Multiple Sclerosis And Incontinence
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Living with multiple sclerosis (MS) presents many daily challenges—and one of the most frustrating can be losing control over your bladder. MS affects how your brain and body communicate, and when those signals are disrupted, it can lead to a range of urinary issues.
The good news is that bladder symptoms caused by MS are manageable, and with the right tools, care, and support, many people regain control and confidence.
WHY MS Can Affect Bladder Control
Urination requires precise coordination between the bladder muscles and the urinary sphincter. MS can interrupt the nerve signals that manage this balance, resulting in a variety of urinary issues. Here are some common bladder challenges experienced by people with MS
Common types of bladder dysfunction in MS
Urinary Urgency – People with this problem feel the need to urinate frequently and urgently. That familiar “tickle” and pressure that help us recognize the right time to head to the restroom is unusually intense. When urinary urgency takes place, the signals that synchronize urination are disrupted which creates an uncontrollable urge to urinate—the very definition of incontinence.
Nocturia – People with nocturia must awake frequently during the night to go to the bathroom. There are a number of causes for this type of incontinence, but persons with MS may experience nocturia due to the interruption of brain impulses that travel up and down the spine to coordinate urination.
Urinary Hesitancy – This refers to difficulty initiating urination. With multiple sclerosis, this problem may be caused by interruption of brain impulses that control that part of the urination process.
Sphincter Dyssynergia – Another common problem seen in a bladder affected by MS is sphincter dyssynergia (SD). This occurs when there is both a storage dysfunction and an emptying dysfunction. The bladder is trying to contract and empty, and the urethra is contracting instead of relaxing, therefore allowing little or no urine to pass. This phenomenon is usually due to nerve damage in the spine as opposed to the brain.
Underactive Bladder – The nerve damage occurring from MS can cause the bladder to weaken, and as a result, the bladder may not contract to release the urine. If nerve signals from the bladder cannot tell the brain to empty, the bladder continues to fill and expand. Eventually, it overflows, with leakage of urine (i.e., overflow incontinence). Even if urination occurs, the bladder usually does not empty completely, resulting in urinary retention.
Why Treatment Matters
If left untreated, bladder control problems can cause other health concerns, including:
Recurrent bladder or kidney infections
Urinary retention or damage to the bladder wall
Social withdrawal, anxiety, or depression due to fear of leakage
Disrupted sleep and reduced quality of life
Treatment Options For Bladder Dysfunction IN MS
There’s no one-size-fits-all approach. MS affects everyone differently, so your treatment may require a combination of strategies.
The key is to have positive support from your physician and loved ones so you can concentrate on making each day better than the last. Treatment of urinary control problems is individualized.
A urologist or urogynecologist familiar with neurogenic bladder can help tailor a plan that works for you.
Behavioral Strategies
Bladder Training
Involves scheduling bathroom trips and gradually increasing the time between them to help regain control.Fluid Management
Avoid drinking more than 2 quarts (1.89 L) of fluid per day
Reduce caffeine and alcohol, which can irritate the bladder
Time fluid intake earlier in the day to reduce nighttime trips
Pelvic Floor Therapy
Working with a pelvic floor physical therapist can help improve muscle coordination and support.
Non-Invasive Treatments
- Intermittent Catheterization – Catheterization involves inserting a tube through the urethra and into the bladder to drain urine. This practice can prevent the bladder from overfilling, eliminate residual urine, and help prevent urinary infections. Catheter design and materials have come a long way and a patient’s comfort has been improved significantly.
- Absorbent Products & Support Tools
Quality incontinence pads, underwear, and leakproof clothing offer peace of mind while you work toward better symptom control. See NAFC’s Product Finder Tool for reviews and recommendations.
Medications
Oral medications may be used to relax the bladder and reduce urgency. These include anticholinergics or beta-3 agonists.
OXYTROL® FOR WOMEN (oxybutynin transdermal patch, 3.9 mg/day) is an over-the-counter patch for women that helps control overactive bladder symptoms. For men, it is available by prescription.
BOTOX® FOR OVERACTIVE BLADDER
For people with MS experiencing urinary urgency, frequency, or urge incontinence, Botox may be a highly effective treatment.
How It Works
Botox is injected directly into the bladder wall in a brief in-office procedure. It helps relax overactive bladder muscles and reduce involuntary contractions. Relief often lasts 6–9 months and can dramatically improve symptoms.
Things To Know
- Most people notice symptom improvement within 1–2 weeks.
- Some may need to use a catheter temporarily if they’re unable to empty the bladder completely.
- Repeat treatments are typically needed every 6–9 months.
- Botox is generally well tolerated and safe when performed by a trained urologist.
Want To Learn More?
Explore our Botox for OAB page for detailed information, preparation tips, and FAQs.
Check out the Botox Savings Program for potential cost assistance.
Find a provider through the Botox Specialist Locator.
NERVE STIMULATION THERAPIES
If medication and conservative treatments don’t provide enough relief, nerve stimulation options may be considered. These treatments work by modulating nerve signals between the bladder and brain to improve communication and control.
PTNS (Percutaneous Tibial Nerve Stimulation)
A low-risk, in-office treatment that involves placing a small electrode near the ankle to stimulate the tibial nerve. This gentle electrical pulse indirectly affects bladder control.
- Sessions are usually done once a week for 12 weeks
- Each session lasts about 30 minutes
- It’s a non-surgical and well-tolerated option for many patients
SNM (Sacral Neuromodulation)
This therapy involves a small implanted device that sends electrical signals to the sacral nerves near the spine that influence bladder function.
- Often recommended when other treatments have failed.
- Typically starts with a trial phase to determine effectiveness.
- Can provide long-term improvement for people with neurogenic bladder symptoms.
There are two main SNM systems currently available:
- InterStim® (by Medtronic)
- Axonics® Sacral Neuromodulation System
Talk to your provider about whether PTNS or SNM may be appropriate for you, especially if you’ve tried medications and behavioral strategies without success.
Hear From Others
Dealing with MS and incontinence can feel isolating, but you’re not alone. Hear how Amy managed her bladder symptoms and regained control over her life.
Need Support?
NAFC is here to help. Our mission is to break the stigma around bladder and bowel health and provide you with trusted tools to manage your symptoms.
Browse our resource library for guides and checklists.
Connect with others through our message boards.
Multiple Sclerosis And Incontinence
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