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Bladder Problems

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  • Do you get up more than one time a night to urinate?
  • Do you urinate more frequently than you used to?
  • Do you ever have to rush to the toilet to avoid having an accident?
  • Do you leak urine or have accidents?

If you answered “yes” to any of these questions, you may want to discuss your bladder function with your physician.  Why? Because MS could be affecting your bladder function — and the problems are most likely treatable! Not all changes in bladder function are related to normal aging or childbirth.

Healthy bladder function

Urine is made in the kidneys, and travels down two tubes called ureters to the bladder: an elastic sac that stores urine. When the urinary system is working properly, urine collects slowly in the bladder, causing it to expand. When four to eight ounces of fluid have accumulated, nerve endings in the bladder transmit nerve signals to the spinal cord which, in turn, sends nerve signals to the brain that the bladder needs to be emptied. As the person prepares to urinate, the brain sends a return signal to the spinal cord that triggers the voiding reflex, which causes two things to happen at the same time:

  • The bladder muscle (detrusor) contracts to push the urine out of the bladder; and
  • The external sphincter — which normally remains closed — opens to allow the urine to leave the body.

Bladder problems in MS

Bladder dysfunction, which occurs in at least 80 percent of people with MS, happens when MS lesions block or delay transmission of nerve signals in areas of the central nervous system (CNS) that control the bladder and urinary sphincters. A spastic (overactive) bladder that is unable to hold the normal amount of urine, or a bladder that does not empty properly and retains some urine in it can cause symptoms including:

  • Frequency and/or urgency of urination
  • Hesitancy in starting urination
  • Frequent nighttime urination (nocturia)
  • Incontinence (the inability to hold in urine)
  • Inability to empty the bladder completely

Bladder and overall health

Healthy bladder function is essential for long-term kidney health, prevention of infection, personal independence, self-confidence, and overall quality of life. Untreated bladder issues can cause:

  • Worsening of other MS symptoms, such as weakness and spasticity
  • Repeated bladder or urinary tract infections (UTI), or kidney stones that can cause serious pain and compromise overall health
  • Challenges with work, home and social activities
  • Loss of independence, self-esteem and self-confidence

Early medical evaluation is important to determine the cause of the bladder symptoms and choose the appropriate management and treatment strategies — in order to maintain health, comfort and avoid complications. At their most serious, untreated urinary problems can lead to infections in the blood (urosepsis) and skin breakdown — two factors that can shorten life in someone with MS.

More questions to ask yourself

Since first being diagnosed with MS or having neurologic symptoms:

  • Am I finding it more difficult to start urinating when I get to the toilet?
  • Do I feel as though my bladder isn’t completely empty when I’ve finished urinating?
  • Do I experience frequent or recurrent urinary tract infections?
  • Am I using pads or any other strategies to protect my clothing from urinary leakage?
  • Am I limiting the amount of fluids I drink because I worry about having to urinate frequently?
  • Am I planning my daily activities around my bladder symptoms?
  • Do my bladder symptoms keep me from doing what I enjoy?
  • If I had to spend the rest of my life with my bladder behaving the way it does now, would I be unhappy?

If you answered ‘yes’ to any of these questions, contact your neurologist, nurse or primary care provider about an evaluation of your bladder function. Print these questions (.pdf) to bring with you for reference. Either your healthcare provider or the National MS Society (1-800-344-4867) can refer you to an urologist with expertise in MS bladder management.

Management and treatment options

Bladder symptoms can usually be managed successfully with lifestyle modifications, medications, physical therapy and/or nerve stimulation procedures.

  • Lifestyle changes may include diet modifications, adequate fluid intake up to a few hours before bedtime, bladder training or planned voiding, among others. Learn more (.pdf) and ask your doctor for advice, as some changes — such as limiting fluid intake — can lead to dehydration and other potentially dangerous complications.
  • More than a dozen medications in a variety of forms (pill or capsule, nasal spray, skin patch and injection of botulinum toxin into the bladder muscle by a healthcare professional) are available to address specific bladder symptoms in MS. A careful assessment of your bladder symptoms will allow you and your healthcare provider to select the optimal treatment approach for you.
  • Pelvic floor physical therapy is often prescribed for people with spastic or overactive bladder symptoms, and targets the group of muscles attached to the pelvic bone and sacrum that play an important role in healthy bladder and bowel function. The therapy uses pelvic floor training, biofeedback, neuromuscular stimulation and daily home exercises to reduce urinary urgency and frequency, and loss of bladder control. It works by strengthening the pelvic floor muscles, improving muscle control, and promoting muscle relaxation as needed for urination.
  • Percutaneous tibial nerve stimulation (PTNS) is a treatment that may be helpful for symptoms of spastic or overactive bladder. During PTNS, a very small needle electrode inserted in the ankle transmits a nerve impulse to the sacral plexus (a network of nerves that controls the bladder and pelvic floor muscles). Treatment for 30 minutes per week for 12 weeks has been shown to reduce urinary frequency, urgency, nighttime urination and incontinence.
  • Intermittent self-catheterization (ISC) may be recommended for difficulty emptying the bladder. In ISC, a small tube (catheter) is inserted into the urethra to empty the bladder, and then removed. ISC one or more times per day can help control bladder leakage, urgency and frequency, and nighttime urination in people who cannot completely empty their bladder on their own.
  • InterStim® is a small device surgically implanted under the skin that stimulates the sacral nerves and is used to treat overactive bladder, urinary retention and some types of bowel dysfunction.
  • Other surgical interventions are available to address urinary problems that do not respond adequately to any of these interventions.

Summary

The health of your bladder is crucial to your overall health and quality of life — which means that any symptoms you experience are important to address with a healthcare professional. The good news is that the available treatment options are effective for managing most symptoms, allowing you to live your life fully without bladder issues getting in your way.

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