American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary mode of treatment for urinary retention in MS patients?

1. Timed voiding

2. Manual pelvic pressure

3. Intermittent catheterization

4. Both B and C

The correct answer is: Both B and C

In patients with multiple sclerosis (MS), urinary retention can be a significant issue due to neurogenic bladder dysfunction. The correct management involves both manual pelvic pressure and intermittent catheterization, as these methods address the underlying causes of urinary retention effectively. Manual pelvic pressure can help stimulate bladder contractions by physically compressing the bladder, thus facilitating urination in patients who have some degree of bladder muscle activity. This approach may be particularly useful in patients who are unable to void due to detrusor sphincter dyssynergia, a common phenomenon in MS where there is a lack of coordination between the bladder and the external sphincter during urination. Intermittent catheterization is essential for managing patients who have severe urinary retention and cannot empty their bladders voluntarily. This method helps prevent urinary complications such as infections, bladder distension, and kidney damage by allowing for regular drainage of urine. It is often the most reliable way to ensure that the bladder is emptied completely in these patients. While timed voiding can be beneficial for some patients in establishing a routine, it may not be sufficient as a stand-alone treatment for those with significant urinary retention related to MS. Therefore, combining manual pelvic pressure and intermittent catheterization provides a comprehensive approach to managing urinary retention