Skip to main content

Advertisement

SpringerLink
Log in

The effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicentre, randomised placebo-controlled trial (CAMS-LUTS)

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Objective: To test whether cannabinoids reduce urge incontinence episodes without affecting voiding in patients with multiple sclerosis. This was part of the multicentre trial of the Cannabinoids in Multiple Sclerosis (CAMS) study. Subjects and methods: The CAMS study randomised 630 patients to receive oral administration of cannabis extract, Δ9-tetrahydrocannabinol (THC) or matched placebo. For this substudy subjects completed incontinence diaries. Results: All three groups showed a significant reduction, p<0.01, in adjusted episode rate (i.e. correcting for baseline imbalance) from baseline to the end of treatment: cannabis extract, 38%; THC, 33%; and placebo, 18%. Both active treatments showed significant effects over placebo (cannabis extract, p=0.005; THC, p=0.039). Conclusion: The findings are suggestive of a clinical effect of cannabis on incontinence episodes in patients with MS. This is in contrast to the negative finding of the CAMS study, where no difference was seen in the primary outcome of spasticity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Betts CD, Dmellow MT, Fowler CJ (1993) Urinary symptoms and the neurological features of bladder dysfunction in multiple-sclerosis. J Neurol Neurosurg Psychiatry 56(3):245–250

    PubMed  CAS  Google Scholar 

  2. Goldstein I, Siroky MB, Sax DS, Krane RJ (1982) Neurourologic abnormalities in multiple-sclerosis. J Urol 128(3):541–545

    PubMed  CAS  Google Scholar 

  3. Hinson JL, Boone TB (1996) Urodynamics and multiple sclerosis. Urol Clin North Am 23(3):475

    Article  PubMed  CAS  Google Scholar 

  4. Sliwa JA, Bell HK, Mason KD, Gore RM, Nanninga J, Cohen B (1996) Upper urinary tract abnormalities in multiple sclerosis patients with urinary symptoms. Arch Phys Med Rehabil 77(3):247–251

    Article  PubMed  CAS  Google Scholar 

  5. Nathan PW, Smith NC (1982) The centrifugal pathway for micturition with the spinal cord. J Neurol Neurosurg Psychiatry 21:177

    Article  Google Scholar 

  6. Chancellor MB, Blaivas JG (1994) Urological and sexual problems in multiple-sclerosis. Clin Neurosci 2(3–4):189–195

    PubMed  CAS  Google Scholar 

  7. Gonor SE, Carroll DJ, Metcalfe JB (1985) Vesical dysfunction in multiple-sclerosis. Urology 25(4):429–431

    Article  PubMed  CAS  Google Scholar 

  8. Madersbacher H, Wyndaele JJ, Igawa Y, Chancellor M, Chartier-Kastler E, Kovindha A (2002) Conservative management in neuropathic urinary incontinence. In: Abrams P et al (eds) Incontinence: 2nd international consultation on incontinence, Health Publication Ltd., Plymouth, pp 697–754

    Google Scholar 

  9. De Ridder D, Baert L (2000) Vanilloids and the overactive bladder. BJU Int 86(2):172–180

    Article  PubMed  Google Scholar 

  10. de Seze M, Wiart L, Ferriere JM, de Seze MP, Joseph PA, Barat M (1999) Intravesical instillation of capsaicin in urology: a review of the literature. Eur Urol 36(4):267–277

    Article  PubMed  Google Scholar 

  11. Rapp DE, Lucioni A, Katz EE, O’Connor RC, Gerber GS, Bales GT (2004) Use of botulinum-a toxin for the treatment of refractory overactive bladder symptoms: an initial experience. Urology 63:1071–1075

    Article  PubMed  Google Scholar 

  12. Litwiller SE, Frohman EM, Zimmern PE (1999) Multiple sclerosis and the urologist. J Urol 161(3):743–757

    Article  PubMed  CAS  Google Scholar 

  13. Burton TA (1979) Urinary retention following cannabis ingestion. JAMA 242(4):351

    Article  PubMed  CAS  Google Scholar 

  14. Consroe P, Musty R, Rein J, Tillery W, Pertwee R (1997) The perceived effects of smoked cannabis on patients with multiple sclerosis. Eur Neurol 38(1):44–48

    PubMed  CAS  Google Scholar 

  15. Brady CM, DasGupta R, Wiseman OJ, Dalton CM, Berkley KJ, Fowler CJ (2002) The effect of cannabis based medicinal extract on lower urinary tract dysfunction in advanced multiple sclerosis: preliminary results. J Neurol Neurosurg Psychiatry 72(1):139

    Google Scholar 

  16. Zajicek J, Fox P, Sanders H, Wright D, Vickery J, Nunn A, Thompson A (2003) Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial. Lancet 362(9395):1517–1526

    Article  PubMed  CAS  Google Scholar 

  17. Groutz A, Blaivas JG, Chaikin DC, Resnick NM, Engleman K, Anzalone D, Bryzinski B, Wein AJ (2000) Noninvasive outcome measures of urinary incontinence and lower urinary tract symptoms: a multicenter study of micturition diary and pad tests. J Urol 164(3):698–701

    Article  PubMed  CAS  Google Scholar 

  18. Kelleher CJ, Cardozo LD, Khullar V, Salvatore S (1997) A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 104(12):1374–1379

    PubMed  CAS  Google Scholar 

  19. Lose G, Fantl JA, Victor A, Walter S, Wells TL, Wyman J, Mattiasson A (1998) Outcome measures for research in adult women with symptoms of lower urinary tract dysfunction. Neurourol Urodyn 17(3):255–262

    Article  PubMed  CAS  Google Scholar 

  20. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A (2002) The standardisation of terminology of lower urinary tract function: report from the of the International Standardisation Sub-Committee Continence Society. Neurourol Urodyn 21(2):167–178

    Article  PubMed  Google Scholar 

  21. Artibani W, Andersen JT, Gajewski JB, Ostergard DR, Raz S, Tubaro A (2002) Imaging and other investigations. in: Abrams P et al (eds) Incontinence: 2nd international consultation on incontinence, Health Publication Ltd., Plymouth, pp 697–754

    Google Scholar 

  22. Goldstein H (1995) Multilevel statistical models, 2nd edn. Arnold, London

    Google Scholar 

  23. Cnaan A, Laird NM, Slasor P (1997) Using the general linear mixed model to analyse unbalanced repeated measures and longitudinal data. Stat Med 16(20):2349–2380

    Article  PubMed  CAS  Google Scholar 

  24. Coyne KS, Matza LS, Thompson CL (2005) The responsiveness of the Overactive Bladder Questionnaire (OAB-q). Qual Life Res 14:849–855

    Article  PubMed  Google Scholar 

  25. Greenland JE, Brading A (1995) The in-vitro effect of delta-9 tetrahydrocannabinol on the detrusor smooth muscle of the pig. Proceedings of the International Continence Society, Sydney, pp 87–88

  26. Ost D, Van der Aa F, De Ridder D (2001) Immunohistochemical study of the cannabinoid receptors CB1 and CB2 in the human bladder. Mult Scler 7(1):S24

    Google Scholar 

  27. Pertwee RG, Fernando SR (1996) Evidence for the presence of cannabinoid CB1 receptors in mouse urinary bladder. Br J Pharmacol 118(8):2053–2058

    PubMed  CAS  Google Scholar 

  28. Blyweert W, Van der Aa F, De Ridder D (2003) Cannabinoid therapy in detrusor overactivity: local versus systemic effect in a spinalised rat model. Neurourol Urodyn 22(5):379–380

    Google Scholar 

  29. Schurch B, Hauri D, Rodic B, Curt A, Meyer M, Rossier AB (1996) Botulinum-A toxin as a treatment of detrusor-sphincter dyssynergia: a prospective study in 24 spinal cord injury patients. J Urol 155(3):1023–1029

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This study was funded by a grant from the Multiple Sclerosis Society. The Medical Research Council sponsored the main CAMS study. Solvay Healthcare Ltd. and the Institute for Clinical Research, IKF, Berlin, provided medication. We thank all patients who took part in the study. We acknowledge the assistance of the CAMS study team, particularly Jane Vickery for trial coordination and help with drafting the paper, Wendy Ingram for assistance with figure construction, Hilary Sanders for further statistical support as well as Suzi Reilly, Judy Willcocks, Sue Varley, Mark Warner, Lara Teare, Felicity Coates and Rosemary Bishop (urodynamic nurse).

Author information

Authors and Affiliations

  1. Urogynaecology Unit, Derriford Hospital, Plymouth, Devon, UK

    R. M. Freeman, O. Adekanmi & A. E. Waterfield

  2. Department of Statistics, University of Plymouth, Plymouth, UK

    D. Wright

  3. Peninsula Medical School, Universities of Plymouth and Exeter, Plymouth, UK

    M. R. Waterfield & J. Zajicek

Authors
  1. R. M. Freeman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O. Adekanmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. R. Waterfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. E. Waterfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Wright
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Zajicek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. M. Freeman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Freeman, R.M., Adekanmi, O., Waterfield, M.R. et al. The effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicentre, randomised placebo-controlled trial (CAMS-LUTS). Int Urogynecol J 17, 636–641 (2006). https://doi.org/10.1007/s00192-006-0086-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-006-0086-x

Keywords

Search

Navigation