Bladder problems are extremely common among the general population; however the symptom is more common in people with MS. They can affect up to three quarters of people with MS. MS-related bladder problems can happen at any stage, although they tend to be more common if you have difficulties with walking.
Problems include: – inability to hold on, needing to urinate frequently, being unable to go even though you feel the need to go, and not emptying you bladder completely when you go.
The bladder itself has two key functions: storage and emptying. To store and empty urine the bladder uses two main muscles- the detrusor (in the bladder wall) and the sphincter (at the outlet of the bladder). The two muscles need to work in coordination with each other so that one is relaxed while the other is contracted. When the bladder is storing urine, the detrusor is relaxed and the sphincter is contracted. When the bladder is emptying, the sphincter relaxes to open and the detrusor contracts to expel the urine.
A nerve centre in the brain switches the bladder from storage to emptying. In MS, if lesions affect the nerve pathways in the spinal cord, causing leg weakness, this is also going to interrupt the connecting nerve pathways of the bladder.
The main types are problems with storage and problems with emptying. It is not known why some people get one and not the other, or why some people get a bit of both.
When the nerve pathways in the spine are interrupted, faulty reflexes can appear so that even a small amount of urine in the bladder causes it to contract. This is called ‘detrusor over activity’ which leads to over active bladder – a need to urinate frequently. This effect is known as Frequency.
If the inability to ‘hold on’ is severe, urgency incontinence will be a problem. Medication can be highly effective in reducing the tendency for the bladder to contract, and this helps to relieve both frequency and urgency.
Instead of bladder muscles being coordinated, the sphincter does not relax when the detrusor muscles contracts. This makes the flow of urine poor and interrupted, and the bladder does not always empty completely.
If your bladder isn’t emptying completely you may not be able to feel it. However a sign is that you need to go to the toilet for a second time a short while later and passing similar amount of urine. It is important to test whether you are emptying your bladder completely as urine left in the bladder – known as residual volume- stimulates further bladder contractions and can add to problems of urgency and frequency and can increase your risk of developing urinary tract infections. A continence advisor can measure residual volume, usually done by using an ultrasound machine on the lower abdomen.
Discuss any bladder related issues with your Neurologist, GP, Public Health Nurse or Physiotherapist. They can also arrange for a referral to your local Continence Advisor if you wish.
Medication Self-Catheterisation Botox Nerve Stimulation Bladder Stimulators Pelvic Floor Exercises Drinking Enough Water
Source: This information has been taken from the MS Essentials Publication Managing Bladder Problems published by the MS Society UK. www.mssociety.org.uk. Please refer to this document for more in-depth information.
Other Reading: MS Ireland Publication – What everybody should know about Incontinence. www.ms-society.ie
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