Why Does MS Cause Bladder Problems?
As many as 80% of people with multiple sclerosis (MS) experience bladder problems. Issues with bladder control occur because MS disrupts the transmission of signals to and from the brain, which disturbs the electrical impulses to the muscles responsible for emptying out the bladder.
In a healthy person, the bladder fills and the nerves send messages along the spinal cord, informing the brain of the need to urinate. The muscles keep the urethra closed to prevent leakage until you go to the bathroom and squeeze the bladder, at which point the muscles relax and the urine is released. If these nerves are damaged, as they are in many people with MS, the brain does not get the message until it is too late. Or if you have spinal cord lesions and/or dysfunction of your lower limbs, you are very likely to also have bladder problems.
If you experience bladder problems as a result of your MS, you may feel overwhelmed or embarrassed by the issue. The good news is there are some effective steps you can take towards managing your bladder issues — allowing you to live your life without worrying about your bladder acting up.
Common MS Bladder Problems to Be Aware Of
There are a few different bladder control problems with can occur with MS. They include:
Urinary Urgency
Those who experience urinary urgency feel the need to urinate frequently. While frequent urination can be annoying, it’s not the real issue here.
The issue with this particular bladder control issue is the urgency. You may feel fine one moment, and then when urinary urgency takes place, you will experience an uncontrollable urge to urinate, leading to incontinence.
If you experience urinary urgency, you can control this by paying attention to your body’s signals. Prior to urinating, you will experience what is described as a small tickle, along with pressure. This is your body’s way of telling you it is time to go to the restroom. By heading to the restroom as soon as this sensation is experienced, you’re more likely to make it on time.
Incontinence
Incontinence is a complete loss of bladder control. This occurs when the nerve signals in your body that control urine movement are disrupted. Those with MS sometimes experience a disruption, which causes urine to move out without notice and beyond your control.
Bladder training, frequent trips to the restroom and fluid management techniques along with medication can help prevent loss of bladder control due to incontinence.
Nocturia
Those who experience nocturia find that they wake often during nighttime hours to go to the restroom. Nocturia occurs due to the disruption of brain impulses that travel up and down your spine and control urination.
MS is one of the most common causes of nocturia. If left untreated, this problem can contribute to the fatigue associated with MS.
In order to treat this bladder control issue, you should reduce or eliminate evening fluid consumption. Additionally, if you take water pills, always take them first thing in the morning.
Urinary Hesitancy
This condition causes the opposite effect of those previously mentioned. Rather than causing you to urinate without notice, those with urinary hesitancy experience difficulty initiating urination.
The culprit here is the interruption of brain impulses that control the initial urination process. Some people with this condition find that a catheter can eliminate the issue while others experience relief from prescription medication.
Seeing Your Doctor for Your MS Bladder Problems
Be sure to see your doctor to rule out other problems that could be causing your bladder problems, like a urinary tract infection, for example. Tests like a PVR (post-void residual) can evaluate the amount of urine left in the bladder after urination and help to detect any other bladder dysfunctions.
Treatments for MS Bladder Problems
There is a number of effective treatments for bladder dysfunctions caused be MS. They may include:
- Prescription drugs – The drugs prescribed for bladder dysfunction are quite effective, in many cases helping to relieve symptoms entirely. Oxybutynin is one option and is usually taken one to three times daily. You can also get it as a patch you wear throughout the day. Another effective drug is tolterodine.
- Bladder training – Training techniques like Kegel exercises can help you to strengthen your pelvic muscles and improve your level of bladder control.
- De-stress – The bladder is very sensitive to stress, so consider taking up stress-management techniques like yoga and meditation.
- Catheter – To keep bladder volume low (below 500cc of urine) and therefore improve symptoms, clean technique intermittent catheterization can be used. Urine is eliminated from the bladder through a catheter on a regular basis.
- Botox – Botox injections aren't just for wrinkles. Also, botox injections can be used to treat an overactive bladder, especially when drug therapy fails or is not tolerated well. Based on research studies, a botulinum toxin injected into the detrusor muscles can improve urinary incontinence and the overall quality of life in MS sufferers.
In addition to the drugs and therapies that specifically target urinary dysfunction, standard MS drugs can also help. These drugs decrease inflammation and prevent the loss of myelin and future MS relapses.
Certain behavioral changes, like avoiding drinking anything in the hours leading up to bedtime, or drinking more than two liters of liquid in a day, and also help. While you work on improving your bladder control, consider using incontinence pads or underwear.
Bladder problems from multiple sclerosis do not have to control your life. With ongoing education, behavioral changes and the use of urination aids, you can treat your MS-related bladder control problem and prevent ongoing health concerns caused by bladder control issues.