Multiple Sclerosis and Incontinence

When your bowel or bladder starts to become full, your body sends signals to your brain that you will need to go to the bathroom. When you get to the bathroom, your brain transmits signals to your bowel or bladder that it’s OK to void your bladder or have a bowel movement.

When MS destroys myelin, it creates scarred areas called lesions. These lesions can destroy any part of the pathway of transmission from the brain to the bladder and bowels.

The results can be a bladder that won’t empty fully, is overactive, or won’t hold urine well. Examples of symptoms someone with MS may have related to their bladder include:

• difficulty holding urine
• difficulty starting a urine stream
• feeling like the bladder won’t empty completely
• having to go to the bathroom at night frequently
• having to urinate frequently

Many people with MS experience an overactive bladder. MS can also affect the nerves that transmit to the muscles responsible for emptying your bowels. The results can be constipation, incontinence, or a combination.

Both medical and lifestyle treatments are available to treat MS-related bladder incontinence. Examples of medical interventions include:

Medications

A number of medications can reduce the incidence of incontinence in someone with MS. Your doctor should take into account any medications you are currently taking related to your MS and other health conditions.

Common medications for treatment are called anticholinergics. These medications reduce the incidence of muscle contractions. Examples include oxybutynin (Ditropan), darifenacin (Enablex), imipramine (Tofranil), tolterodine (Detrol), and trospium chloride (Sanctura).

Each medication has it’s own set of possible side effects such as drowsiness, dry mouth, and constipation. It’s important to discuss the risks and benefits with your doctor.

Percutaneous tibial nerve stimulation

This treatment for overactive bladder involves inserting a small electrode via a needle into your ankle. The electrode is able to transmit nerve impulses to the nerves that affect your bowels and bladder. This treatment is usually delivered for 30 minutes once a week for 12 weeks.

Pelvic floor physical therapy

This treatment involves working with a pelvic floor physical therapist that specializes in promoting exercises to enhance the strength of your pelvic floor muscles. This can improve your control in urination, both for holding your urine, and for emptying your bladder more fully.

InterStim

This treatment involves a surgeon implanting a device under your skin that can stimulate your sacral nerves. This can reduce symptoms of overactive bladder, bowel incontinence, and urinary retention.

BOTOX injections

BOTOX is an FDA-approved form of botulinum toxin that can cause paralysis to overactive muscles. BOTOX injections in the bladder muscles are an option for people who haven’t responded to or can’t take medications to reduce bladder spasms.

This treatment is delivered under anesthesia. You doctor uses a special scope to view the inside of your bladder.

A doctor will likely recommend you incorporate at-home treatments into your overall treatment plan. These options include:

Intermittent self-catheterization

Self-catheterization involves inserting a small, thin tube into your urethra. This allows you to fully empty your bladder.

It will reduce the incidence of leakage during the day. Some people may self-catheterize up to four times per day.

Careful fluid intake

You shouldn’t cut back on fluid intake because that could increase your risk for acute kidney injury (AKI). However, if you avoid drinking water about two hours before bedtime, you’re less likely to need to use the bathroom at night.

You can also take steps to ensure that when you’re out that you can quickly get to a bathroom. You might plan frequent stops to use the bathroom about every two hours.

You could also wear protective underwear or pads. And keeping a small pouch or bag with supplies, like an extra pair of underwear, pad, or catheter can also help when you’re away from home.

Treatments for bowel issues depend on if you are experiencing constipation or incontinence. Doctors often recommend at-home and dietary treatments to promote regularity. Examples of steps you can take include:

Establishing healthy habits

One of the keys to passing stools comfortably is getting enough fluid per day, usually 64 ounces or 8 cups of water. Fluids will add bulk to your stool and make it softer and easier to pass.

You should also eat enough fiber, which can add bulk to your stool. Most people need between 20 and 30 grams a day. Excellent fiber sources include whole-grain foods, fruits, and vegetables.

Engage in regular physical activity

Physical activity can stimulate your bowels and keep you more regular.

Consider a bowel training program

These programs are similar to the concept of emptying your bladder at regular intervals. A doctor can work with you on when you could more comfortably go to the bathroom each day.

It’s possible for some people to “train” their bowels to move at designated times. This program can take up to three months to see results.

Avoiding foods known to contribute to incontinence

Some foods are known to irritate your intestines. This can cause incontinence. Examples of foods to avoid include greasy and spicy foods.

Your doctor may also discuss potential intolerances, like an intolerance to lactose or gluten, which could worsen incontinence symptoms.

Treatments for MS-related incontinence may not completely reverse your symptoms. But they’re important for ensuring you don’t experience side effects. For example, people who are unable to fully empty their bladders are at greater risk for UTIs.

If your incontinence results in repeat bladder infections or UTIs, this can compromise your overall health. Sometimes UTIs can trigger other immune responses in a person with MS. This is known as a pseudo relapse.

A person having a pseudo relapse may have other MS symptoms, such as muscle weakness. Once a doctor treats the UTI, the pseudo relapse symptoms usually go away.

Also, bladder and bowel incontinence can lead to skin infections. The most serious infection is called urosepsis, which can be fatal.

Seeking treatments as early as possible may help to delay or slow the progression of MS-related incontinence symptoms. This can reduce the likelihood that your bladder could become weaker or more spastic.

In addition to the physical side effects of incontinence, there could be mental health effects. Those with MS may avoid going out in public for fear they will have an incontinence episode. This can lead to a withdrawal from friends and family who are often great sources of support.

Talking openly with your doctor about your incontinence symptoms and working toward solutions are good coping strategies.

Support groups are also available for those with MS and their families. These groups allow you to share your fears and concerns, and hear suggestions and solutions from others.

You can visit the National MS Society Support Groups page to look for a support group in your area. If you don’t yet feel comfortable with an in-person support group, there are online support groups.

There are also organizations that support those with incontinence concerns. An example is the National Association for Continence, which has message boards and organizes events.

Your medical team can often help you find local resources in the area. And you can talk with trusted family members and friends even if they may not always understand every symptom you’re having.

Sometimes letting them know how they can help you, such as picking locations for get-togethers with easily accessible bathrooms, can make a difference in your well-being.