Many people with MS experience a range of bladder problems, including urinary incontinence. Urinary incontinence may range from occasional leaks when coughing  or sneezing to sudden urges to urinate throughout the day, sometimes leaking before making it to the bathroom.

There are a number of successful approaches to treating and managing urinary incontinence in people with MS.

Main causes of MS urinary incontinence

There are several causes of urinary incontinence MS, including:

  1. Urge incontinence, which occurs when there is nerve damage in the part of the brain and spinal cord that controls the bladder. This results in a need to urinate more frequently and urgently as the bladder becomes overactive.
  2. Stress incontinence, which happens when urine leaks when coughing, laughing, or sneezing. This happens because the pelvic floor muscles are weak. In people with MS, this is a result of an impairment of the pelvic floor muscle messages.

Some people with MS may suffer from both of these conditions.

Urinary incontinence diagnosis in MS patients

Before treatment is determined, there are some medical tests that should be performed, such as a uroanalysis to look for blood in the urine, a urodynamics test, and a renal ultrasound. The urodynamics test is the gold standard and 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 informs the clinician about pressure and flow.

Afterward, a renal ultrasound is often used to determinate whether the kidneys are functioning normally.

Management and treatment of urinary incontinence in MS

The first thing people with MS tend to do is to decrease their fluid intake. But this makes the urine so concentrated that it irritates the lining of the bladder, increasing the risk of infections and possibly leading to dehydration and other complications.

The most important way to manage this condition is to protect the kidneys. If the kidneys go unprotected, it may lead to urosepsis and skin breakdown, two factors that can worsen MS.

Depending on the stage of the disease, cognitive function, dexterity, mobility and support at home, treatment for urinary incontence is usually tailored for each patient.

Treating the condition may be as simple as bladder retraining: learning to hold the bladder a little bit longer.

Routine changes are sometimes also suggested, such as better fluid management. Instead of drinking eight cups of coffee a day, switch to some water, reducing the fluid intake at night. Also, taking cranberry pills or drinking cranberry juice may turn the urine more acidic, helping reduce the number of bacteria in the urine.

Stress incontinence can often be simply managed with pelvic floor exercises, which is probably the least expensive and one of the most effective manners to treat urinary bladder issues. Pelvic floor or kegel exercises strengthen the muscles, improving their control, and can be very effective.

For urge incontinence, techniques include percutaneous tibial nerve stimulation (PTNS), where a needle electrode sends impulses signaling the bladder and pelvic floor; intermittent self-catheterization (ISC) may be recommended for those with difficulty emptying the bladder and can be easily performed by MS patients anywhere; 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.

Medications can help as well, especially for urge incontinence, to stop spasms and decrease the frequency of urges. A healthcare provider can select the best approach for an MS patient’s condition.