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Multiple Sclerosis Centers of Excellence

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Are Bladder Problems Tied to Falls in Multiple Sclerosis?

Michelle Cameron, MD, PT, MCR -- Portland, OR

Does your MS affect your bladder? Do you fall because of your MS? We know falls and bladder symptoms are common in people with MS. More than 50% of people with MS fall in a 3 to 6 month period, and about 75% or more have problems with their bladder. We now think that in some people these symptoms may be related.

A study led by Dr. Michelle Cameron, a neurologist at VA Portland Healthcare System, VA MS Center of Excellence-West, found that in people with MS, urinary urgency (a sudden, compelling urge to urinate) with incontinence (involuntary leakage of urine) was associated with a significantly increased risk of falling multiple times in a 3-month period. In fact, in this study, people who had both urinary urgency and incontinence had almost a 60 times greater odds of recurrent falls compared to those people who did not have these bladder symptoms.

Interestingly, those people who only had urinary urgency or urinary frequency, but not incontinence, were not at increased risk for multiple falls. And, no bladder symptoms were associated with an increased risk of just falling once.

Participants in this study had to meet certain criteria, including a confirmed diagnosis of MS, mild-to-moderate disability due to MS, no relapse within 30 days of the study start date, and be 18-50 years old to minimize the cause of falls being something other than MS. In addition, participants were excluded if they had balance or walking issues because of a condition other than MS, or if they could not walk at least 100 meters. In this study, a fall was defined as “any unexpected event that results in ending up on the ground, floor, or any lower surface.” Of the 51 study participants, 32 people fell at least once in 3 months, and 15 fell at least twice in 3 months.

The findings of this study are important and useful because we really don’t know all the reasons why people with MS fall, or how to best help prevent them from falling so much. Many treatments to prevent falls in people with MS have been tried. Most of these consist of a combination of safety education and balance exercises. Although these may be helpful, they certainly don’t fix the whole problem. They increase knowledge and improve people’s balance, but they don’t prevent all falls. Many of the reasons people with MS fall, like weakness or numbness, probably can’t be fixed completely or easily. Finding that something like urinary incontinence, which can often be treated easily and effectively with medications, may help prevent falls is therefore particularly encouraging. This study suggests that improved bladder management may be able to reduce the risk of falls in people with MS.

It is not clear why people with MS who have urinary urgency with incontinence tend to fall more. Although it is possible that they just have worse MS, this is not likely. In Dr. Cameron’s study, statistical tests showed that the relationship between bladder symptoms and falls was not affected by how severe the person’s MS was. So, we think that bladder problems might cause falls in people with MS because, if you have urinary urgency and incontinence, you are likely to often rush to the bathroom, not paying as much attention to your safety when walking or transferring. It is also possible that people with bladder problems avoid drinking water and become dehydrated, which can then make them dizzy when walking.

How can knowing that bladder problems and falls may be connected help you? If your MS affects your bladder, and you have frequent falls or near falls, tell your provider about it. Treatment for your bladder might not only help resolve or improve your bladder problems, it might also help prevent you falling.