Treatment options agonists), and have shown to improve overallwill range from conservative management to quality of life in patients with MS. These actsurgery depending on the nature and severity ontwodifferentreceptorsinthebladderof the symptoms.(detrusor) muscle, and relax the bladder. ThisPhysical therapy allows the bladder to hold more urine andhence, improve frequent urination andConservative management (pelvic oor urinary leakage.physical therapy) is the rst-line treatment in These medications can have side eects regainingcontrolofoveractivebladder including dry mouth, dry eyes, constipation,symptoms. A specially trained physical and headaches. Some of these medicationstherapist will assess the muscles of the pelvic may be a better choice than others for patientsoor, which are responsible for supporting with memory loss, especially in advancedthe bladder and promoting continence. By stagesof the disease. It is important that patientsincreasing strength and control of these muscles, with MS discuss their medical problems patients with MS can learn how to hold their such as memory loss, glaucoma, high bloodurine for longer periods as well as being able pressure, and heart diseasewith their medicalto make it to the bathroom without leaking. provider in order to choose an appropriatePelvic oor physical therapy has been shown medication. Let your medical provider knowto help improve frequent urination and urine how the medications are working for you asleakage with urgency. The physical therapist you may have to try dierent medicationsmayusedifferenttechniquessuchas before nding one that works for you. biofeedback and/or electrical stimulation to Other treatment optionshelp patients gain awareness and control oftheir pelvic oor muscles by identifying the Other eective treatment options that arecorrect muscles to either contract or relax.available for bladder control (overactive bladder)In PFPT, patients are educated on reducing are bladder Botox injections, and nervedietary bladder irritants, limiting environmental stimulation. Bladder Botox injections helpchemical exposure and proper uid manage- relax the bladder muscle and allows the bladderment in order to improve urinary symptoms. to store more urine. A medical provider willMany foods and drinks we consume including: perform a procedure called cystoscopy (placingcoee, tea, citrus fruits or juices, spicy foods, a special camera in the bladder) and injectBotox on multiple areas inside the bladder.tomato-based foods, alcohol and chocolateMost patients need the injection to be repeatedcan irritate the bladder and contribute to once or twice a year. A small number offrequent urination and urinary leakage.patients may experience urinary tract infectionOften, a multimodal approach is used when or diculty emptying their bladder. Patientsmanagingbladdersymptomsforpatients shoulddiscusstheprocedureindetailwith MS. If the initial treatment options are with their medical provider to see if Botoxineective, second-line treatment options for is a treatment option for them. overactive bladder, such as medications, can be Nerve stimulation can be done in two ways:utilized. There are two types of medications posterior tibial nerve stimulation or sacral nerve9 msfocusmagazine.org'