Multiple sclerosis (MS) can cause different bladder issues. Some happen when the muscles that help with urination contract too easily, while others occur when the muscles do not contract at the right time. This causes difficulty holding in or releasing urine.

The above information is from the National Multiple Sclerosis Society (NMSS).

Treatment includes interventions such as medications to calm a hyperactive bladder, along with pelvic floor physical therapy to strengthen muscles that facilitate urination.

Up to 90% of people with MS experience bladder issues. The symptoms usually start 6–8 years after the initial diagnosis, but in 10% of cases, they are present at the time of diagnosis.

Keep reading to learn more about MS bladder issues, including diagnosis, treatment, and management.

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MS is a condition in which the body’s immune system attacks the myelin sheath that coats and protects nerve cells.

Depending on where the damage occurs, it can cause a wide range of symptoms throughout the body. If it occurs in the nerves that control bladder function, the damage may block nerve signals, causing urinary symptoms.

Urination involves two muscles: the detrusor muscle and the sphincter muscle. In healthy urination, the detrusor contracts when the bladder is full, which triggers the urge to go to the restroom. The sphincter relaxes to open, which allows urine to flow out, and then it closes.

In MS, the detrusor can become hyperactive or hypoactive, and the sphincter may not open or close at the right time.

Doctors categorize the bladder issues of MS as hyperactive, hypoactive, or a combination of the two.

Hyperactive bladder

A hyperactive bladder affects 60% of people with MS. It occurs when the detrusor muscle contracts when the bladder is not full, increasing pressure inside and reducing how much urine the bladder can hold.

The inability to hold urine in the bladder leads to the following symptoms:

Hypoactive bladder

A hypoactive bladder affects approximately 20% of individuals with MS.

In this condition, the bladder overfills, which stretches the walls of the bladder. This causes the sensors that stimulate the contractions that empty the bladder to stop working. Also, the sphincter does not release.

These issues can cause:

Additionally, if the bladder overfills, the urine may flow backward into the kidney, which can cause an infection or damage.

Combined hyperactivity and hypoactivity

Hyperactivity and hypoactivity can also occur together. When this happens, the bladder contracts to signal it is time to urinate, but the sphincter that releases urine is unable to relax and open.

This type of bladder issue may be more difficult to treat.

Many people with MS have relapsing-remitting MS, which means the symptoms come and go. This can include bladder symptoms.

At times, the myelin repairs itself, which makes symptoms disappear after a relapse. Other times, a person may have an exacerbation, meaning symptoms come back.

Doctors may use the following to diagnose MS-related bladder symptoms:

  • a medical history that includes symptoms
  • a physical examination that includes:
  • tests that include:
    • measurement of residual urine after emptying the bladder
    • urinalysis and culture
    • in some cases, ultrasound imaging and bladder function assessments

Additionally, doctors may ask a person to make a 3-day urination diary.

The NMSS states that treatment options include:

  • Medications: These can involve drugs for a hyperactive bladder, such as oxybutynin (Ditropan), and antibiotics for a bladder infection, such as ciprofloxacin (Cipro).
  • Pelvic floor physical therapy: This is the use of exercises, neuromuscular stimulation, and biofeedback to strengthen pelvic floor muscles and promote the muscle relaxation necessary for urination.
  • Intermittent self-catheterization: This entails inserting a small tube into the urethra to drain the bladder one or more times per day to collect urine manually.
  • Percutaneous tibial nerve stimulation: This involves inserting a small needle electrode into the ankle to transmit signals to nerves that control pelvic floor and bladder muscles. It consists of one 30-minute session per week for 12 weeks.
  • InterStim: A surgeon implants this small device under the skin to stimulate the nerves that promote bladder function.

The Multiple Sclerosis Association of America advises the below lifestyle practices to manage bladder issues:

  • Stay hydrated: Drink 48–64 ounces of fluid, or 6–8 glasses, per day. Water is the best hydrator.
  • Follow a schedule to urinate: Urinate at regular intervals. Try to urinate every 1.5–2 hours instead of waiting to feel the urge.
  • Limit alcohol, smoking, caffeine, and other bladder irritants: Alcohol and smoking are bladder irritants. It is OK to drink 1 cup of coffee or tea, although this can increase urgency and frequency.
  • Do not drink less fluid to avoid bladder symptoms: Inadequate hydration can cause infections and constipation.

MS can cause problems with the nerve signals that control the bladder, including the muscle that creates the feeling of needing to urinate, as well as the muscle that allows urine to exit the body.

If a person develops bladder hyperactivity, they may feel the need to urinate frequently, or have leakage. Bladder hypoactivity can result in difficulty urinating.

Doctors treat MS bladder issues with a combination of medications, pelvic floor therapy or stimulation, and intermittent self-catheterization. Lifestyle changes can also help with managing these symptoms.

If a person’s MS symptoms have changed, gotten worse, or are affecting urination, they should consult a doctor. There may be ways to reduce the impact of symptoms and improve the person’s quality of life.