Multiple sclerosis and bladder dysfunction
Multiple Sclerosis (MS) is a disease of the nervous system and is likely to affect your
bladder and bowel function. It is common in newly diagnosed patients as well as
people who have had the disease for many years. Your bladder and bowel
dysfunction will be classed as “neuropathic” or “neurogenic”.
This leaflet aims to explain the main types of bladder dysfunction associated with
MS. Remember, you can also suffer from other types of bladder and bowel
dysfunction e.g. stress incontinence (associated with childbirth) or poor urinary flow
in men (associated with prostate enlargement). Assessment of your bladder and
bowel dysfunction is important in identifying the type of dysfunction and appropriate
treatments. This should be by a health professional trained in this specialty.
Overactive bladder
This is also known as an “irritable bladder” or “bladder spasm” and all these terms
describe the over activity of your bladder muscle. Your bladder only tolerates small
amounts of urine before it starts to contract. The main symptoms that you may
experience are urgency to pass urine, going to the toilet a lot during the day
(frequency), using the toilet more than once at night (nocturia) and incontinence
(urge incontinence) because you do not make it to the toilet in time.
Medication is available to help control detrusor instability, such as Oxybutynin and
Desmospray. It is also useful to trial only having drinks which do not contain caffeine
as it often irritates detrusor instability.
Dyssinergia
Dyssinergia is when you feel the need to pass urine and you go to the toilet but you
cannot pass it. This is called “dyssinergia” and means that the nerves that supply
your sphincter (a ring-like band of muscle which closes the bladder neck) and
bladder muscle (detrusor) are not working in harmony. This results in the inability to
pass urine when you need to. Dyssinergia may be short-term and come and go and
you may be able to pass urine later on.
You will need to learn about methods to help you empty your bladder. Ask for our
leaflet on Bladder emptying techniques. If the dyssinergia becomes troublesome then
intermittent catheterisation may help.
Incomplete voiding
The nerve pathways which keep the contraction of the bladder muscle (detrusor)
going can be damaged resulting in only a proportion of your urine being passed.
This will leave you with a residual urine left in your bladder after you have used the
toilet. Residual urines of 100mls or more are likely to cause problems. Symptoms
associated with incomplete voiding can include increased toilet use by day and night,
urgency to use the toilet, passing smaller amounts of urine and increased
incontinence (called urge incontinence).
You should have a post void residual bladder scan undertaken at least every six
months to check your residuals. If your urinary symptoms are worsening then a
bladder scan is indicated urgently.
Medway Community Healthcare CIC providing services on behalf of the NHS
Registered office: 5 Ambley Green, Bailey Drive, Gillingham, Kent ME8 0NJ
Tel: 01634 382777
Registered in England and Wales, Company number: 07275637
Bladder emptying techniques may also be useful with incomplete voiding.
Intermittent catheterisation may also be indicated if your residuals are high and
symptoms are bothersome.
Constipation
It is common to suffer from constipation when you have MS. Constipation can worsen
your bladder symptoms and so it is important to aim at three motions per week. Ask
for our leaflet on Bowel emptying techniques.
Fluid intake
Reducing your fluids to cope with your bladder problems is a common practice. If you
wish to restrict your fluids at times of social need or while travelling this is
understandable. Try to have about 1½ litres of mixed fluids in every 24 hours and
compensate for any that you miss at specific times.
Please remember:
It is possible to have all of the above types of dysfunction together or separately.
You may have periods when the symptoms are present and periods when they are
not (such as when your symptoms are in remission). If your multiple sclerosis
deteriorates then you can expect your bladder and bowel function to also be affected.
To monitor and treat your bladder and bowel problems it is strongly recommended
that you contact your MS specialist nurse or continence care to arrange an
assessment.
Other sources of information are:
The Bladder and Bowel Foundation
SATRA Innovation Park, Rockingham Road, Kettering, Northants NN16 9JH
Tel: 01536 533255
Email : [email protected]
Website : www.bladderandbowel foundation.org
PromoCon (Continence products)
Disabled Living, St Chad’s Street, Manchester, M8 8QA.
Tel: 0161 834 2001
Fax: 0161 214 5961
Email : [email protected]
Website : www.promocon2001.co.uk
Who to contact if you have any questions about this information:
Continence Care, Keystone, Gun Lane, Strood, Kent ME2 4UL Tel: 01634 719252
Customer care Please send any comments about Medway Community Healthcare
services to: Customer care manager, Medway Community Healthcare
7-8 Ambley Green, Bailey Drive, Gillingham, Kent, ME8 0NJ
p: 01634 382266 f: 01634 382700
[email protected] All contact will be treated confidentially.
Leaflet reference: MCH305
Medway Community Healthcare CIC providing services on behalf of the NHS
Registered office: 5 Ambley Green, Bailey Drive, Gillingham, Kent ME8 0NJ
Tel: 01634 382777
Registered in England and Wales, Company number: 07275637
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and who agree to keep your information confidential. For your direct care we often
share information with NHS hospitals and clinics, GPs and social care.
Leaflet reference: MCH305
Medway Community Healthcare CIC providing services on behalf of the NHS
Registered office: 5 Ambley Green, Bailey Drive, Gillingham, Kent ME8 0NJ
Tel: 01634 382777
Registered in England and Wales, Company number: 07275637