March is Multiple Sclerosis Awareness Month here in the US and we’re taking a moment to talk about MS and it’s effect on the bladder and bowel.
WHAT IS MULTIPLE SCLEROSIS?
Multiple Sclerosis (MS) happens when the body’s immune system attacks the protective coating around the nerve fibers in the central nervous system (CNS), damaging the nerves. This alters or stops the messages within the CNS and can produce a variety of symptoms in people.
WHAT ARE THE SYMPTOMS OF MS?
While symptoms of MS vary from person to person, and even within the same person at different points throughout their lifetime, some of the more common symptoms of MS are fatigue, pain, numbness or tingling, weakness, walking difficulty, vision problems, sexual problems, dizziness and vertigo, bladder and bowel problems, thinking difficulty, emotional changes and depression.1 Luckily, many of these symptoms are treatable with medication.
HOW DOES MS AFFECT BLADDER FUNCTION?
In a healthy bladder, the nerves in the bladder communicate through the spinal cord to the brain, notifying it that the bladder needs to be emptied. For this process to work smoothly, it requires a coordination between the bladder muscles and the sphincter.
For people with MS, bladder function can be impaired when the signal from the bladder to the brain is delayed or blocked. This can cause the bladder to be either overactive (often referred to as a “spastic” bladder), or under-active, resulting in the inability to empty the bladder completely. Either of these conditions can lead to a variety of problems, including:
- Urinary Urgency (The need to urinate frequently and urgently.)
- Nocturia (Needing to wake to use the bathroom more than one time per night.)
- Difficulty urinating.
- Sphincter Dyssynergia A problem where there is both a storage dysfunction and an emptying dysfunction. The bladder is trying to contract and empty, and the urethra contracts instead of relaxing, allowing little or no urine to pass.
- Under-active Bladder: The nerve signals from the bladder to the brain are damaged and the signal for the bladder to contract and release urine are blocked. This can cause the bladder to eventually overflow and leak urine, or, if the bladder cannot empty completely, results in urinary retention.
In addition to disease related complications, some medications for MS can also cause bladder problems.
HOW CAN BLADDER PROBLEMS WITH MS BE TREATED?
Luckily, there are various treatment options that can be used to address bladder problems associated with multiple sclerosis.
Behavioral modifications, such as avoiding bladder irritating foods and drinks, and bladder retraining can help to manage problems in some people. Pelvic floor physical therapy can also work by strengthening the pelvic floor muscle, providing greater muscle control.
Intermittent self-catheterization, in which a small tube is inserted into the urethra to empty the bladder, can prevent the bladder from overfilling and help prevent urinary infections.
There are many pharmaceutical options available for bladder control. In addition, PTNS, Interstim, and Botox are all in office procedures that can have a positive effect on bladder control for many patients.
Talk to your doctor about your options to find one that works best for you.
References: 1. National MS Society: https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms