Unlikely cosmetic procedure treats 'embarrassing' multiple sclerosis side effect

For the first time at Cleveland Clinic Abu Dhabi, doctors are treating incontinence caused by MS with Botox.

Abu Dhabi, UAE,  April 10, 2018.   Rashed Al Ramsi, he suffers from MS, and has had botox treatment for incontinence.
Victor Besa / The National
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A procedure ordinarily reserved for combatting wrinkles is being used by a hospital in Abu Dhabi to treat side effects associated with multiple sclerosis.

For the first time at Cleveland Clinic Abu Dhabi, doctors are treating incontinence caused by MS with Botox.

One of their first patients, Rashid Al Ramsi, says the procedure has dramatically improved his quality of life.

Mr Al Ramsi has struggled with MS for more than half his life.

The 31-year-old Emirati had the disease diagnosed when he was aged 15 and has since battled with numbness, partial blindness and memory loss. Though his most severe attack came four years ago and resulted in him being unable to control his bladder.

“I would wet myself. It was very embarrassing, especially at work,” he said.

After repeated accidents at work, his employers asked him to begin wearing a diaper to the office.

“It was a very difficult period for him,” said his wife, Ahlam Al Mubarak.


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Mr Al Ramsi was prescribed medication to manage his incontinence in addition to general treatment for the disabling disease, but the medication did little to control his bladder.

“I travelled the world and took every kind of medication but nothing worked and no doctor could help me,” he said.

“I was in constant fear that the diapers would leak and I would wet myself at work in front of my colleagues.”

A few months ago, Mr Al Ramsi found success in the minimally invasive procedure when surgeons at Cleveland Clinic Abu Dhabi injected his bladder with Botox to control his symptoms.

The cosmetic staple is also commonly used as an effective treatment for neurological disorders including stroke, spinal cord injuries, and chronic migraines.

Dr Zaki Almallah, a consultant urologist and physician in the Surgical Subspecialties Institute at Cleveland Clinic Abu Dhabi, said urinary incontinence (UUI), or an overactive bladder is common in MS patients.

“This is a common symptom of MS but can particularly embarrassing and affects the quality of life,” he said.

The problem is compounded by the limited mobility that the majority of MS patients experience. “It is often hard for MS patients to move so with the lack of bladder control, they cannot reach the toilet in time.”

Dr Almallah said he has performed the procedure more than 400 times during his career and now administers Botox on a weekly basis to patients suffering from a wide range of neurological problems that cause bladder incontinence.

The procedure takes around 40 minutes and efficacy can last up to twelve months.

Using a small telescope to look inside the bladder, Botox is injected into the bladder wall to relax the muscle. This enables the patient to store a larger amount of urine and reduces the symptoms of an overactive bladder.

“After the procedure, Rashid is a new man,” his wife said.

“He is confident and no longer wears the diapers. He has complete control now and it is actually me who worries and have insisted that he wear it just in case - especially if he is travelling long distances.”

But Rashid refuses to heed his wife’s warnings, adamant that he no longer must live in fear.

“Thank God, I am finally leading a normal life for the first time in years. There are so many patients with MS and we don’t need to live a life of shame and embarrassment anymore. With the medication and the surgery, we can be like anybody else” he said.

The number of Emiratis in the capital living with multiple sclerosis (MS) is more than twice the global ­average, according to a study published in 2016.

The autoimmune disorder affects 64.44 per 100,000 people in Abu Dhabi, while the World Health Organisation estimated average global prevalence was 30 per 100,000. Low vitamin D levels, smoking and genetic factors may be causes.