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 MS lesions in the brain and/or spinal cord.
There are basically two major muscles involved in emptying the bladder: the detrusor muscle and the sphincter muscle. As a result of MS, the detrusor muscle in the wall of the bladder involuntarily contracts, increasing the pressure in the bladder and decreasing the volume of urine the bladder can hold. This causes symptoms of going frequently, urgently, leaking urine, or interfering with a good night’s sleep.
In other words, the inability to store or hold urine in the bladder occurs when the bladder is unable to retain urine when it accumulates. Instead of expanding when urine collects, the bladder involuntarily contracts, which can make you feel as if you have an urgent need to go to the bathroom much of the time – even when there isn’t much urine in the bladder.
The flow of urine is controlled by the sphincter in the bladder, the muscle which relaxes to open and contracts to close. An inability to empty means that even though a person senses that his bladder is full, the nerve impulse telling the muscle to open is interrupted and never reaches the urinary sphincter, and the sphincter muscle closes before all the urine is emptied from the bladder. If you’re not emptying your bladder completely, you might feel the urge to void often but have hesitancy when you try to void. You may also wake up at night often to void since the bladder is not completely empty during the day. Bladder infections or urinary tract infections (UTIs) can occur if urine, which is a waste product, sits in the bladder too long.
Leakage of urine can occur in some cases when the sphincter remains at least partially open, resulting in involuntary leaks. Sometimes the detrusor muscle and the sphincter muscle do not work in coordination and a person with MS can experience many bladder symptoms.
Many behavior modification techniques may be used to manage bladder symptoms. Here are a few suggestions:
- Drink 48 to 64 ounces of fluid a day (one and a half to two quarts) to keep well hydrated. Water is best.
- Drink six to eight ounces of fluid at regular intervals and then urinate on a regular schedule, rather than waiting for the urge. It takes about one and a half hours for fluid that you drank to get to the bladder, so try to void by the clock, every one and a half to two hours.
- Limit the amount of caffeinated beverages, alcohol, and orange juice. It’s okay to have one cup of coffee or tea, but remember that caffeine can cause you to void more frequently and more urgently. Alcohol is also a bladder irritant.
- Stop smoking (yes, smoking is a bladder irritant too).
- Don’t try to self-treat your bladder problems by drinking less fluid! This can lead to constipation and/or urinary tract infections.
Assessing how your bladder works first involves a simple screening for a urinary tract infection (UTI), which is very common in MS and can cause many of the symptoms mentioned. If you have an infection, you will be treated with antibiotics to clear up the infection and symptoms may improve.
If you do not have an infection, then further evaluation of how your bladder works is important before suggesting treatments. After proper assessment, medications might be prescribed to allow the bladder to hold more urine or empty better. There are many medication options on the market now, so don’t get discouraged if one doesn’t work or causes too many side effects.
Another intervention is to learn the technique of intermittent self-catheterization to allow the urine to flow and empty the bladder if you are not emptying completely. Intermittent catheterization (IC) is a safe procedure that can help bring your urinary symptoms under control. Many people self-catheterize and report that it has improved their quality of life. It will allow you to completely empty your bladder at regular intervals, protect your kidneys from infection and damage, lower the risk of distending (stretching) the bladder, and eliminate the need for wearing a continuously draining catheter. However, some individuals would benefit from an indwelling catheter (Foley catheter) for a short period of time.
Other interventions can be offered by a urologist, including a suprapubic catheter. This is another type of urine drainage catheter that is surgically inserted into the bladder so that urine can drain out. Instead of urine being passed through the urethra opening as usual, the suprapubic catheter is inserted through the abdominal wall just above the pubic bone and into the bladder.
There are also other surgical procedures that might be recommended by a urologist. More recently, Botox injections into the bladder have been approved by the FDA to help with managing symptoms.
The message here is that bladder symptoms can be treated once these symptoms are discussed openly and proper assessment is completed. It’s important to share your concerns with your healthcare providers; if they are not able to help, ask for a referral to someone who can help. You may need a referral to a urologist to treat bladder symptoms.
Bladder medications for failure to store:
- Ditropan® and Ditropan XL® (oxybutynin)
- Detrol® and Detrol LA® (tolterodine tartrate)
- Vesicare® (solifenacin)
- Enablex® (darifenacin)
- Levsinex® (hyoscyamine)
- Flomax® (tamsulosin) and other antihistamines
- Hytrin® (terazosin); Minipress® (prazosin)
- DDAVP (desmopressin)
- Botulinum Toxin (Botox®)
- Myrbetriq® (mirabegron)
- Toviaz® (fesoterodine fumarate)
Medications to treat bladder infections:
- Bactrim® (sulfamethoxazole/trimethoprim)
- Septra® (sulfamethoxazole/ trimethoprim)
- Cipro® (ciprofloxacin)
- Macrodantin®, Macrobid® (nitrofurantoin)
Written by Marie A. Namey, APN, MSCN
Advanced Practice Nurse
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic
This content originally appeared in the Summer/Fall 2013 issue of The Motivator.