10 Ways to Take Back Control When MS Causes Bladder Dysfunction
Bladder problems are common in multiple sclerosis, but lifestyle changes, physical therapy, and medication can all help.
Bladder problems are very common in people with multiple sclerosis (MS), affecting at least 80 percent of those who have it, according to the National Multiple Sclerosis Society (NMSS). In some cases, bladder dysfunction is the first sign a person has MS.
Bladder dysfunction occurs when MS lesions — areas of damage to the myelin sheath that normally protects nerve fibers — block or delay nerve signals that control how the bladder and the muscles surrounding the bladder store or release urine, a condition called neurogenic bladder, says Kristi Epstein, APRN-CNP, an advanced practice registered nurse and a certified nurse practitioner who specializes in treating people with MS at the Ohio State University Wexner Medical Center in Columbus.
“This disruption in the nerve signal can cause the bladder to be spastic or overactive, as well as retain urine or not empty correctly; both bladder tone and sphincter control can be affected in MS patients,” says Epstein.
Why Do So Many People With MS Experience Fatigue?
In overactive bladder, the muscles controlling the bladder contract involuntarily and too frequently before the bladder actually fills with urine, according to the NMSS. This can lead to symptoms such as:
- Urgency, an intense feeling that you need to urinate immediately
- Frequency, or taking trips to the bathroom more than eight times in 24 hours
- Nocturia, or waking up at night to urinate
- Incontinence, or loss of bladder control
In underactive bladder, the bladder fails to empty completely. The muscles around the urethra (the tube through which urine exits the body) may remain contracted — even when you are trying to urinate. This can lead to symptoms such as:
- Hesitancy, or having difficulty starting to urinate
- Retention, a condition in which the bladder never empties completely
Social, Emotional, and Physical Consequences of Bladder Dysfunction
Many people with MS aren’t aware that bladder dysfunction is an MS-related issue and don’t bring it up with their doctors, says Tamara B. Kaplan, MD, a neurologist at Brigham and Women’s Hospital in Boston.
Another big problem is that doctors don’t always talk about bladder dysfunction with their patients. “It is an embarrassing and uncomfortable situation and can have a major effect on quality of life,” says Dr. Kaplan. “I’ve had patients who don’t want to leave their home because they are afraid that they will have an accident. It can be emotionally and socially isolating.”
Untreated bladder issues may also lead to loss of self-confidence and independence, according to the NMSS.
Left untreated, bladder dysfunction can lead to bladder infections or kidney damage, according to the Urology Care Foundation. The excess moisture caused by urine leakage can also make irritation and yeast infections more likely, per MedlinePlus.
Bladder dysfunction can also lead to constipation, bowel urgency, and bowel incontinence, especially when people try to self-treat by not drinking enough water, says Kaplan.
Both bladder and bowel problems can also cause sexual dysfunction. You may be worried about having a bladder accident or feel uncomfortable because you are constipated, says Kaplan. “When people have bladder incontinence, they may not emotionally feel they can engage in sexual activity,” she adds.
Bladder dysfunction can also cause problems with sleep, says Epstein.
Gaining Control of MS-Related Bladder Problems
You should talk to your provider right away if you experience urinary symptoms so that the appropriate therapy can be prescribed, says Epstein. “Early intervention leads to fewer complications and improved quality of life,” she says.
Your doctor may refer you to a urologist — a specialist in diseases of the urinary tract — for a complete checkup, diagnosis, and treatment plan. A urologist may perform urodynamic testing, or urodynamics, which examines the lower urinary tract function, including pressure, volume, and how the bladder is storing and releasing urine, according to Stanford Medicine.
“This can range from simple observation to precise measurements using sophisticated instruments to better measure how the bladder and urethra are working,” says Kaplan.
Bladder problems can often be managed effectively with certain lifestyle adjustments, medication, physical therapy, or devices. The following are some treatment options.
1. Adjusting What and When You Drink
Your body needs six to eight cups of fluids daily, but you can modify what you drink and when. Limiting your consumption of coffee, tea, and soda may help, says Epstein.
“There is no need to decrease your water intake overall; this can lead to dehydration, which can lead to constipation,” says Kaplan. She tells her patients to limit fluid intake after dinner to avoid nighttime urination.
2. Planned Times for Drinking and Urinating
Drink water at designated times during the day, and plan bathroom breaks afterward.
Bladder training (also called “timed voiding”) can be helpful, too. This technique involves keeping a journal and scheduling times to urinate, whether or not you feel the urge, says Epstein.
Double voiding is another technique that can help, the Urology Care Foundation says. To double void, urinate, wait a few minutes, then try to urinate again. Some doctors may even have simple charts or guidance that help patients learn how to map out a double void plan, like this one from Johns Hopkins Medicine.
3. Pelvic Floor Physical Therapy
Exercises that engage the pelvic floor muscles are often recommended for incontinence, according to the NMSS. A pelvic floor physical therapist can teach a person to contract, relax, and coordinate the muscles involved in bladder and bowel control, helping to normalize these functions.
RELATED: Pelvic Floor Physical Therapy for MS
4. Smoking Cessation
Smoking can be very irritating to the bladder, says Kaplan. Talk to your doctor about developing a plan and building the right support system to quit smoking.
5. Incontinence Pads and Underwear
Absorbent pads sold specifically for urinary incontinence can help a person stay dry and odor-free during the day or night. Incontinence pads are made for men as well as for women.
A lot of people use menstrual pads or adult diapers for urinary incontinence, and these can be embarrassing and uncomfortable, notes Kaplan. Next to the menstrual supplies in drugstores and supermarkets, there is usually a whole section dedicated to urinary incontinence, she says.
A variety of companies now make absorbent washable underwear for incontinence, primarily in women’s styles and sizes, although men’s absorbent underwear is also available.
If lifestyle changes aren’t effective at resolving bladder problems, prescription medication may help. You’ll need to consult a doctor to determine what works best for you.
The following drugs are used to treat various forms of bladder dysfunction:
- desmopressin (DDAVP) is a nasal spray used to reduce frequent nighttime urination.
- tolterodine (Detrol) treats overactive bladder by relaxing the bladder muscles and preventing contractions.
- oxybutynin (Ditropan) treats overactive bladder by relaxing the bladder muscles and preventing contractions.
- oxybutynin (Oxytrol) is a patch that delivers the same active ingredient as oxybutynin, but the patch version may reduce the risk of side effects like dry mouth and blurry vision.
- darifenacin (Enablex) treats overactive bladder by relaxing the bladder muscles and preventing contractions.
- tamsulosin (Flomax) is used in men to promote the flow of urine by relaxing the muscles in the prostate and bladder.
- prazosin (Minipress) is a drug for hypertension that’s used off-label in MS to promote the flow of urine through the external sphincter, a circular band of muscle fibers located just below the juncture between the bladder and the urethra.
- mirabegron (Myrbetriq) treats overactive bladder by relaxing the bladder muscles.
- trospium (Sanctura) treats overactive bladder by relaxing the bladder muscles.
- imipramine (Tofranil) and other tricyclic antidepressants can be used to relax the bladder muscles.
- solifenacin (VESIcare) treats overactive bladder by relaxing the bladder muscles.
Onabotulinumtoxin A, commonly known as Botox, is approved by the U.S. Food and Drug Administration (FDA) to treat urinary incontinence caused by overactive bladder, according to the NMSS. Injecting Botox into the bladder muscle controls spasticity, which can prevent the bladder from holding a normal amount of urine.
Increased bladder capacity reduces incontinence episodes, although some people develop urinary retention from Botox treatments and have to rely on catheterization to fully empty their bladder.
Intermittent self-catheterization (ISC) involves inserting a tiny tube through the urethra into the bladder to allow it to empty. This can be helpful for people who are retaining urine, and performing ISC one or more times a day can help with bladder leakage, urgency, and frequency, as well as nighttime urination, according to the NMSS.
9. Percutaneous Tibial Nerve Stimulation
In percutaneous tibial nerve stimulation (PTNS), a very small needle electrode is inserted into the ankle, which transmits a signal to the sacral plexus. The sacral plexus is a network of nerves that controls the bladder and pelvic floor muscles. This treatment is administered weekly over the course of three months and can reduce urinary frequency, urgency, nighttime urination, and incontinence, per the NMSS.
10. Sacral Nerve Stimulation
When other approaches haven’t helped, a treatment called sacral nerve stimulation therapy, in which a small device is surgically implanted under the skin of the upper buttock to stimulate the sacral nerves, may be effective for both overactive bladder and urinary retention.
Other surgical procedures are also available for severe bladder dysfunction, as outlined by the NMSS.
Additional reporting by Becky Upham.
Editorial Sources and Fact-Checking
- Bladder Problems. National Multiple Sclerosis Society.
- What Is Neurogenic Bladder? Urology Care Foundation. September 2021.
- Skin Care and Incontinence. MedlinePlus. February 18, 2022.
- Urinary Incontinence Diagnosis. Stanford Medicine.
- What Is Overactive Bladder (OAB)? Urology Care Foundation.
- Bladder Drills or Timed Voids [PDF]. Johns Hopkins Medicine.
- FDA Approves Botox for Treating Urinary Incontinence in MS and Other Neurologic Conditions. National Multiple Sclerosis Society. August 30, 2011.