Managing MS Symptoms

Bladder dysfunction

Bladder dysfunction (BD) is common and can be an upsetting symptom. BD can impact energy levels by interfering with sleep patterns, and the uncertainty associated with it can interfere with social activity, sometimes tying people to their homes and isolating them completely. BD can also predispose the individual to urinary tract infection (UTI), which in turn, can worsen spasticity and mobility, adding to the overall picture of disability.

BD is generally well managed and relatively minor interventions can bring big gains to the person living with MS. Changes in frequency, bladder control, amount emptied, difficulty starting to urinate, and waking at night to empty should be reported to the treating physician. BD can vary from day to day and it is not unusual to have good days and bad days, so fluctuations in function should be tracked. It is important not to limit fluid intake in an attempt to minimize bladder frequency. Limiting fluid intake concentrates urine and this can predispose individuals to urinary tract infection (UTI) and all the potential complications that UTI entails including increased spasticity, worsening of MS symptoms, and the appearance of new ones. Urinary tract infection should be considered if any of these things suddenly occur. Finally, bladder function may contribute to fatigue, particularly if it becomes necessary to get up at night to go to the bathroom, once or even several times.

BD can be caused by a few different mechanisms. A spastic small bladder can cause a failure to store urine, resulting in the need to empty often. A weak bladder can cause a failure to empty completely. This can also result in frequent voiding as unemptied urine leaves little room for the production of new. A dysfunction of the sphincter that controls the opening to the bladder can also cause incomplete emptying and frequency of the urge to void. It is not unusual for someone to experience more than one of these and sorting out the cause is important in determining the best remedy.

Tests used in diagnosing BD include a post void residual volume where one is asked to empty, and then a small catheter is inserted to see what has been retained in the bladder. A volume of more than 25-50 cc’s suggests that intervention is necessary. Sometimes more formal urodynamic studies are necessary which involves looking at things like strength of flow, sphincter function, and total bladder capacity. None of these tests are painful, and the information they offer has great potential for improving bladder function.

Key Healthcare Professionals:
Family physician, urologist, neurologist, and MS nurse.

Symptom Management:
Kegel exercises are a series of lower abdominal contractions followed by relaxation and can help to strengthen the pelvic floor which sometimes improves function.

Intermittent catheterization can be useful in failure to empty. A small clean catheter can be inserted into the bladder 3-5 times a day, or even just once, prior to bedtime. This completely empties the bladder, improving storage and resulting a longer time before it is necessary to empty again. It is painless and simple to do. It is not a sterile procedure and can be done anywhere.

There is a variety of medications that can offer significant relief, but the determination of which to prescribe requires clear identification of the problem causing the symptoms.

Other Resources:

Urinary Dysfunction and MS: A guide for people with multiple sclerosis
MS Society of Canada publication.

Learning for Life: Managing MS-related Bowel and Bladder
Audio education session offered on the MS Society of Canada website.

An MS Society of Canada website that provides information on a variety of topics. Information is provided by a range of North American experts who respond to inquires from individuals affected by MS.

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