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Difficulty Controlling Urine

Multiple Sclerosis: MS-Related Bladder Control Problems

One of the problems that occurs in people who have MS is loss of bladder control—wetting the pants or the bed. The cause of this is a breakdown in the transmission of signals between the brain and the bladder.

Discouraging? Yes. Embarrassing? Yes. Inevitable? No! Though this problem is all too common among MS patients (roughly 80% of MS patients have it), the good news is that there are ways to control it.

Most Common Types of Bladder Control Problems

Let’s take a look at the most common types of bladder-control issues that MS patients are faced with:

  • Urinary urgency. We all know the feeling that tells us, “I’d better go and pee now.” People with urinary urgency experience that feeling often and feel it strongly. What’s more, urinary urgency not only causes the sensation of needing to urinate but also may cause urination to begin before the person can get to the bathroom.
  • Incontinence. Incontinence is the loss of bladder control—wetting the pants or the bed. This may occur with or without your first feeling the need to urinate. The brain and the bladder “talk to each other” by way of nerve signals, but MS can create an interruption in the flow of those signals, somewhat like jamming a radio frequency. The result is that the signals don’t travel back and forth the way they should, and as a consequence, the MS patient may find herself or himself emptying his/her bladder partially or totally.
  • Nocturia. Nocturia is the medical term for the need to get up often during the night to urinate. This is inconvenient, annoying, and sleep-disruptive. Nocturia has various causes, but in people with MS, it’s once again a question of an interruption in the communication between the brain and the bladder. The result? That annoying experience of waking up with an urgent need to head to the bathroom.
  • Urinary hesitancy. After our discussing urgency, incontinence, and nocturia, you may think that all MS problems related to the bladder involve the need to empty it at inopportune times. But actually urinary hesitancy is at the other end of the spectrum. Though not as inconvenient or embarrassing, this condition, too, can be pesky at the least. The name “urinary hesitancy” refers to difficulty getting your urine flow started when you sit down on the toilet (or, for men, stand at the ready). Once again, the problem results from a breakdown in the body’s signals between the brain and the bladder.

What Happens if a Bladder Control Problem Goes Untreated?

These bladder control problems we’ve been discussing are, as we said, embarrassing and uncomfortable to begin with, but there’s even more to it than that. If you don’t do anything to help the situation, they can lead to even more problems. These include:

  • Repeated urinary and bladder infections, or kidney damage
  • Personal hygiene problems, such as unpleasant odor
  • A self-imposed restriction on your activities (e.g. refusal to leave the house) and an unwillingness to be around others

How Can You Deal with Urinary Control Problems?

The good news? There are ways that these types of urinary problems can be minimized or eliminated. There is a menu of different choices in treatment, one or more of which can help. The choice(s) will vary from person to person, often under the guidance of a doctor who specializes in bladder-related issues.  Here are some of the types of treatment your doctor may recommend:

  • Changes in your diet
  • Changes in your behavior
  • Medications
  • Mechanical aids to help control the flow of urine
  • Catheterization (inserting a thin tube through the urethra and into the bladder to remove urine). The catheter may be left in place, or inserted only at times.

Let’s take a closer look at what’s involved in each of these types of treatment.

Dietary Changes

Ways to increase your urinary control through your diet may include any or all of the following:

  • Drinking less fluids. It stands to reason that if you drink less, you will have less need to urinate. But reducing your intake of fluids is a good idea only if you drink more than 2 quarts (1.89 L) of liquids a day.
  • Stopping drinking anything that contains caffeine, or at least drinking less of caffeinated drinks. These include coffee, tea, and some sodas. Caffeine increases the need to urinate.
  • Not having more than one alcoholic drink a day.

Behavioral Changes

The most common behavioral change is something called bladder training, also known as bladder retraining. This method is used to cope with what’s called “motor urge incontinence,” a term that refers to contractions of the bladder that you can’t control, which result in urine being squeezed out of your bladder.

In bladder training, your doctor will give you a schedule of when you are to urinate, and you are asked to stick to the schedule as much as possible. If you feel the need to urinate in between scheduled “pee breaks,” you’re asked to try to resist the urge and not use the bathroom till your next scheduled break. As you become successful, the length of time between scheduled trips to the bathroom is increased. By the successful end of your training, you should be able to avoid the bathroom and still stay dry for several hours.

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Dr. Aguirre
Dr. Aguirre is the Director of Aguirre Specialty Care, The Center for Female Pelvic Medicine. Dr. Aguirre is also a member of the Laser Vaginal Rejuvenation Institute of America.
The Laser Vaginal Rejuvenation Institute of America is founded and directed by Dr. David L. Matlock.

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