Bladder Dysfunction in Multiple Sclerosis

An estimated 80 percent of people with multiple sclerosis (MS) have bladder problems related to the condition. These problems (dysfunctions) happen when nerve signals are disrupted between the brain or spinal cord and bladder muscles.^1,2

Bladder symptoms caused by MS can include:^1-3

• Leaking urine (incontinence)
• Urgency (feeling like you have to rush to the toilet)
• Trouble emptying your bladder (retention)

If you pee too much or have accidents, you know how much it impacts your quality of life and overall health. Many symptoms can be treated, depending on which problem you have.^1-4

Bladder symptoms with MS

Multiple sclerosis is a neurological (nerve) disorder. So bladder problems can get worse as the disease advances. But other things can also play a role in your bladder health, such as:^1-4

• Changes in hormones
• What you eat and drink
• Pelvic floor dysfunction
• Urinary tract infections (UTIs)

If you have MS, you need to rule out other medical problems. Talk to your doctor. If they cannot help you themselves, they should refer you to a urologist or urogynecologist.^1-4

Signs of bladder problems linked to MS include:^1-4

• Leaking urine or having accidents
• Urgency or needing to rush to the toilet
• Avoiding public places or events without a bathroom
• Planning your daily activities around your bladder symptoms
• Finding it difficult to pee when you try to go
• Retaining urine or having trouble emptying your bladder
• Waking up during the night to urinate (nocturia)

Causes of bladder problems in MS

With MS, lesions or scars can block or delay nerve signals. Some of these nerve signals control the bladder and urinary sphincters (muscles). Problems with the nerve signals can lead to a spastic (overactive) bladder. This can make you feel like you need to go all the time or cause problems with emptying your bladder.^1-4

In some cases, the bladder is unable to keep in urine as it builds up. The detrusor muscle may involuntarily contract, causing symptoms of urgency or frequency.³

In other cases, the bladder sphincter does not work properly. If it closes too soon, you may not empty your bladder all the way. If it remains partially open, it can cause leaks.³

Bladder health and quality of life

Many people ignore their bladder health or suffer in silence. An out-of-control bladder can greatly reduce your quality of life. Plus, it is important to maintain a healthy bladder for your long-term health.^1-4

Untreated bladder dysfunction can cause:^1-3

• UTIs and bladder infections, which can temporarily worsen MS symptoms
• Kidney stones or kidney damage
• Social isolation, fear of leaving the house
• Loss of independence
• Hygiene and odor concerns
• Shame, embarrassment, emotional, or self-esteem issues

Diagnosing bladder dysfunction with MS

Share your concerns with your doctor. You can ask for a referral to a specialist. A urologist experienced in MS can evaluate your symptoms and run tests. For example, ultrasound imaging of your bladder can be used to measure how much pee is left in after you urinate (called postvoid residual).^1-4

A urologist can also rule out or treat co-occurring issues, such as:^1-4

• Repeated UTIs
• Problems with how your kidneys work (renal impairment)
• Blood in your urine (hematuria)
• Kidney or bladder stones

How to manage bladder symptoms

The good news is overactive bladder and other symptoms can be treated or managed. Often, you can start with changing lifestyle habits and fluid intake. This may help to minimize your symptoms.^1-4

Other treatment options include:^1-4

• Medicine for overactive bladder
• Pelvic floor therapy and exercises such as Kegels
• Using a tube to drain your urine as needed (intermittent self-catheterization)
• Nerve stimulation treatment
• Botox injections into the bladder

People with urinary incontinence and other bladder symptoms may feel reluctant to seek treatment, due in part to shame or embarrassment. However, they often report a significant improvement in their quality of life once they start a successful treatment plan for their urinary symptoms.^1-4

Behavior and lifestyle changes for bladder dysfunction

Your doctor may suggest behavioral changes to start. Lifestyle changes can be effective depending on your symptoms. These include:^1-3

• Reducing how much you drink of bladder irritants, including coffee, fruit juices, and alcohol
• Staying hydrated by drinking mostly water
• Reducing fluids 2 to 3 hours before bedtime
• Exercising to improve control of your pelvic floor and bladder
• Reducing or stopping medicines that give you urinary side effects, such as water pills (diuretics)
• Bladder training or planned bathroom breaks