Up to 75% of the people with MS may experience bladder problems at some point in their life. These problems usually develop as the disease progresses, typically six years on average after diagnosis1. Bladder problems are related to lesions that block or delay the transmission of nerve signals in areas of the central nervous system that control the bladder,2 and are worsened by a patient’s reduced mobility.
Bladder problems include problems with storage of urine and problems with emptying it. Some people experience a combination of these issues, which can lead to urinary incontinence,1 the most complicated health complication to treat.
Problems with urine storage make the bladder overactive and include an increased need of urinating (more than eight times a day, and more than twice at night), an immediate urge to empty the bladder, and a feeling of inability to hold the urine. Problems with emptying the bladder include difficulty in starting to urinate and incomplete bladder emptying.1
Urinary tract infections are also common in MS.
Diagnosing Bladder Problems
Before treatment for bladder problems is determined by physicians, a series of medical tests are typically performed:
- Uroanalysis, looking for blood in the urine
- Urodynamics test
- Renal ultrasound
The urodynamics test, considered a gold standard test, is a computerized assessment of the overall bladder function. It consists of placing a small catheter connected to a computer monitor in the bladder and filling it with water in real time. While the bladder is being filled, the technician asks the patient questions. After filling, the patient urinates into a special machine that provides data about pressure and flow.
Afterward, a renal ultrasound is conducted in order to determinate if the kidneys are normal.3
Management and Treatment of Bladder Problems
The first thing people with MS tend to do to manage bladder problems on their own is to decrease their fluid intake. Decreasing fluid intake causes urine to become so concentrated that it irritates the lining of the bladder, increasing the risk of urinary tract infections, and can lead to dehydration and other complications.
Physicians note that most important point in managing this condition is to protect the kidneys, as it may lead to urosepsis and skin breakdown — two factors that can worsen MS.
Depending on the stage of the disease, and a person’s cognitive function, dexterity, mobility and support at home, the treatment of bladder problems is usually tailored for each individual.3 Treatment may be as simple as bladder retraining, or learning to hold the bladder a little bit longer.
Doctors can also suggest a routine change for better fluid management — instead of having eight cups of coffee each day, try switching to water, reducing fluid intake at night, and taking cranberry pills or juice that may turn the urine more acidic, helping to reduce the amount of bacteria in the urine.
Other techniques include percutaneous tibial nerve stimulation (PTNS), where a needle electrode sends impulses signaling the bladder and pelvic floor; intermittent self-catheterization (ISC), which may be recommended for those with difficulty emptying the bladder and can be easily performed by the person with MS with sufficient motor control; InterStim, a small implantable device that stimulates the sacral nerves and aids communication between the brain and the pelvic floor; and botox injections that help the bladder to relax and are an injectable treatment approved for MS bladder.
Medications can also help for specific bladder problems, stopping spasms and decreasing urgency frequency. A patient’s healthcare provider can select the optimal approach for each condition.
There are other surgical interventions available to those who do not respond to any of the ones previously presented, such as a suprapubic cystostomy, which is an implanted tube that drains urine into an external bag, or an indwelling catheter, a flexible tube in that is implanted in the bladder that drains urine into an external bag.3
Read the latest news on MS and bladder dysfunction.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
- http://www.nationalmssociety.org/Programs-and-Services/Resources/Managing-Bladder-and-Bowel-Issues-in-MS-(video-DVD?page=1&orderby=3&order=asc (video)