Bladder Issues are frequent in multiple sclerosis, but life evolves, physical therapy, and medication can all help.
Bladder problems are a common issue for people living with multiple sclerosis (MS), plaguing at least 80 percent of those affected, according to the National Multiple Sclerosis Society (NMSS). In several cases, bladder dysfunction is the first symptom a person has MS.
Bladder dysfunction hits when MS lesions — areas of damage to the myelin sheath that usually protects nerve fibers — block or delay nerve signals that control how the bladder and the muscles surrounding the bladder store or release urine.
Persons with MS may develop overactive bladder, underactive bladder, or both, according to the Urology Care Foundation.
In overactive bladder, the muscles controlling the bladder contract hesitantly and too frequently before the bladder actually fills with urine. This can lead to symptoms such as:
- Urgency, an intense feeling that you need to urinate instantly
- Frequency, or taking trips to the bathroom more than eight times in 24 hours
- Nocturia, or waking up at night to urinate
- Loss of bladder control
In underactive bladder, the bladder fails to perform fully and never empties completely. The muscles around the urethra (the tube through which urine exits the body) may remain contracted — even when you are trying to urinate. This can lead to symptoms such as:
- Hesitancy, or having difficulty starting to urinate
- Retention, a condition in which the bladder never empties completely
Emotional, Social, and Physical Implications of Bladder Dysfunction
Bladder dysfunction can be humiliating, interfere with social and sexual relationships, and even affect your ability to hold a job.
Mostly people aren’t even aware that this is an issue related to MS and, as a result, don’t bring it up with their doctors, says Tamara B. Kaplan, MD, a neurologist at Partners Multiple Sclerosis Center at Brigham and Women’s Hospital in Boston.
Another big issue is that doctors don’t always talk about bladder dysfunction with their patients.
“It is a humiliating and uncomfortable condition and can have a major effect on quality of life,” says Dr. Kaplan. “I’ve had patients who don’t want to leave their home because they are afraid that they will have an accident. It can be emotionally and socially isolating.”
If not treated, bladder dysfunction can lead to bladder infections or kidney damage. In addition, constantly leaking urine due to incontinence can lead to skin infections, as well as loss of independence and self-esteem.
Bladder dysfunction can also lead to constipation, bowel urgency, and bowel incontinence, especially when people try to self-treat by not drinking enough water, says Kaplan.
Both bladder and the bowel problems can also cause sexual dysfunction. You may be worried about having a bladder accident or feel uncomfortable because you are constipated, says Kaplan. “When people have bladder incontinence, they may not emotionally feel they can engage in sexual activity,” she adds.
Nocturia can additionally interfere with sleep.
Taking Control of MS-Related Bladder Problems
Handling problems associated with bladder dysfunction should start with a visit to your primary care doctor, who may further refer you to a urologist — a specialist in diseases of the urinary tract — for a complete scan, diagnosis, and treatment plan.
A urologist may perform urodynamic testing, or urodynamics, which examines the lower urinary tract function, including pressure, volume, and how the bladder is storing and releasing urine. “This can range from simple observation to precise measurements using sophisticated instruments to better measure how the bladder and urethra are working,” says Kaplan.
Bladder problems can often be managed effectively with certain lifestyle adjustments, medication, physical therapy, or devices. Among the available treatment options are:
If lifestyle adjustments aren’t effective at resolving bladder problems, prescription meds may help. You’ll need to work with a doctor to determine what works best for you.
The following drugs are used to treat various forms of bladder dysfunction, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):
- Enablex (darifenacin)
- Flomax (tamsulosin)
- Levsin (hyoscyamine)
- Pro-Banthine (propantheline)
- Sanctura (trospium)
- Oxytrol (oxybutynin patch)
- VESIcare (solifenacin)
- DDAVP (desmopressin)
- Detrol (tolterodine)
- Ditropan (oxybutynin)
Using Oxytrol, the patch version of oxybutynin, may reduce the risk of side effects like dry mouth and blurry vision.
Tricyclic antidepressants, such as Tofranil (imipramine), can also be used to relax the bladder muscles, the NIDDK notes.
2. Mechanical Aids
Using a catheter, which involves inserting a tiny tube through the urethra into the bladder to remove urine, may be helpful for people who are retaining urine. For some people with MS, this can allow them to have more normal bladder function within weeks or months.
For those with incontinence, a thin, solid tube may be inserted into the urethra to block leaking urine. An adhesive patch can also be placed over the urethra.
When other approaches haven’t helped, surgery may be an option. A treatment called sacral nerve stimulation therapy, in which a small device is surgically implanted under the skin to stimulate the sacral nerves, may be effective for both overactive bladder and urinary retention. The sacral nerves carry signals between the spinal cord and bladder. Other surgical procedures are also available for severe bladder dysfunction.
4. Dietary Adjustments
Your body still needs six to eight cups of fluids daily, but you can modify what you drink and when. Avoiding caffeinated and carbonated beverages and limiting your alcohol intake can help.
“There is no need to decrease your water intake; this can lead to dehydration, which can lead to constipation,” says Kaplan, who tells her patients to limit fluid intake after dinner.
5. Incontinence Pads
Absorbent pads sold specifically for urinary incontinence can help a person stay dry and odor-free during the day or night. Incontinence pads are made for men as well as for women. However, a lot of people use menstrual pads or adult diapers for urinary incontinence, and these can be embarrassing and uncomfortable, notes Kaplan. Next to the feminine hygiene supplies in drugstores and supermarkets, there is usually a whole section dedicated to urinary incontinence, she says.
6. Behavioral Changes
Drink water at designated times during the day, and plan bathroom breaks afterward.
Bladder training (also called “timed voiding”) can be helpful too. This technique involves keeping a journal and scheduling times to urinate, whether or not you feel the urge.
Double voiding is another technique that can help, the Urology Care Foundation says. To double void, urinate, wait a few minutes, then try to urinate again.
7. Pelvic Floor Physical Therapy
Exercises that engage the pelvic floor muscles are often recommended for incontinence, the NMSS says. A pelvic floor physical therapist can teach a person to contract, relax, and coordinate the muscles involved in bladder and bowel control, helping to normalize these functions.
8. Smoking Cessation
Smoking can be very irritating to the bladder, says Kaplan. Talk to your doctor about developing a plan and building the right support system to quit smoking.