Transverse Myelitis

Management of Transverse Myelitis.

Sometimes transverse myelitis requires no treatment as it will improve on its own. Sometimes patients may require treatment for their symptoms, the swelling, or the underlying cause.

Symptomatic Treatment.

There are different treatments available for transverse myelitis symptoms.

Muscle weakness

• Physiotherapy can help improve strength, and the muscle spasms and stiffness that may sometimes develop
• Techniques such as stretching exercises can help if your movement is restricted.
• If your muscle spasms are more severe, you may be prescribed a medicine that can relax your muscles. This will usually be either baclofen, gabapentin or tizanidine.
• These medicines all have side effects. You might experience dizziness, weakness, nausea and diarrhoea. Discuss which of these would be best for you with your healthcare professional.

Mobility problems

• Mobility problems are often the result of muscle spasms and spasticity. Muscle weakness, or problems with balance can also cause mobility problems.
• If you have problems with mobility, your healthcare professional might suggest:
• an exercise programme supervised by a physiotherapist
• mobility aids, such as a walking stick, or a wheelchair
• home adaptations such as stair lifts or railings
• An occupational therapist can carry out an assessment of your home and suggest adaptations.

Treatment of the inflammation (swelling)

• Steroids. This can help with some types of transverse myelitis. Steroids are only given for a short period of time to avoid possible steroid side effects. The side effects could include reflux and stomach irritation, worsening infection, mood swings, and difficulty sleeping.

Bladder problems

• Medication might help if you have an overactive bladder or need to pee frequently during the night.
• If you find it difficult to empty your bladder, advice from a continence nurse or physiotherapist can help. Hand-held external stimulators can help some people to start peeing or to empty the bladder.
• Catheter can empty the bladder when needed. You might be taught how to do intermittent self catheterisation (ISC).
• In rare cases, people with transverse myelitis may need a long-term catheter to keep the bladder emptying safely.

Bowel problems

• It might be possible to treat mild to moderate constipation by changing your diet or taking laxatives.
• More severe constipation may need to be treated with suppositories,  or an enema. During an enema, liquid medication is rinsed through your bottom and large bowel, which softens and flushes out your stools.
• Anti diarrhoea medication or pelvic floor exercises might help bowel incontinence.

Sexual problems

• If you experience problems with less interest in sex or difficulty reaching orgasm, relationship counselling or seeing a sex therapist might help.
• If you have transverse myelitis and find it hard to get or maintain an erection (erectile dysfunction) you may be prescribed medication to increase the blood flow to the penis.

Musculoskeletal pain

• A physiotherapist might be able to help with this pain by suggesting exercises or better seating positions.
• If your pain is more severe, you may be prescribed painkillers. Or, you might have a transcutaneous electrical nerve stimulation (TENS) machine that stimulates your nerves.

Neuropathic pain

• Neuropathic pain is caused by damage to your nerves and is usually sharp and stabbing. It can also occur in the form of extreme skin sensitivity, or a burning sensation.
• This type of pain can be treated using neuropathic painkillers.