Asking the Embarrassing Questions: My Interview With a Urologist

I have struggled with bladder symptoms since being diagnosed with multiple sclerosis (MS), and I know I am far from being alone! I not only live it firsthand, but as an MS specialist, I spend a lot of time talking about bladder frequency, urgency, hesitancy, infection, and incontinence with my patients. Bladder dysfunction can hold us back and keep us isolated from the activities we once enjoyed, yet many people are afraid to face their symptoms head-on.1

I recently interviewed a colleague of mine, Dr. Dana Rice, who is a fantastic urologist to get her take on MS-related bladder issues, and what we should be doing about them.

Q: Why does MS affect the bladder?

The bladder is a surprisingly complex organ that requires nerves, neurotransmitters, and muscles to work in sync. Neurogenic bladder is a term we use when a person has bladder dysfunction because of a neurological issue, like MS.1

Q: What are the most common symptoms of MS-related bladder dysfunction?

Common symptoms can include:1

  • Recurrent urinary tract infections (UTI)
  • Incomplete bladder emptying
  • Urinary frequency
  • Urinary urgency
  • Urinary hesitancy
  • Urinary incontinence
  • Urinary retention

Bladder issues can present in many ways and have devastating medical and social consequences. Many people with MS experience bladder symptoms.1

Many early signs and symptoms of MS are overlooked or minimized by patients. As a urologist, I see a wide variety of patients with urinary dysfunction. Occasionally I will see a patient for a seemingly common issue that turns out to be a symptom of an undiagnosed neurological disease, like MS. It is important for patients to recognize and be evaluated early for bladder issues.

Q: What should people with bladder dysfunction do?

Early diagnosis and prevention strategies should be a goal for all people with MS. Speak to your neurologist about your concerns, and schedule an appointment with a urologist. Establishing a baseline for your urinary health is an essential first step.

The doctor will help determine what, if any, bladder problems you have. Your urologist will then determine what testing is necessary. A general workup may consist of:

  • Obtaining a urine sample
  • Getting pictures of the kidney and ureters
  • Urodynamics (explained below)
  • Cystoscopy (using a scope to look into the bladder)

Q: What are urodynamics? Does the testing hurt?

Urodynamics are important because they help determine the type of problem, if any, you are having. Bladder dysfunction in MS can occur for different reasons. It is critical to find the underlying issue so we can treat it effectively.2

The test itself involves a small catheter into your urethra and anus. The bladder is then filled, and urination is monitored with small stickers similar to those used for EKG (heart tests). Urodynamics are more awkward than painful. Please be aware that we perform these tests frequently and will try our best to make you comfortable at all times. If you are feeling uncomfortable, please let us know.2

Q: What treatments are available for bladder issues?

Once patients have a diagnosis of bladder dysfunction, treatment is tailored for optimal medical health and ease of care. Medicines and behavioral management are often the first steps. It is important to discuss lifestyle habits and goals with your doctor to establish long-term care plans.

There are also a variety of options ranging from clean intermittent catheterization to surgical interventions. Surgical interventions like a permanent catheter (suprapubic tube), urinary diversion, or neuromodulation procedures can also help certain people.1

Q: What happens when the dysfunction is left untreated?

Just like MS can be a progressive disease, bladder dysfunction can become worse and change over time, especially if left untreated. Establishing a baseline and having regular follow-ups will allow your doctor to help implement care strategies early, which can help prevent many long-term issues.

Complications of untreated bladder dysfunction can include:1

  • Frequent UTIs
  • Drug-resistant UTIs
  • Urinary incontinence
  • High-pressure voiding
  • Kidney disease
  • Kidney stones
  • Non-compliant bladder

Q: What can those of us with MS do to prevent long-term problems?

Just like every person with MS is different, every bladder is different. Establishing a good healthcare team is crucial for long-term health in chronic illnesses. Many urologic interventions and strategies can help prevent UTIs, incomplete bladder emptying, and more serious complications.

Individual strategies should be reviewed with your doctor but may include:

  • Timed voiding
  • Avoiding antibiotics for asymptomatic infections
  • Good bowel regimens
  • Urinary catheterization
  • Pelvic floor exercises

Q: Are there any tools to help me control my symptoms?

Most of my patients have a smartphone, so I recently developed a mobile app that can help people track and minimize their bladder symptoms and infections. The UTI Tracker has an alarm to remind you to empty your bladder regularly, a voiding diary to help record intake and output, an education center to review urinary health issues and prevention, as well as a daily symptom tracker for voiding dysfunction symptoms and antibiotic use. You can learn more about it here.

Q: What other resources do you recommend?

  • Urology Care Foundation: The official foundation of the American Urologic Association and a wonderful resource for voiding dysfunction
  • National Multiple Sclerosis Society: Easy-to-read overview of bladder dysfunction

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