Faculty Bibliography

Objective: To identify barriers multiple sclerosis (MS) patients experience in seeking evaluation for urinary symptoms and its relationship to the Actionable Bladder Symptom and Screening Tool (ABSST). Background: The ABSST is used to identify urinary symptoms in patients with MS and may identify patients in need of referral and evaluation for neurogenic overactive bladder symptoms (NDO). Although up to 80% of MS patients may experience urinary symptoms, evaluation by a specialist and treatment are under-utilized in this population. Methods: This was a prospective observational study. 100 patients with MS, but currently not seeing a genitourinary specialist were enrolled from an MS comprehensive center with a Female Pelvic Medicine and Reconstructive Surgery (FPMRS) physician on staff. Patients completed demographic information, a short form of the ABSST and questions to assess barriers to seeking a specialist for bladder problems. An ABSST score >3 met criteria for referral and evaluation. In addition they were asked a single item question about their desire to be evaluated by a specialist for bladder problems. Two-month after enrollment, follow up calls assessed whether patients had seen a specialist to assess their urinary complaints. X² tests were used to compare categorical variables. Results: Of the 100 patients, there were 79 women and 21 men, mean age was 44.5 years and average time since diagnosis of MS was 10.4 years. Ethnicities included 45% Caucasian, 21% African American, 21% Hispanic, 2% Asian, and 11% Other/Multiracial. Overall, 40% of patients indicated that they would want to see a specialist to evaluate their bladder symptoms and 33% of patients had already seen one in the past. Most frequent reasons for seeking prior care were incontinence (46%) and recurrent UTIs (24%). Overall, the most common barriers to seeking care included "Doctor never referred" (18%), "Doctor never asked" (15%), "Had enough problems to deal with" (15%), "Thought there were no treatments available" (12.5%) and "Felt embarrassed" (10%). 40% of men stated "Doctor had never referred or asked" compared to 10% of women (p=0.002). 27 patients had an ABSST Score>3 and were more interested in seeing a specialist compared to those scoring <3 (91% vs. 40%; p= .000). When compared to patients with an ABSST<3, those with an ABSST>3 had a significant difference in level of education (p<0.05), type of mobility used (p<0.05), and employment status (p=0.005). Patients with an ABSST >3 cited limitations associated with insurance, cost, transportation, or inaccessibility more often than those with an ABSST <3 (9% vs. 3%, p=0.009). After 2 months, 49 patients were reached for follow up. Despite persistent or worsening urinary symptoms in some patients, only 1 participant had followed up. Conclusions: The ABSST is a valuable tool to identify MS patients with urinary symptoms and willingness to seek evaluation. Identification of this need alone unfortunately did not result in a significant increase in evaluation, despite ongoing symptoms. This underscores that other barriers, beyond awareness such as communication, costs and logistics, play a tremendous role preventing patients getting the evaluation that is needed. Further work is required to elucidate these factors

Limited information is available regarding alcohol abuse in people with multiple sclerosis (MS). Tools are available to assist clinicians in screening and intervention for alcoholism. Though the literature does not convincingly support that patients with MS are at a significantly increased risk for developing alcohol abuse, it may complicate symptoms or aggravate their underlying neurologic disease. This case study provides an example of an individual with MS whose condition is complicated by alcohol abuse. Further research may validate assessment tools in this population and examine the physiologic, psychologic, and neuro-immune implications of alcohol abuse on patients with MS.