Multiple Sclerosis and Incontinence

Bladder problems or urinary dysfunction are common with Multiple Sclerosis, although not everyone with MS will experience them. Symptoms can vary from person to person, and should always be handled on an individual basis. But know that they can be handled, and need to be for better health, and quality of life.

Problems with urination can be overwhelming when they first occur. Losing bladder control can be especially difficult to deal with. People try restricting fluids in order to deal with an embarrassing situation. This is not a good idea. Restricting fluids increases the risk of infection, and irritates the bladder.

When problems begin to occur it is important to inform your physician or health-care provider as soon as possible.

The best way in managing bladder problems is to know the measures used to relieve symptoms and preserve urinary tract function. What causes symptoms, the procedures used in making a diagnosis, and test involved are all part of the process.

It is always a good idea to avoid beverages containing caffeine. Caffeine can worsen some symptoms, and may be a bladder irritant. Drinking cranberry juice, or taking a cranberry tablet daily is a step in the right direction. Cranberries contain antioxidants, and cranberries contain a mineral that can reduce the risk of infection by preventing bacteria from sticking to the bladder wall. A registered dietitian, doctor, or nurse can help you with making any possible dietary changes.

There are some ways to provide security. Absorbent pads, adult diapers, or a male leg bag system with male external catheters can provide a solution for bladder problems. But these should not be the sole solution. The goal is to eliminate leaking or loss of control so that they are not needed.

What Multiple Sclerosis can do to the urinary system.

MS plaques in the brain and spinal cord may interrupt the transmission of signals to and from the brain. This in turn can result in problems storing urine to normal capacity or problems emptying the bladder completely.

Any of these symptoms may occur, regardless of the underlying problem:

Urinary urgency: A very strong sensation that urination is imminent and cannot be postponed.

Urinary Incontinence: Loss of urinary control.

Nocturia: Urinating several times during the night.

Urinary hesitancy: Difficulty initiating the flow of urine.

Overflow incontinence: Loss of urinary control due to a very full bladder, usually described as “dribbling” or “leaking”.

Sensation of incomplete emptying: A feeling that some urine remains in the bladder after voiding. (Sometimes bladder sensation is decreased in MS, and a person may have incomplete emptying with no awareness that urine is being retained.)

Weak urinary stream: The flow is noticeably thin and slow.

Managing the emptying problem

A number of people will have to use a catheter as a management tool for the emptying dysfunction. There are two types of catheters we will list. One is an intermittent catheter. Urine is periodically drained by inserting a thin tube into the bladder through the urinary opening. This procedure is usually painless, and is much easier to do than it sounds, even if MS has caused numb, or uncooperative fingers. Practice sessions, and minimal instruction with a nurse are required. Women are much more receptive than men to intermittent catheters. This could be because they are more familiar with the process of tampon insertion. Men are much more resistant. This is why we suggest the use of male external catheters (MEC). Male external catheters are worn like a condom, and safe to use for everyday use. They are easy to apply, and remove with out any help. But before using any product it is best to contact you physician about what product would work best for you.

Potential problems

The emptying dysfunction can cause urine to be retained. This is when bacteria multiply freely in stagnant urine. When urine is left in the bladder it is known as “post-void residual urine”. This may predispose a person to frequent urinary tract infections.

Kidney damage may occur from frequent upper urinary tract infections. This happens when the exit is blocked by a tight or contracted sphincter. Kidney or bladder stones are another potential factor of incomplete emptying. Minute mineral particles that normally pass through during urination may clump together to form stones which cannot be passed through the normal process of urination. Kidney stones, bladder stones, and urinary tract infection all suggest a problem with chronic urinary retention. .

One thing to avoid is a technique that was taught in the past call crede. This procedure involved pushing down on the lower abdomen while urinating. This is now considered harmful. This often pushes urine up, not down. So avoid this practice method all together.

Some people may experience more complex bladder problems than others. They may ultimately need a catheter inserted into the bladder, or use of a external catheter on a more permanent basis. In rare cases surgery may be required to improve quality of life, and better health.

Points to remember

Bladder problems are common for people with Multiple Sclerosis. Understanding the process, and solutions is the best way to come to terms.

At the first sign of problems urinating you should contact a physician, or health care provider. Early treatment is the key.

In most cases bladder symptoms can be controlled using strategies that include management techniques, the correct medication, and self help.

Always do a follow up with a physician, or health care provider.

Since bladder and sphincter function may vary over time, it may be necessary to repeat diagnostic tests and vary the strategies.

For general information, visit our FAQ. Also, you can visit our Resources page for some helpful links for more information.