Asking the Embarrassing Questions: My Interview with a Urologist

I have struggled with bladder symptoms since being diagnosed with 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. I recently interviewed a colleague of mine who is a fantastic urologist, Dr. Dana Rice, 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 synch. Urination requires complex communication between neural circuits in the brain and the spinal cord and the muscles in the bladder and urethra.1 Neurogenic bladder is a term we use when a person has bladder dysfunction because of a neurological issue, like MS.

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

Common symptoms can include:

  • 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. As many as 52-97% of MS patients experience bladder symptoms, and 37-72% of people with MS experience incontinence at some point.2 That is a significant portion of the MS community! Additionally, many people have asymptomatic bladder issues, which can be dangerous because they are unaware there is an issue. In fact, one study demonstrated that 100% of MS patients studied with urodynamics (a test that can diagnose bladder issues) had positive findings, despite only 52% of the patients reporting urologic symptoms.3

Many early signs and symptoms of multiple sclerosis (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 symptoms of an undiagnosed neurological disease, like MS. It is important for patients to recognize and be evaluated early for bladder issues.

Q: I was really surprised to learn just how common bladder symptoms are, and often they can go unnoticed. It really is nice to know that I’m not alone in this. If a person living with MS suspects they have bladder dysfunction, what should they do?

Early diagnosis and prevention strategies should be a goal for all MS patients. 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 work up may consist of obtaining a urine sample, getting pictures of the kidney and ureters, urodynamics (explained below), and/or 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 including overactivity of the bladder muscle (neurogenic detrusor overactivity), being unable to relax the sphincter that allows urine to flow out of the bladder (detrusor-sphincter dyssynergy), or lack of nerve signaling by the bladder muscle (areflexia).1 It is critical to find the underlying issue, so that we can treat it effectively.

The test itself involves a small catheter into your urethra and anus. The bladder is then filled and and urination is monitored with small stickers similar to those used for EKG (heart tests). Urodynamics is more awkward then 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.

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. Medications and behavioral management are often first steps. It is important to discuss lifestyle habits and goals with your physician to establish long-term care plans. There are also a variety options ranging from clean intermittent catheterization to surgical interventions. Surgical intervention such as permanent catheter (suprapubic tube), urinary diversion or neuromodulation procedures can also help certain people.

Q: I was initially very hesitant to see a urologist, but ultimately I’m very glad that I did. What could have happened if I didn’t seek treatment?

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 include:

  • 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 health care team is crucial for long-term health in chronic illnesses. There are many urologic interventions and strategies that can be utilized to help prevent UTIs, incomplete bladder emptying and more serious complications. Individual strategies should be reviewed with your practitioner, but may include timed voiding, avoiding antibiotics for asymptomatic infections, good bowel regimens, urinary catheterization, and 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
This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
  1. Wein, AJ: Chapter 59: Lower Urinary Tract Dysfunction in Neurologic Injury and Disease. In Kavoussi LR et al(eds): Campbell-Walsh Urology, 9th edition. Philadephia, PA, Saunders an imprint of Elsevier Inc. 2007, pp 1922, 2156.
  2. Wyndael, J.J., Casto, D., Madersbacher, H., et al: Neurogenic and faecal incontinence. In Abrams, P. et al (eds): Incontinence, ed 21. Paris, Health Publications LTD, 2005, pp 1059-1162. Retrieved from https://www.ics.org/Publications/ICI_3/v2.pdf/chap17.pdf
  3. Litwriller, S.E., Frohman, E.M., Zimmern P.E. (1999) Multiple Sclerosis and the Urologist. The Journal of Urology, 161:743-757.

Comments

View Comments (5)
  • Azjackie
    1 year ago

    35 years LuvMyDog?! For me almost 10 years and many many days where I fall, crawl, or have intense, drop me to my knees, mid back pain (more with than without) I wish I didn’t have another day. I wish I could have an ouce of your attitude. Really.!

  • itasara
    1 year ago

    Phone correction, cave should say team.

  • itasara
    1 year ago

    Yeah couple other small errands phone communication that I missed but I think you figure it out. I try but sometimes my phone changes things right after I’ve sent them or I missed them just before I sent him and it just takes a long time as it is.

  • itasara
    1 year ago

    I agree with the poster LuvMyDog. I could not have said it better myself. I’ve had over active bladder and stress incontinence for a long time. The stress incontinence I probably had before I ever knew about or thought I would ever have MS. I remembered that my mother had stress incontinence also and she did not have MS. She was probably in her 60s that I remember a specific incident when she had stress incontinence, but she probably had it earlier than that under a certain incidences like laughing or running around etc. I’ve had MS 12 years that I know of and OAB has gotten a little worse at times, but on the other hand I’ve gotten much older! These conditions are a sign of old age as well as MS. Both situations could be causing the symptoms, but when I ask my gynecologist he said there’s no way to know for sure. When I mentioned a few years ago about my urinary symptoms to my neurologist he said, “not my area of expertise,” talk to your gynecologist. So I guess he’s not an MS specialist but today everybody needs a specialist if you have a specific area of the body that needs to be dealt with. So my gynecologist has given me medication, but I don’t use it all the time because I am a singer and I don’t want to dry out my vocal cords which you can do. I also find that I can take it or even part of a pill which works for a while. Can I stop taking it and I’m OK for a while. Right now I have not been on it for many months and once in a while usually when I’m home I cannot make it to the bathroom but it doesn’t happen all the time and I’m living with it. The idea of a cave is a great idealogical one. Sounds “team” is not very practical. It just doesn’t work that way at least from where I am. Anyone I get referred to has to be from my internist and then I need a referral for most doctors. It’s a lot of paperwork and a lot of extra time. I don’t think doctors get together like that used to back in the day to discuss patients. They hardly have time to talk to each other as it is. I know this for a fact. Once in a while one may contact another. It is not ideal like all the team approach iI’ve read about in different MS groups and boards that I belong to. I hate to sound pessimistic about it all but that is the reality as I see it.

  • LuvMyDog
    1 year ago

    I was diagnosed with MS 35 years ago. I have had bladder problems for almost as long. I am sorry to say, I can’t see the point in making a big deal out of it, what good does it do. MS brings about many problems in our lives and I have found in 35 years of struggling with this monster that a more positive attitude is the only thing that helps in the long run. If I ran to the doctor each and every time a UTI hits, about once a month or so….I’d be forever running to a doctor, taking a medication that was merely a temporary band-aid until the next time. In 35 years…..that’s a lot of “next times”. If I ran to the doctor each and every time I started wetting my pants without any warning, I’d be running to the doctor about once every two months or so…so that would be at least 6 times a year….for doing a little “leaking”. It goes on and on…nothing is ever going to help all that much. I have learned to deal with it all, live with it and say the he// with it each time and wait for a week or two or three until MS has had it’s monthly laugh and decides to give me a break for awhile. Complaining never helps, dealing, looking for a way to get through the aggravating times is the only way to manage and I’m not going to fund a doctor’s vacation account to do so.

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