How Common is Bladder Dysfunction?
Bladder dysfunction occurs in at least 80% of people with MS. Some estimate that up to 96% of people with MS who have had MS for more than 10 years will experience urinary problems at some point.
What Causes Bladder Dysfunction?
Bladder dysfunction in MS happens when nerve signals to the bladder and urinary sphincter (the muscles surrounding the opening to the bladder) are blocked or delayed because of lesions on the spinal cord. The dysfunction can be for two reasons: the bladder is spastic, so it isn’t holding the urine, or the bladder isn’t emptying all the way, because the sphincter is spastic (contracting when it is supposed to be relaxing to let out the urine, or vice versa).
What Does It Feel Like?
Bladder dysfunction can take several forms, including:
- Hesitancy: There is an urge to urinate, but it takes a long time to begin to urinate or it is difficult to keep the urine flowing. Sometimes, the attempt is even “dry,” meaning no urine is released at all.
- Urgency: The need to urinate comes on suddenly and strongly and may be accompanied by an uncomfortable “full” feeling in the bladder.
- Frequency: There is a need to urinate much more often than usual. This often happens at night, causing sleep disturbances.
- Incontinence: This can either feel like a sudden urge to urinate, followed by the flow starting immediately before there is a chance to react, or dribbling or leaking with no warning or sensation.
How Severe Can It Get?
If bladder dysfunction is left untreated, it can cause permanent damage to the urinary tract. This happens when there is incomplete emptying of the bladder and urine is retained, resulting in both urinary tract infections and formation of stones from minerals which collect. Constantly leaking urine can result in skin breakdown and infection. In addition, bladder dysfunction often results in people avoiding socializing and restricting their normal daily activities.
What Medical Tests Will be Performed?
The first test that will probably be done is a simple screening for a urinary tract infection (UTI), which are very common in people with MS and can cause many of the symptoms mentioned. (If it is positive, the infection will be treated with antibiotics to see if the symptoms clear up.) If that is negative, there is a variety of tests which make up a “urodynamic assessment,” which is necessary to know which treatment to prescribe and which behavioral and self-care management approaches might work.
How Can Bladder Dysfunction be Managed?
- Intermittent self-catheterization is the insertion of a thin tube into the bladder to allow the urine to flow out. This is an extremely successful method of management, and many people find that their bladder function becomes more normal after a period of weeks or months.
- Behavioral therapies include regulating and timing fluid intake, as well as urinating on a regular schedule, rather than waiting for the urge.
- Dietary changes include restricting use of caffeine, alcohol and orange juice.
- Surgeries are available for situations where people are unresponsive to treatment or have difficulties catheterizing themselves. A newer surgical approach involves the insertion of an electrical device (similar to a pacemaker) implanted to stimulate the sacral nerves.
What Medications are Available?
- Antispasticity agents to relax the sphincter muscle, such as Zanaflex® (tizanidine hydrochloride) and Lioresal® (baclofen)
- Drugs to promote the flow of urine, such as Minipress® (prazosin), Hytrin® (terazosin) and Flowmax® (tamsulosin)
- Drugs to reduce bladder spasms, such as Ditropan® (oxybutinin)
- Drugs to reduce the amount of urine made by the kidneys, such as DDAVP® (desmopressin)
- Don’t try to self-treat your bladder problems by drinking less fluid! This can lead to constipation or urinary tract infections (see below).
- Urinary tract infections, which are common in people with bladder dysfunction, can cause MS relapses. Prevent them by drinking plenty of fluids and include a daily glass of cranberry juice.