This study included 602 patients with MS. The mean and SD of the age of the participants, duration of MS, age at onset of MS, and disability score were 35.45 ± 9.08 years, 7.63 ± 5.56 years, 26.85 ± 7.81 years, and 2.45 ± 2.11, respectively. According to the EDSS, 432 (71.6%), 151(25.0%), and 20 (3.4%) patients had mild, moderate, and severe disability. In addition, 76.1%, 33.7%, and 37.8% of the patients had a clinical relapsing-remitting period, treatment with beta interferon’s, and comorbid illnesses, respectively. Moreover, 78.6%, 68.8%, 40.5%, and 21.2% of the subjects were women, were married, had university degrees, and were employed, respectively (Table 1).
The prevalence of LUTS was 87.7%, with a similar rate among women (88.2%) and men (85.9%). Furthermore, 18.7% of patients reported experiencing LUTS only in the acute phase and recurrence of the disease. The most commonly reported symptoms among all subjects based on the definitions provided by the International Continence Society (ICS) were nocturnal polyuria (59.3%) and urgency (57.1%) in the storage phase, urinary hesitancy (39.7%) and intermittent urine flow (36.0%) in the emptying phase, and feeling of incomplete emptying in the post-emptying phase (43.2%) (Table 2).
Symptoms with the highest prevalence among women were, respectively, nocturia (61.0%) and urgency (58.0%) in the storage phase, hesitancy (35.7%) and intermittent urine flow (33.8%) in the emptying phase, and feeling of incomplete emptying in the post-emptying phase (42.6%). Among men, symptoms with the highest prevalence included urgency (53.9%) and nocturia (53.1%) in the storage phase, hesitancy (54.7%) and intermittent urine flow (44.5%) in the emptying phase, and feeling of incomplete urine emptying in the post-emptying phase (45.3%). Symptoms of bladder pain and burning sensation while urinating were common among 17.7% and 18.8% of women and men, respectively. The prevalence of SUI symptoms was reported as 33.8% and 17.2% among women and men, respectively, and the chi-square test showed a significant difference between the two groups (P < 0.001). Moreover, this test showed a significant difference between the two groups of men and women in terms of the prevalence of intermittent urine flow, urinary hesitancy, straining, and dribbling (P < 0.050). There was no significant difference between the two groups of men and women in terms of the prevalence of other symptoms (P > 0.050) (Table 2).
The prevalence of the times Intermittent urine stream, frequency, and straining at the onset of urination symptoms was not similar between men and women, and the chi-square test indicated significant differences between the two groups (P < 0.050). However, there was no significant difference between the two groups of men and women in terms of the prevalence of other symptoms (P > 0.050) (Table 3).
The prevalence of mild, moderate, and severe LUTS was 46.3%, 24.5%, and 5.8% in the 18-30 years age group, 44.9%, 33.6%, and 8.1% in the 30-40 years age group, and 37.1%, 40.7%, and 12.2% in the 40-50 years age group, respectively. The chi-square test showed a significant difference between the four groups in this regard (P < 0.001). Furthermore, the mean age of the patients with mild, moderate, and severe LUTS was 34.50 ± 7.87, 37.51 ± 7.98, and 37.60 ± 8.33 years, respectively, and ANOVA showed a significant difference among LUTS severity groups in terms of age (P ≤ 0.001).
The mean body mass index (BMI) of the patients with mild, moderate, and severe LUTS was 24.22 ± 4.25, 24.31 ± 4.51, and 23.93 ± 4.16 Kg/m2, respectively, and ANOVA showed no significant difference among LUTS severity groups in terms of BMI (P = 0.670). The prevalence of mild, moderate, and severe LUTS was, respectively, 44.3%, 33.8%, and 6.7% among women and 39.1%, 28.9%, and 14.8% among men, and the chi-square test indicated a significant difference between the two groups (P = 0.024). This rate was 40.9%, 29.6%, and 8.7% among single individuals, 45.1%, 33.0%, and 7.4% among married subjects, and 31.6%, 42.1%, and 18.4% among divorced and dead subjects, respectively, and the chi-square test showed significant differences among the three groups (P = 0.051). Furthermore, the mean duration of marriage of the patients with mild, moderate, and severe LUTS was 13.57 ± 8.24, 18.33 ± 8.76, and 15.65 ± 10.01 years, respectively, and ANOVA showed a significant difference among LUTS severity groups in terms of mean duration of marriage (P < 0.001). The prevalence of mild, moderate, and severe LUTS was, respectively, 32.4%, 48.3%, and 11.0% in the group with secondary school degree or lower, 51.5%, 28.0%, and 6.5% in the group with a high school degree, and 42.2%, 27.5%, and 8.6% in the group with a university degree, and the chi-square test showed a significant difference among the three groups (P < 0.001) (Table 4).
The prevalence rate of mild, moderate, and severe LUTS was 49.8%, 26.8%, and 3.9% in the group with duration of illness of < 5 years, 43.2% 33.6%, and 7.1% in the group with duration of illness of 5-10 years, and 33.8%, 40.0%, and 16.8% in the group with duration of illness of > 10 years, respectively. The chi-square test revealed a significant difference among the three groups in this respect (P < 0.001). In addition, this rate was 49.2%, 26.0%, and 5.3% in the group with mild disability, 28.5%, 50.5%, and 14.6% in the group with moderate disability, and 25.0%, 45.0%, and 15.0% in the group with severe disability, respectively, and the chi-square test indicated a significant difference among the three groups (P < 0.001). Finally, the prevalence of mild, moderate, and severe LUTS was 50.0%, 17.9%, and 0.0% in the group with clinically isolated syndrome (CIS), 46.9%, 28.8%, and 7.0% in the group with RRMS, and 26.7%, 51.7%, and 16.4% in the group with a progressive clinical course, respectively, and the chi-square test showed a significant difference among the three groups (P < 0.001).
The mean anxiety score of the patients with mild, moderate, and severe LUTS was 13.70 ± 9.30, 17.25 ± 10.09, and 16.35 ± 8.44, respectively, and ANOVA showed a significant difference among LUTS severity groups in terms of mean anxiety score (P < 0.001) The mean depression score of the patients with mild, moderate, and severe LUTS was 13.28 ± 9.07, 15.34 ± 9.24, and 15.37 ± 8.10, respectively, and ANOVA showed a significant difference among LUTS severity groups in terms of mean depression score (P < 0.001). The mean stress score of patients with mild, moderate, and severe LUTS was 19.63 ± 10.25, 21.97 ± 9.78, and 20.82 ± 8.04, respectively, and ANOVA showed a significant difference Among LUTS severity groups in terms of mean stress score (P < 0.001) (Table 4).
Moreover, variables that showed significant unadjusted associations with urinary problems were age, marital status, marriage duration, educational status, disease duration, EDSS, clinical course of the disease, anxiety, depression, and stress. The final regression model showed that there was a higher probability of a urinary problem among patients with MS and a high EDSS score [0.67(0.507-0.903); P = 0.008] (Table 5).