Multiple sclerosis: MS related bladder control problems

Bladder control problems occur in at least 80% of people with MS. Because MS interrupts or slows the transmission of signals to and from the brain, the electrical impulses to the muscles that are involved in emptying the bladder can become disrupted.

These problems can seem overwhelming, and often embarrassing but, there are steps you can take to manage bladder control problems.

What are the most common types of bladder control problems?

• Urinary urgency. People with this problem feel the need to urinate frequently and urgently. The small "tickle" and feeling of pressure that help us recognise the right time to head to the loo is very intense. When urinary urgency takes place, the signals that coordinate urination are disrupted and you experience this uncontrollable urge to urinate which can cause incontinence.
• Incontinence. This is the loss of bladder control. Sometimes MS will disrupt the nerve signals sent to the body parts that control urine movement allowing urine to be expelled involuntarily.
• Nocturia. People with nocturia wake up frequently during the night to go to the loo. There are a number of causes for this type of incontinence, but people with MS may experience nocturia due to the interruption of brain impulses that travel up and down the spine to coordinate urination.
• Urinary hesitancy. This refers to difficulty initiating urination. With multiple sclerosis, this problem may be caused by interruption of brain impulses that control that part of the urination process.

What happens if a bladder control problem goes untreated?

If left untreated, bladder control problems can cause other health concerns, including:

• Repeated urinary and bladder infections or kidney damage
• Personal hygiene problems
• Interfering with normal activity and leading to isolation

How are urinary control problems treated?

Treatment of urinary control problems is tailored to the individual patient. Often, a doctor who specialises in treating incontinence, called a urologist, will be involved in your care. Your doctor may recommend one or more of the following:

• Dietary changes to minimise incontinence
• Behavioural changes
• Medications
• Mechanical aids to help control the flow of urine
• Intermittent or continual catheterisation (inserting a thin tube through the urethra and into the bladder to remove urine)

Dietary changes

Dietary changes you can try that may help to reduce urinary control problems include:

• Reduce the amount of fluids you drink if you drink more than 4 pints (1.89 litres) daily

• Reduce or eliminate caffeine-containing drinks, such as tea and coffee from your diet
• Do not drink more than one alcoholic drink per day

Behavioural changes

Behavioural treatments used to control urinary control problems include:

Bladder training: Bladder training (also called bladder retraining) is used to treat motor urge incontinence (uncontrollable bladder contractions that force urine out of the bladder). Bladder training attempts to increase the time interval between urinating. A voiding schedule is established, and the person is trained to resist the first urge to urinate and refrain from urinating until the scheduled time. The interval between scheduled visits to the loo is increased until the person can refrain from urinating (remain continent) for several hours.