American Board of Internal Medicine (ABIM) Certification Practice Exam

What non-pharmacologic approach is suggested for urinary retention in multiple sclerosis?

1. Timed voids and caffeine reduction

2. Cognitive behavioral therapy

3. Manual pelvic pressure and intermittent catheterization

4. Occupational therapy and stretching exercises

The correct answer is: Manual pelvic pressure and intermittent catheterization

The non-pharmacologic approach suggested for managing urinary retention in multiple sclerosis involves manual pelvic pressure and intermittent catheterization. This method is effective in addressing urinary retention, which is a common issue in patients with multiple sclerosis due to neurological impairments that affect bladder control. Manual pelvic pressure can help stimulate bladder contractions and promote urination. By applying pressure to the bladder area, patients may be able to initiate urination more effectively. Intermittent catheterization serves as a practical solution for those who may not be able to empty their bladder fully due to muscle weakness or spasticity associated with multiple sclerosis. This approach allows for regular drainage of urine, reducing the risk of complications like urinary tract infections, bladder distension, and associated discomfort. In contrast to this, timed voids and caffeine reduction, while helpful in managing urinary frequency or urgency, are less effective for retention specifically. Cognitive behavioral therapy, while beneficial for other aspects of mental health, does not directly address the physiological issues causing urinary retention. Occupational therapy and stretching exercises might improve functional abilities and mobility, but they do not specifically target the urinary retention issue. Thus, manual pelvic pressure combined with intermittent catheterization is the most appropriate choice for managing urinary retention in this context.