Multiple Sclerosis Centers of Excellence
Bladder Changes in Multiple Sclerosis
Changes in bladder function are common after developing MS and they often occur early in the disease process. Between 50 to 90% of people with MS will develop bladder problems at some point. The big question is - why does this occur?
The symptoms of bladder problems are wide ranging, and can include:
- Urgency - barely getting to the bathroom in a timely manner,
- Frequency - feeling the need to urinate more than every 2 to 3 hours,
- Hesitancy - being unable to easily start a flow of urine,
- Incontinence - a loss of control of urine,
- Nocturia - being awakened from a restful state by a need to urinate, and
- Double voiding - needing to urinate again a few minutes after voiding.
Other symptoms can be: feeling like the bladder isn’t empty after urinating, involuntary leaking of urine, difficult or painful discharge of urine, and urinary tract infections (UTI’s).
Bladder symptoms are broken down into three basic types of problems: emptying problems (hypoactive bladder), storage problems (hyperactive bladder), and a mixture of these two types of problems (combined dysfunction). Each of these types of problems has a different treatment approach.
Approximately 20% of people with MS have a hypoactive bladder. A hypoactive bladder overfills and stretches the bladder wall, causing the sensors that trigger bladder contractions to stop working. Additionally, often the sphincter that allows urine to leave the bladder doesn’t release and the urge to urinate doesn’t occur until after a large volume of urine has collected (and sometimes not at all!). The danger with this type of bladder is that when it becomes overfilled, urine can back up into the kidneys, causing kidney damage or infection.
The methods used to treat this condition are abdominal tapping (tapping on your lower abdomen to trigger a urination reflex), double voiding, adequate fluid intake, good bowel management, catheterization (intermittent catheterization or indwelling Foley/suprapubic urinary catheter) and, for males, good prostate care. Medications, such as bethanechol, to stimulate bladder contractions or reducing prostate swelling with prostate or anti-hypertension medications have been successfully used.
The majority of people with MS (60%) have the opposite type of bladder - a hyperactive bladder. A hyperactive bladder doesn’t hold the normal amount of urine before the urge to urinate occurs. Instead of triggering urination when it fills to 350-400 ml (normal), the urge occurs at 150-200 ml (or less), making it important to always know where every bathroom is located.
Treatments for this type of problem include decreasing irritants that trigger bladder spasms (caffeine, artificial sweeteners, alcohol, tobacco, spicy foods), reducing excessive weight, practicing good bowel care (to reduce the amount of abdominal pressure on the bladder), pelvic muscle exercises (especially with women), and learning to manage when and where urination occurs.
Managing urine output can involve a number of strategies: wearing easily and quickly opened/removed lower garments, the use of external urinary drainage devices or protective pads/garments, and determining what the best time and amount of fluid intake should be. Changing the volume or time fluids are consumed will help make sure the need to urinate doesn’t occur at inopportune times.
The last common treatment strategy is the use of medications. Common medications used include antispasmodics (such as baclofen), bladder relaxing medications (such as oxybutynin and tolterodine), or botulinum toxin (Botox) injections into the bladder sphincter.
The third type of problem is a mixture of these first two problems and may be more difficult to treat. With this type of bladder dysfunction, the bladder wall spasms, but the sphincter releasing urine won’t relax and open. Finding the correct balance of the above treatments that work best can be a trial-and-error process. Most people are able to find a combination of treatment strategies that work well for them by working with their health care provider.
Hopefully, this description of bladder function has helped you understand the bladder better. If you feel that you are experiencing bladder difficulties, please talk to your VA health care provider.