Multiple Sclerosis and Bladder Problems
Bladder problems can be one of the first signs of multiple sclerosis. It's also one of the most common symptoms suffered by up to 80% of people with MS at some stage.
For many people it is an embarrassing problem that can severely affect daily living including social life, sexual relationships and jobs. But it is not something that has to be suffered in silence, because medication is available that can help manage the symptoms.
Bladder incontinence occurs because multiple sclerosis involves damage to the nerves in the part of the central nervous system which control the bladder and the sphincter muscle surrounding the bladder opening. It's this muscle which keeps urine in or out.
The problem usually manifests itself in a number of ways. The urinary continence experts talk about storage dysfunction, emptying dysfunction or a combination of both problems.
Simply put, MS sufferers often experience:
- A sudden desperate need to pass urine
- Little or no bladder control
- A need to urinate frequently
- A feeling as though their bladder is never quite empty
- A need to urinate but the urine is slow to pass
- Bedwetting at night (known as nocturia)
- Hesitancy in urinating
Anyone with MS who begins to experience bladder problems should seek immediate medical help to determine whether the problem is due to the bladder not being able to hold urine or not emptying properly.
If the bladder isn't emptying properly and therefore holding in some urine it can lead to repeated urinary tract infections (UTIs) or kidney damage. Also if the problem isn't treated there will inevitably be knock on emotional, social and personal hygiene problems to deal with. The sooner the cause is found and treated, the earlier complications can be avoided.
Regular monitoring of the problem is also important because if the disease progresses the symptoms may change and need a different course of treatment.
Treating bladder problems and incontinence related to MS
So what can be done to help? The majority of treatments look at improving the quality of life of a person with bladder problems, promoting better management of the symptoms and reducing UTIs. Looking at toilet patterns and fluid intake is an important part of the process.
Drugs such as oxybutynin and trospium can be used to reduce incontinence and problems with urination such as frequency and urgency. They can have side effects such as blurred vision or constipation but these can be reduced by slowly releasing the drug into the system. A slow dose medicated patch is currently being trialed. Desmopressin, a drug which suppresses the production of urine, has been found to be useful for night time bed wetting.
If medication is not appropriate because it simply doesn't work on the individual, extra absorbent pads can be used.
When the problem involves emptying the bladder, intermittent self-cathertisation (ISC) is effective. With this method the sufferer can drain their own bladder several times a day whenever needed, following training from an MS health care professional.
If both emptying and storage is a problem, an external bladder stimulator is useful. This hand held device is put on the lower abdomen and gentle vibrations encourage the bladder to empty.
Botox injections into the bladder wall have been found to "freeze" muscle spasms which can cause the urine to be pushed out. This procedure can only be performed by a qualified doctor.