Bladder Dysfunction Overview:

Bladder dysfunction with people afflicted with multiple sclerosis (MS) is a relatively common symptom of the disease. It is estimated the over 60% of people with MS have bladder and or bowel dysfunction. As is the case with many other MS symptoms this symptom and severity tend to vary from individual to individual.

Multiple Sclerosis (MS) is an autoimmune disorder of the central nervous system (brain, brain stem and spinal cord). Nerve cells are surrounded by an insulating sheath made of a fatty substance called myelin that helps to transmit nerve impulses. In multiple sclerosis (MS), this myelin sheath is inflamed or damaged as the immune system attacks the nerves. This disrupts or slows nerve impulses and causes nerves to malfunction. The result is scarring (sclerosis) occurring in brain and spinal cord. These areas of myelin damage and scarring are called multiple sclerosis (MS) plaques.

Bladder dysfunction occurs in at least 80 percent of people with MS during the course of the disease. Lesions block or delay transmission of nerve signals in areas of the central nervous system (CNS) that control the bladder and urinary sphincters. A spastic (overactive) bladder can cause a variety of symptoms.

Symptoms such as incontinence (inability to control release of urine), frequent urges to urinate, feelings as though one’s bladder is constantly full and having difficulties beginning to urinate or a continual steady stream are some of the symptoms.

Some people experience urine retention and generally require some form of a catheter to assist in urinating.

The causes of bladder dysfunction usually are due to function of the muscles that control urination though problems in urination can also be due to urinary tract infections or UTI’s as they are called.

Bladder Dysfunction Symptoms:

  • Urinary urgency means you feel the need to urinate often and urgently. A tickle and / or feeling of pressure resulting in an intense need to use a restroom.
  • Incontinence is a lack or urine control and a persons bladder will empty with no warning.
  • Nocturia is getting up numerous times during sleeping having to urinate.
  • Urinary hesitancy is a feeling of needing to urinate but attempting to do so is slowed and difficult to begin.
  • Inability to empty the bladder completely
  • Urinary tract infections

Bladder Dysfunction Diagnosis:

Urinary Tract Diagram
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It is important to not try and treat yourself when it comes to bladder symptoms as doing so can result in creating more issues such as urinary tract infections (UTI).  Bladder dysfunction is best discussed with your neurologist who will likely refer to a urology specialist that can more thoroughly evaluate the condition in both the upper or lower urinary tracts.  A urine sample will be taken and examined to rule out any forms of urinary tract infections, it is important to make sure you are well hydrated prior to seeing the urologist in most cases.

Often people attempt to cope with bladder problems by attempting to limit fluid intake which is dangerous to a person’s health and kidney function.  Fluid intake should be between 1 1/2 – 2 quarts per day.  It should also be noted that aspartame, alcohol, caffeine  and smoking all are bladder irritants and should be avoided.

Again, it is important to stay hydrated with proper fluid intake, not doing so can be dangerous to overall health and lead to numerous complications.

Bladder Dysfunction Treatment:

Bladder Diagram
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It is important to have a urologist fully evaluate bladder dysfunction and to create a plan of action which may require some lifestyle alterations. There are several medications to assist with mitigating bladder dysfunction as well as other options. Depending on the severity of the bladder dysfunction medications may be prescribed,  procedures such as Botox® or surgery may be warranted or assistance devices be recommended such as a catheter.

Medications:

Darifenacin (Enablex)
Fesoterodine (Toviaz)
Imipramine (Tofranil)
Oxybutynin (Ditropan, Gelnique gel, Oxytrol transdermal patch)
Solifenacin (Vesicare)
Tolterodine (Detrol)
Trospium (Sanctura)
Myrbetriq (Mirabegron)

Botox:

Percutaneous Tibial Nerve Stimulation (PTNS):

Another available treatment is called Percutaneous Tibial Nerve Stimulation (PTNS). PTNS can be tried in cases where the symptems are an overactive or spastic bladder. A small needle is inserted in a persons ankle. The needle sends electrical impulses to a network of nerves called the Sacral Plexus which control bladder and eplvic floor musculature.  Treatments tends to be for 10-12 weeks and 30 minutes at a time of the therapy.  Percutaneous Tibial Nerve Stimulation has shown good results in reducing urgency to urinate, frequency and incontinence.

Treatment for 30 minutes per week for 12 weeks has been shown to reduce urinary frequency, urgency, nighttime urination and incontinence.

Surgical Implants:

InterStim and Interstim II are small surgical implants under the skin that stimulate sacral nerves. The devices are used to treat overactive bladder, urinary retention and some types of bowel dysfunction as well.  Medtronic Sacral Neuromodulation is a therapy delivered exclusively by the InterStim® System. The implantable neurostimulation system uses a neurostimulator and lead to send electrical pulses to an area near the sacral nerve to help normalize neural activity from the bladder or bowel to the brain. The stimulation parameters are controlled by external, handheld clinician and patient programmers.

Mechanical Aids:

  • Catheters: A thin, flexible,  tube through the urethra and into your bladder to drain urine.
  • Urethral Insert: A thin, flexible tube in the urethra that blocks urine from leaving the body.
  • External Urethral Barriers: These self-adhesive patches are placed over the area where urine leaves the body effectively blocking leakage.

Some lifestyle changes that can be helpful include:

  • Taking over the counter cranberry pills as they may keep urine acidic and thus reduce bacteria in urine and reduce changes of infections.
  • When drinking fluids do not sip beverages.  Instead finish them rapidly and then try and urinate about 1 1/2 –  2 hours afterwards.
  • Drink 6-8 ounces at a time.
  • Stop drinking fluids about 2 hours before bedtime and then urinate right before going to sleep.
  • Try and make sure you completely empty your bladder this will help reduce the possibility of infections.
  • Using undergarments to help catch and trap urine leakage.

Physical therapy:

Physical therapy is commonly prescribed for MS patients who have a spastic or overactive bladder. Pelvic therapies work muscles which have an important role in proper bladder and bowel function. These therapies utilize pelvic training, muscular stimulation and bio feedback mechanisms. Daily home exercises reduce may help reduce symptoms by strengthening the pelvic muscles and aiding muscle control.

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