Ditropan and retention

  I was diagnosed with MS 9 years ago, and have had mild problems with urinary urgency for the past 3-4 years. This past December my urologist prescribed Ditropan (2.5 mg 3x/day)for me because the urgency had progessed to the point that I wasn't always making it to the toilet in time. He was a little concerned about prescribing it because I also have about 5-6 ounces retention, and he said the Ditropan can make that worse. I always have a self-cath kit readily available, at his suggestion, but have not had to use it. Fortunately, my retention has remained at 5-6 ounces. However, I have noticed that in the past few weeks I have been having increasing problems with urgency once again. I have an appointment to see my urologist in a couple weeks, but in the meantime I am trying to find the answer to a couple of questions:  (1)assuming that I have to keep increasing the doseage of Ditropan to control the urgency, how will this effect my retention, i.e. is it probably inevitable that I will eventually need to do intermittent self-cath? (2)are there any new drugs available that are as effective as Ditropan in reducing urgency, but that don't cause retention?  Thank you very much for your time and consideration.
  Sincerely,
  Susan
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Dear Susan,
Multiple sclerosis, MS, affects the bladder in different ways.  The majority of patients have detrusor hypereflexia (overactive bladders i.e. urgency).  However, some patients have bladders that do not contract and empty well.  You may have a combination of these components.  Anytime the bladder is affected by a neurologic problem the patient and urologist is concerned about urinary incontinence, infections , and kidney failure.  A combination of anticholinergic medications that relax the bladder (such as ditropan) and intermittant catheterization that helps empty the bladder may be appropriate.  Your urologist may want to perform urodynamic studies to sort this out.
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