Treatment of Multiple System Atrophy with Urinary Incontinence and Overactive Bladder Symptoms
Autonomic bladder dysfunction is a recognised feature of Multiple System Atrophy. When patients present with overactive bladder symptoms — urinary frequency, urinary urgency, and urinary urge incontinence — a targeted pharmacological approach is warranted, one that accounts for the underlying autonomic instability of MSA.
Clinical Scenario
This protocol applies to Multiple System Atrophy in the presence of overactive bladder (OAB) symptoms: urinary frequency, urinary urgency, and urinary urge incontinence. The coexistence of these symptoms with MSA's broader autonomic dysregulation directly shapes which agents are appropriate and what adverse effects require monitoring.
Treatment Approach — Partial Overview
Management focuses on selective receptor-targeting pharmacotherapy aimed at reducing detrusor overactivity. Available agents act through distinct receptor pathways — adrenergic and muscarinic — each with a different side-effect profile that is particularly relevant given MSA's autonomic background. The choice between options depends on the patient's specific autonomic features and tolerability.
When nocturia is a concurrent concern, additional pharmacological options exist within the overall management plan.
References
DOI: 10.1212/cont.0000000000001598
- Overactive bladder symptoms of urinary frequency, urgency, and urge incontinence can be managed by using selective β3-adrenergic receptors (such as mirabegron 25 mg 1 time a day titrating to 50 mg 1 time a day if needed or vibegron 75 mg 1 time a day), which have no anticholinergic side effects but may cause hypertension, abdominal pain, and urinary retention.
- Overactive bladder can also be managed with selective antimuscarinic type 3 receptor agents (such as solifenacin and darifenacin), which could aggravate urinary retention and constipation and cause xerophthalmia and xerostomia but are less likely to cause cognitive impairment because they have minimal central nervous system penetrance compared with other nonselective drugs such as oxybutynin and tolterodine.
- Intranasal desmopressin can decrease nocturia but can also cause hyponatremia.