CAM and bladder issues.

CAM stands for Complementary and Alternative Medicine, a group of diverse therapies and products that are neither part of conventional medicine as taught in U.S. medical schools, nor generally available at U.S. hospitals. The practice of using an unconventional therapy together with conventional medicine is called "complementary medicine."

In response to interest from readers, we're launching eyeonCAM to explore available evidence and to bring some clarity to a growing and often confusing field.

The authors, Dr. Allen C. Bowling, neurologist, and Tom Stewart, certified physician assistant, are both at the Rocky Mountain MS Center in Englewood, Colorado, which emphasizes a multi-faceted approach to MS care. For information about CAM and MS, go to www.ms-cam.org.

Urinary problems affect about 80% of people with MS. People managing these problems, including people with MS, often try CAM strategies, such as dietary supplements, acupuncture, and biofeedback. What does the evidence say?

You've got that burning feeling

One of the best-studied dietary supplements for the prevention of urinary tract infections (UTIs) is cranberry. Compounds in cranberry appear to interfere with the ability of some bacteria to stick to the lining of the urinary tract. In studies of people with healthy bladders, cranberry may be effective in preventing UTIs.

Unfortunately, for people with the kinds of bladder problems that can occur in MS, such as emptying dysfunction, cranberry does not appear to be effective. If you want to try this supplement, you and your health-care provider will have to assess how well it might work for your situation.

To treat an active UTI, research does not demonstrate that cranberry is effective. The consequences of UTIs can be especially severe for people with MS. Antibiotic medication, prescribed by a physician, is recommended.

How to use cranberry

For UTI prevention, drink the pure juice (not cranberry cocktail juice blends) or take capsules. Cranberry is generally safe and relatively inexpensive. However, cranberry may interfere with blood-thinning medications, such as warfarin (Coumadin), and increase the risk of kidney stones in those with a history of kidney stones.

Not recommended

Two other supplements are sometimes claimed to prevent UTIs: vitamin C and bearberry (uva ursi). There is scant evidence for their effectiveness for UTI prevention. Vitamin C, while safe in reasonable doses, can interfere with testing for blood or sugar in the urine. Bearberry may cause nausea and vomiting, and contains chemicals which may have cancer-causing properties.

Can't hold it in?

An essential first step to managing MS bladder problems is to have a thorough evaluation and diagnosis by a doctor.

One self-help strategy is to avoid caffeine, a bladder irritant. As a test, try decreasing or eliminating caffeinated products, such as coffee and tea, for a few weeks.

Talk back to your body

Biofeedback may be effective for incontinence caused by weakness in the pelvic floor muscles. However, because incontinence in MS results from brain and spinal cord lesions, it is less clear whether bio-feedback is helpful.

On pins and needles 

Acupuncture is claimed to promote healing by inserting fine needles in specific places on the body. While surveys suggest that some people with MS find acupuncture helpful for bladder symptoms, this has received little systematic study. One small clinical trial involving 41 people with MS found that acupuncture reduced the amount of urine retained in the bladder and decreased urinary urgency. The effect of acupuncture on the immune system is not well understood. Some studies report that it inhibits immune cells and others report that it activates them. If, indeed, acupuncture activates immune cells, this would create theoretical risks for people with MS.

Chinese herbs?

Sometimes Chinese herbs are recommended along with acupuncture. There is significant variability in these preparations. Some may interact with prescription medications. Their safety has not been extensively studied. Until more information is available, these herbs should probably be avoided by people with MS.

It's important to tell your physician about any supplements or complementary treatments you are considering or taking. It's equally important that your physician listen respectfully to your questions and concerns regarding CAM.

BY ALLEN C. BOWLING, MD, PHD, AND TOM STEWART, JD, PA-C