An Overview of Bladder Dysfunction in MS

Symptoms can impact quality of life

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Urinary incontinence is probably among the most distressing symptoms of multiple sclerosis (MS). Bladder dysfunction occurs in at least 80 percent of people living with MS, and up to 96 percent who have had the disease for more than 10 years will experience urinary complications as a result of their condition.

As frustrating and embarrassing as the symptoms may be, it's important not to ignore them. There are many medical treatments available today that can improve urinary function, while simple dietary and lifestyle measures can help you better manage the condition, often with minimal stress or impact on your life.

Signs and Symptoms of Bladder Dysfunction
​Verywell / JR Bee

Causes

Multiple sclerosis is characterized by an abnormal immune response that causes damage to the protective covering of nerve cells (myelin sheath). This damage results in the formation of lesions on the brain and/or spinal cord which, in turn, interfere with the nerve impulses that regulate movement, vision, sensations, thought processes, and bodily functions like bladder control.

Bladder dysfunction in MS happens when electrical signals to the bladder and urinary sphincter are delayed or obstructed by lesions that develop on the spinal cord.

Dysfunction can occur for three reasons:

  • The bladder is spastic, making it less capable to hold urine.
  • The urinary sphincter is spastic, preventing the bladder from emptying completely.
  • The bladder is flaccid and unable to contract, leading to urine retention.

Signs and Symptoms

The symptoms of bladder dysfunction can vary by the extent and location of the lesions. In some cases, the symptoms will be mild and transient. In others, they may be persistent and aggravating.

Urinary symptoms can present in one or more of the following four ways:

  • Hesitancy: You may feel the need to urinate, but it may take a long time to begin or you may be unable to maintain a constant flow.
  • Urgency: The sudden, strong need to urinate accompanied by an uncomfortable rush of fullness in the bladder
  • Frequency: The need to urinate much more often than usual. This often happens at night, causing sleep disturbances.
  • Incontinence: When you are less able to control urine from leaving the bladder, leading to leakage

Complications

If bladder dysfunction is left untreated, it can cause permanent damage to the urinary tract. Urinary stones and urinary tract infections (UTIs) can often develop if the bladder is unable to empty. Chronic leakage can also lead to localized skin infections. In severe cases, potentially deadly urosepsis may develop if a urinary infection spreads into the bloodstream.

It's also important to note the impact of bladder dysfunction on a person’s peace of mind and lifestyle. It is not uncommon for people with bladder control problems to isolate themselves or restrict their daily routines, often adding to the burden of depression frequently seen in people with MS.

Diagnosis

When investigating bladder dysfunction, doctors will ask you about your symptoms. They will want to rule out a UTIs by testing your urine.

If positive, antibiotic treatment will be prescribed. If not, other tests (known as a urodynamic assessment) will be performed to evaluate how well the bladder and urethra are storing and releasing urine.

A urodynamic assessment takes around 30 minutes and involves the use of a small catheter to fill the bladder and record measurements.

Treatment

As distressing as bladder dysfunction can be, urinary symptoms can usually be managed successfully with medications, lifestyle modifications, and other therapies.

Treatment will be determined by the specific cause of the dysfunction:

  • For patients with spastic bladder: Bladder relaxants, such as Ditropan (oxybutynin), Detrol (tolterodine), Enablex (darefenasin), Toviaz (fesoterodine), Vesicare (solifenacin), Sanctura (trospium chloride), and Myrbetriq (mirabegron), are used.
  • For patients with an overactive bladder sphincter: Alpha-adrenergic blocking agents, such as Flomax (tamsulosin), Uroxatral (alfuzolin), Cardura (doxazosin), and Rapaflo (silodosin), are used to promote the urine flow through the sphincter. In addition, antispastic drugs, such as Lioresal (baclofen) and Zanaflex (tizanidine), can be used to relax the sphincter muscle.
  • For patients with a flaccid bladder: Intermittent self-catheterization, wherein a thin tube is inserted into the bladder to better enable allow urination, may be recommended.

Other forms of treatment include behavioral therapies which teach people how to regulate fluid intake and strategically schedule urination while at home, work, or social engagements.

Dietary strategies include the restriction of caffeine, alcohol, and orange juice (the latter of which promotes bacterial growth) and the use of cranberry juice or tablets (which inhibit bacterial growth).

More severe cases may require surgical procedures, including an electrical implant, called an InterStim, which stimulates the sacral nerves and helps treat an overactive bladder. Botox can also be used to treat an overactive bladder.

A Word From Verywell

Having bladder problems can be upsetting, but the sooner you tell your doctor, the sooner you will receive proper treatment and be able to resume your normal activities without worrying about leaks or frequent trips to the bathroom. Our Doctor Discussion Guide below can help you start a conversation with your doctor about the specific symptoms you may be experiencing.

Multiple Sclerosis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman
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