Bladder dysfunction occurs in most people with multiple sclerosis (MS). MS lesions disrupt the nerve signals that control the bladder and urinary sphincter (the muscle that regulates urination). Sensations in the bladder can also be affected.

These changes can result in a person not feeling the need to urinate, or wanting to urinate with great urgency or frequency – leading to incontinence (having an “accident” on the way to the toilet).

Nerve damage may also prevent the bladder emptying properly, often with reduced flow. You may have the persistent feeling that your bladder hasn’t been completely drained.

A “spastic” bladder, which is unable to hold the normal amount of urine, can lead to overflow incontinence and other problems, such as infections.

Bladder symptoms can occur during the day or night. (It should be noted that bladder problems are extremely common even among people without MS, and may not be due to the disease.)

These problems can be embarrassing and cause anxiety, affecting everyday activities, social life and personal hygiene. Fortunately, treatments are available:

• For over-frequent urination, certain medications can make the bladder less sensitive.
• Drugs are available to stabilise bladder muscle contractions. They are generally given orally or as a skin patch, or sometimes by catheter.
• A catheter is a thin tube that enters the bladder and drains urine. In self-catheterisation, you will need to learn how to insert the catheter via your urethra when required. If this is too difficult, an indwelling catheter is a longer-term solution – it is left in place, and drains by a valve or into a bag. The catheter must be changed regularly. Suprapubic catheters are even more permanent, and can be more convenient: they’re inserted by minor surgery through the abdomen into the bladder.
• Injected Botox will paralyse or weaken specific muscles (such as the bladder wall). This can reduce incontinence, with effects lasting up to a year.

Failing these medical approaches, the following strategies can help to minimise bladder problems:

• Retraining exercises can strengthen the bladder and increase its capacity.
• Keeping fit will have a good effect on bladder muscle control.
• Avoid constipation, which can affect the bladder.
• Don’t force yourself to empty your bladder too often – this “habit” can make it over- sensitive.
• Avoid caffeine if you’re urinating too often.
• Cranberry juice is said to help to prevent urinary tract infections.
• Find ways to manage unavoidable incontinence – e.g. absorbent pads, protective bed sheets.

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