MS and Continence

Answers to your questions

Many people with MS have some problems with continence, although the nature of these problems differs as widely as an individual’s course of progression. Early on in the disease there may be very few difficulties: a little more urgency, some difficulties with control. Later in the disease process these problems may become more substantial. One important thing to remember, you may have nothing more than a bladder infection (or an infection may be making your symptoms worse) so be sure to discuss any difficulties or changes with your doctor and don't just assume that all your difficulties are being caused directly by the MS itself.

How does MS affect continence?

Urinary control is very closely linked to particular nerves in the spinal cord, If these nerves are damaged by MS, urinary control can be affected. Normally the bladder fills gradually, and then signals are sent via the spinal cord to the brain that you should urinate; once you are in a position to urinate, signals are sent back to contract some muscles and relax others to release the urine. In MS this flow of signals backwards and forwards to and from the brain can be interrupted, distorted or destroyed.

What types of symptoms might I experience?
Urinary control problems generally break down into difficulties in stopping evacuation and difficulties in starting evacuation:

Frequency: You may need to urinate more often than before. If you experience frequency at night, i.e. needing to urinate several times during the night, it is called nocturia.

Urgency You may need to urinate immediately.

Incontinence You may urinate involuntarily - either just dribbling a little, or sometimes more.

Hesitancy You may find it difficult to begin to, or to continue to urinate.

Voiding You may fail to empty your bladder completely.

A number of these problems may occur at the same time, with the nervous system failing to coordinate the necessary muscles. For example, it is possible to have both urgency and hesitancy at the same time, where there is an urgent need to urinate but you still cannot easily do so. Many people with MS have one or more of these problems, either on a temporary or continuing basis. In general the more serious the MS, the more serious your urinary symptoms are likely to be.

What do I do?

Losing bladder control can be embarrassing. Just remember—you are not the first (or the last) person to have to deal with this. Talk to your doctor and discuss the problem. Don't suffer in silence! There are medications, techniques, devices, and exercises that can help. Here are just a few ideas…

• Keep a "bladder diary" so when you see the doctor they can discuss
  your exact issues

• Do exercises to strengthen the muscles of your pelvic floor.
  
  
• Remember, when you have something to drink it takes 1 1/2 to 2 hours to reach the bladder so plan accordingly.
  
  
• Discuss different medication options with your doctor.
  
  
• Plan ahead whenever you leave home and ensure that there are always toilet facilities within easy reach.
  
  
• Use a protective pad to absorb urine in case you have 'an accident'.
  
  
• Keep a drawer or basket in the bathroom (or your bag or office) with a supply of fresh underwear.
  
  
• DO NOT decrease your fluid intake as a means of controlling continence problems!!!

• If you have problems with hesitancy, be patient! Urination often begins after a couple minutes.
  
  
• Sometimes tapping very lightly on your lower abdomen - but not too hard - will help
  
  
• Try turning a tap on and hearing the sound of running water!
  
  
• Discuss intermittent self-catheterization (ISC) with your doctor.
  
  
• Discuss medication options with your doctor.

Will my urinary problems ever get better?

The symptoms of MS are unpredictable, and thus no single pattern emerges. Remissions may be associated with your symptoms getting better for a period of time, and on a day-to-day basis the symptoms can fluctuate with 'good days' and 'bad days'. Remember, everyone is different and will have different symptoms and courses of progression. Figure out what strategies and treatments work best for you and keep the lines of communication open with your doctor. Things change every day!

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