MS and Incontinence: What’s the Connection

Written by Christine Case-Lo | Published on July 25, 2013
Medically Reviewed by George Krucik, MD, MBA on July 25, 2013

MS and Incontinence

It’s been found that 80 percent of people with multiple sclerosis (MS) have bladder problems. Bladder problems can make urination a frustrating process. It’s common to experience trouble controlling the release of urine. This problem is known as incontinence.

You may also have very frequent urges to urinate, constantly feeling like your bladder is full.  Alternately, you may have difficulty starting to urinate or to maintain a steady stream. You may even have all of these problems at once.

Urinary incontinence is annoying and can feel embarrassing. It can be dangerous to your health if left untreated. Don’t just suffer in silence—take action!

How It Is Caused

Urinary incontinence in MS is caused by sclerotic plaques in your central nervous system. These interfere with the nerve signals to your brain from your bladder and sphincter muscles. This can result in the muscles involved in urination being unable to coordinate. This condition is called “detrusor-sphincter dyssynergia” or DSD.

People with only minor MS symptoms can suffer from DSD, as well as those with major MS impairments.

Frequency

MS can cause the detrusor muscle to become hyperactive. This muscle can contract the moment even a small amount of urine is detected in the bladder.

If this happens, you will feel the need to urinate very frequently. This can be exhausting. Urgency and dribbling are common. Frequent urination at night may make it difficult to get a restful night’s sleep. The urge to urinate may be so overwhelming it can result in incontinence.

Voiding Reflex Problems

MS can remove protective myelin from nerves, resulting in interference with important signaling functions. Demyelination of nerves in the spine can cause problems with “voiding reflex.” This results in an inability to completely empty your bladder.

Voiding reflex problems can result in the following:

  • the external sphincter muscle cannot relax
  • the bladder may not contract sufficiently
  • the bladder can retain urine
  • sometimes the bladder becomes so full it becomes stretched

Emptying dysfunction can also lead to urgency, dribbling, and incontinence. Hesitancy can be a problem as well—that is, a delay in the ability to urinate. The most serious problem is the risk of urinary tract infection that can result from urine retention.

DSD

DSD, discussed earlier in this article, combines urine storage problems with emptying problems. More than 25 percent of patients with MS have a form of DSD. The detrusor and sphincter muscles cannot coordinate, leading to incontinence, urgency, and potentially infection. In severe cases, this can cause injury to the kidneys as urine backs up.

Half of those suffering from untreated DSD develop urologic complications, including:

Incontinence Complications

It is important to seek treatment for bladder control and incontinence issues in order to prevent complications. Urinary tract infections (UTIs) are serious. Symptoms can be masked by other MS-related bladder problems. UTI symptoms include:

  • urgency and frequency in urination
  • burning sensation during urination
  • abdominal or lower back pain
  • increased spasticity
  • dark urine with a bad smell
  • fever

The fever can be particularly bad for patients with MS. An elevated body temperature affects nerve conduction. This can cause muscle weakness, vision problems, and spasms.

Treatment

Treatment of MS incontinence is crucial to preventing complications and improving the quality of life. Frequent testing for UTIs is important. Dehydration can be a risk, as many patients don’t drink enough water when trying to reduce the urge to urinate.

For storage problems, medications like Ditropan, Detrol, Enablex, and the Gelnique patch can help reduce urgency. DDAVP hormone nasal sprays can reduce urine during the night and allow restful sleep. Kegel exercises can improve muscle control and reduce incontinence as a result.

For emptying problems, antispasmodic medications like Zanaflex and flow maximizers like Flomax may help. Intermittent self-catheterization may be necessary.

Surgery and other treatment options are possible to make your life easier.

Social Repercussions

Embarrassment and anxiety caused by MS incontinence can keep some people housebound, unemployed, and depressed. With preparation and treatment, you can come up with a plan to allow you to lead a full and active life. Talk to your doctor about how your urinary symptoms are affecting your life.

You can feel more secure by having a supply bag on hand containing absorbent pads and extra clothes. Medications can allow you to have reduced symptoms and more restful sleep. Learning how to self-catheterize can free you from worry when you go out. Some surgical procedures can help with more advanced problems. All of these tools can help prevent infection and reduce complications and anxiety.

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