Multiple Sclerosis and Bladder Problems
Approximately 80 to 90 percent of people with multiple sclerosis (MS) experience a problem with bladder function at one point or another. Given how early toilet training happens in life, it isn’t too surprising that problems in this area are so threatening to self-confidence and self-esteem.
Basically, you’ll come across two types of bladder problems in multiple sclerosis: Keeping it in when you want to and getting it out when you want to. Sounds pretty basic, doesn’t it?
MS and bladder storage problems
These problems happen when the bladder is small and overly active (spastic). Rather than expanding to hold the accumulating urine, the bladder begins to contract as soon as a small amount has been collected. And to top it off, the urinary sphincter keeps opening to let the urine out.
So, instead of a nice, relaxing trip to the bathroom, you experience intense and frequent urges to pee — sometimes as often as every 15 to 20 minutes. You may also experience dribbling or even the occasional flood.
If you’re having this type of bladder problem, contact your neurologist, urologist, or nurse specialist. He or she has a few different treatment options to help calm the hyperactive bladder. Several medications are available, so you and your healthcare professional can experiment to find the one that provides the greatest benefit with the fewest side effects.
The most commonly used medications include three formulations of oxybutynin (Ditropan; Ditropan XL, an extended release formulation; and Gelnique, a topical gel); Detrol (tolterodine); Sanctura (trospium chloride); Vesicare (solifenacin succinate); and Enablex (darifenacin), among others. Each of these medications can reduce urinary frequency and the feelings of urgency so that you can get to the bathroom more comfortably.
And believe it or not, the FDA approved Botox (onabotulinumtoxinA) in 2011 to manage an overactive bladder (that doesn’t store urine properly) in MS and other neurologic conditions. (Yes, we’re talking about a prescription version of the same medication that takes care of wrinkles.) It’s approved for use by people who haven’t gotten sufficient relief from the bladder medications we just described or are unable to tolerate them.
Botox works by relaxing the bladder muscle so that it can retain more urine without leaking. While viewing the inside of your bladder with a cystoscope (a special tube inserted into your urethra with a camera on the end), the doctor injects the Botox into your bladder. To ensure your comfort, the doctor administers either a local anesthetic (with or without sedation) or general anesthesia. The effects of each injection last approximately nine months.
MS and bladder emptying problems
These problems happen when the bladder and the urinary sphincter are out of sync with one another. When the bladder contracts to push out the accumulated urine, the urinary sphincter contracts rather than relaxing, trapping the urine inside.
With this kind of bladder, you may experience urinary frequency, urgency, dribbling, and perhaps incontinence. You may also feel as though you need to urinate but then find yourself sitting or standing there waiting (and waiting, and waiting) for something to happen.
Contact your doctor if you’re having these emptying problems, because (as with storage problems) medication may help you. If your bladder only retains a small amount of urine after your best efforts to empty it, the problem may respond to baclofen, an antispasticity medication that can help relax the sphincter.
Otherwise, the other strategy for emptying the bladder involves intermittent self-catheterization (ISC). Don’t faint — it’s really not as bad as it sounds. You insert a plastic tube (about the size of a thin straw) into your urethra (hint: for guys, that’s through the opening in your penis; for women, it’s through an opening above the vagina) and empty your bladder at a convenient time and place — generally every 4 to 6 hours or so.
It’s painless (yes, really painless) and quick, so you can do it anywhere you happen to be. ISC eliminates the unpleasant symptoms and may actually improve your bladder function to the point that you no longer need to do it.
Your doctor may also prescribe a medication like Ditropan (oxybutynin) or Sanctura (trospium chloride) to stop symptoms of urgency and to extend the length of time between catheterizations. In case you’re wondering, women have an easier time than men getting used to the idea of ISC, but men find the procedure easier to learn because they can actually see what they’re doing.
Diagnosing MS-related bladder problems
You may have noticed that storage problems and emptying problems cause very similar symptoms, which means that neither you nor the healthcare professional can tell what’s going on just from the symptoms you’re having.
And to complicate matters further, people can have a double-whammy — a combination of storage problems and emptying problems. In addition, a urinary tract infection can cause any or all of these symptoms. So your doctor may need to do some detective work to determine what’s going on with your bladder.
The simplest procedure for diagnosing the problem is to measure the amount of urine left in your bladder after you urinate (this leftover urine is called residual urine). To do this, the physician or nurse either inserts a catheter to remove and measure the residual urine or does a bladder ultrasound to measure it. If the residual is less than 100 cubic centimeters (about 3 ounces), the problem is generally with storage; if the residual is greater than that, the problem is probably with emptying.
Both storage and emptying problems can get you scurrying to the bathroom multiple times during the night. This problem is called nocturia. Because disrupted sleep is a major contributor to fatigue in MS, taking care of your bladder symptoms will actually help solve two problems at once.
Take a look at the National MS Society’s List of Publications to find brochures about the symptoms described here (and more). You can download the publications from the website or request them by calling (800) FIGHT-MS (800-344-4867). Or check out Managing the Symptoms of Multiple Sclerosis, 5th edition, by Randall Schapiro, MD (Demos Health).