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ARTICLEMS

How to Manage MS Bladder Issues

By Erica Patino
Reviewed by Dana Cooper, M.D.
October 21, 2022

Multiple sclerosis (MS) commonly causes symptoms like fatigue, pain, numbness, and tingling, among others. But this condition of the central nervous system, which affects the brain and spinal cord, can also lead to additional issues throughout the body, including problems with the bladder. In fact, bladder issues affect at least 80% of people with MS, according to the National Multiple Sclerosis Society.

When a bladder is functioning normally, the nerves controlling the organ communicate with the brain through the spinal cord. “Since multiple sclerosis affects not only the brain but the spinal cord, it essentially damages these neural pathways,” says S. Adam Ramin, M.D., board-certified urologist and medical director of Urology Cancer Specialists in Los Angeles. “Because of that, the bladder doesn't function properly.”

Common MS Bladder Symptoms

MS can affect the bladder in a few different ways. “Basically, there are two manifestations,” says R. Mark Ellerkmann, M.D., director of urology at Mercy Medical Center in Baltimore. “If you think about the bladder, it's either a storage problem or an emptying problem.” MS bladder symptoms can include the following:

  • Incontinence. A lack of bladder control can cause you to urinate when you don’t want to. This can range from leaking a few drops to wetting yourself because you can’t get to the bathroom in time.
  • Frequency. This can mean going to the bathroom far more frequently than every few hours.
  • Nocturia. You may need to get up several times at night to urinate, which disrupts your sleep.
  • Hesitancy. You may feel like you have to go, but when you try, you have trouble starting.
  • Retention. When you urinate, you may be unable to empty your bladder completely.

It can be common for people with multiple sclerosis to experience all these issues at different times. “What happens in MS is a person may actually go through bouts of retention and bouts of incontinence, and they may be well for a while, and then the cycle may start again,” Ramin says, noting that the symptoms may depend on which areas of the spinal cord are affected.

Complications of Bladder Problems

MS urinary issues also mean a much higher risk of developing urinary tract infections (UTIs), which, left untreated, can lead to kidney problems. UTIs can also make your MS symptoms worse by causing pseudo-relapses.

Dealing with MS bladder problems can feel frustrating or defeating, which can lead to emotional issues in some people. “Adults who have had control of their urination all their life who, all of a sudden, are facing issues of incontinence or retention can become angry, stressed, and anxious over their situation,” Ramin says. Both depression and anxiety are common in those with MS bladder issues, according to Ellerkmann and Ramin.

How to Treat MS Bladder Issues

If you’re dealing with MS bladder problems, don’t keep them to yourself. “If you’re having bladder symptoms, give that information to your healthcare provider so you can be referred for appropriate diagnosis and treatment,” says Barbara Giesser, M.D., a board-certified neurologist and MS specialist at Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, California.

Your neurologist will likely refer you to a urologist, who can prescribe treatments such as:

  • Lifestyle modifications. Lifestyle changes such as avoiding caffeine and alcohol, training your bladder to go on a schedule, and reducing fluid intake before bed are all steps that may help.
  • Pelvic floor exercises. Pelvic floor physical therapy can be helpful for incontinence to improve muscle control needed for urine retention. Some research suggests that pelvic floor physical therapy may lead to significant improvements in control over leakage in people with MS.
  • Percutaneous tibial nerve stimulation. During this treatment, a small needle electrode inserted in the ankle transmits a signal to bladder and pelvic nerves to reduce urinary frequency, nighttime urination, and incontinence. One study found that 89% of people were satisfied with the results of this treatment.
  • Intermittent self-catheterization. If you have difficulty emptying, using a catheter one or more times a day may help you more fully empty your bladder.
  • Medications. There are several different medications your doctor can prescribe for bladder symptoms, depending on whether you’re experiencing incontinence or retention.

Once you’ve met with a urologist, they will likely want to see you every three to six months to monitor your treatment and adjust it as needed, especially if your MS bladder symptoms have changed. “If you have bladder issues, you don't have to feel like it's a lost cause and you just have to live that way,” Ramin says. “There are ways that urologists can help.”

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