Bladder and urethral pressures during bladder filling in patients with multiple sclerosis and urge incontinence

Twenty patients with multiple sclerosis and distressing urge incontinence underwent continuous measuring of bladder and urethral pressures during bladder filling. Hyperreflexia with high-pressure peaks resulted in more excessive leakage than detrusor instability with frequent recurring pressure rises of low amplitude and short duration. Atropine reduced leakage by decrease of amplitude as well as frequency of the detrusor contractions. In some patients atropine also normalized urethral instability. Thus it seems probable that both hyperreflexia and instability in patients with multiple sclerosis are mediated by cholinergic neurones in the bladder wall.