Urinary Symptoms of Multiple Sclerosis

Symptoms can impact long-term health and quality of life

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Bladder dysfunction is probably one of the symptoms of multiple sclerosis (MS) you are least likely to share with friends or family. After all, it’s one thing to complain about nerve pain or vision problems; it’s another to discuss urinary incontinence or feeling like you have to go all the time.

As frustrating as the symptoms may be to you, it is important not to ignore them. There are many medical treatments available today that can improve urinary function, while simple dietary and lifestyle "fixes" can help you better manage your symptoms, often with minimal stress or impact on your life.

Overview

Bladder dysfunction occurs in at least 80 percent of people living with MS. Moreover, up to 96 percent who have had the disease for more than 10 years will experience urinary complications as a result of their condition.

Multiple sclerosis is characterized by an abnormal immune response which causes damage to the protective covering of nerve cells (known as the myelin sheath). This damage results in the formation of lesions on the brain and/or spinal cord which, in turn, interferes with the nerve impulses which regulate movement, vision, sensations, thought processes, and bodily functions like bladder control.

Causes

Bladder dysfunction in MS happens when electrical signals to the bladder and urinary sphincter are delayed or obstructed by lesions which develop on the spinal cord. Dysfunction can occur for three reasons:

  • The bladder is spastic, making it less capable to hold urine.
  • The sphincter is spastic, preventing the bladder from emptying completely.
  • The bladder is flaccid and unable to contract, leading to urine retention.

Signs and Symptoms

The symptoms of bladder dysfunction can vary by the extent and location of the lesions. In some cases, the symptoms will be mild and transient. In others, they may be persistent and aggravating. The urinary symptoms can be described in one of four ways:

  • Hesitancy is the difficulty in urinating when you feel the need to. For some, it may take a long time to begin while others are unable to maintain a constant flow.
  • Urgency is the sudden, strong need to urinate accompanied by an uncomfortable rush of fullness in the bladder.
  • Frequency is the need to urinate much more often than usual. This often happens at night, causing sleep disturbances.
  • Incontinence is where you are less able to control urinary function.

If bladder dysfunction is left untreated, it can cause permanent damage to the urinary tract. Urinary stones and urinary tract infections (UTIs) can often develop if the bladder is unable to empty. Chronic leakage can also lead to localized skin infections. In severe cases, potentially deadly urosepsis may develop if a urinary infection spreads into the bloodstream.

Just as frustrating is the impact of bladder dysfunction on a person’s peace of mind and lifestyle. It is not uncommon for people with bladder control problems to isolate themselves or restrict their daily routines, often adding to the burden of depression frequently seen in people with MS.

Diagnosis

When investigating bladder dysfunction, doctors will often begin by screening for UTIs.

If positive, antibiotic treatment will be prescribed. If not, other tests (known as a urodynamic assessment) would be performed to evaluate how the bladder and urethra are performing their job of storing and releasing urine.

A urodynamic assessment takes around 30 minutes to perform and involves the use of a small catheter to fill the bladder and record measurements.

Treatment Options

As distressing as bladder dysfunction can sometimes be, urinary symptoms can usually be managed successfully with medications, lifestyle modifications, and other therapies. Some of the more common therapies include:

  • For patients with spastic bladder: Bladder relaxants, such as Ditropan (oxybutynin), Detrol (tolterodine), Enablex (darefenasin), Toviaz (fesoterodine), Vesicare (solifenacin), Sanctura (trospium chloride) and Myrbetriq (mirabegron).
  • For patients with an overactive bladder sphincter: Alpha-adrenergic blocking agents, such as Flomax (tamsulosin), Uroxatral (alfuzolin), Cardura (doxazosin) and Rapaflo (silodosin), are used to promote the urine flow through the sphincter. In addition, antispastic drugs, such as Lioresal (baclofen) and Zanaflex (tizanidine), can be used to relax the sphincter muscle.
  • For patients with a flaccid bladder: Intermittent self-catheterization, wherein a thin tube is inserted into the bladder to better enable allow urination. 

Other forms of treatment include behavioral therapies which teach individuals how to regulate fluid intake and strategically schedule urination while at home, work, or social engagements.

Dietary strategies include the restriction of caffeine, alcohol, and orange juice (the latter of which promotes bacterial growth) and the use of cranberry juice or tablets (which inhibit bacterial growth).

More severe cases may require surgical procedures, including an electrical implant, called an InterStim, which stimulates the sacral nerves and helps treat an overactive bladder. Botox can also be used to treat an overactive bladder.

Sources

National Multiple Sclerosis Society. "Urinary Function and MS." New York City; 2016.

Williams, D. "Management of bladder dysfunction in patients with multiple sclerosis." Nurs Stan. 2012; 26(25):39-46.