Bladder Management
Bladder problems are common among people with MS and especially those with advanced disease. For families, bladder problems can seem overwhelming.
What is a neurogenic bladder?
Elimination of urine is dependent on intact pathways between the brain, spinal cord and bladder. Nerves and muscles of the urinary system work together to hold urine in the bladder and to release it when it needs to be emptied. In MS, the signals from the brain to these nerves may not work properly which results in poor bladder control, a condition called a neurogenic bladder.
There are two kinds of neurogenic bladder: overactive (spastic) resulting in very frequent bladder emptying and underactive (flaccid) which causes large volumes of urine to collect in the bladder without the person getting an urge to urinate.
The most common is a failure with storage; the less common, a failure with emptying. The location of lesions within the central nervous system primarily determines the kind of symptoms that are experienced. GPs and nurses can check how much urine is left in a bladder after a person urinates (post void residual) by doing a catheterisation or using a bladder scanner.
People with MS, who have underactive or overactive bladders, should periodically be evaluated by a urologist because of the risk of urinary tract infection and other urinary complications. Urologists can do a thorough bladder evaluation called a urodynamic study.
- Frequency and urgency
- Leaking or dribbling urine or loss of control (incontinence)
- Change in the amount of urine
- Urinary hesitancy (difficulty starting to pass urine)
- Not being able to empty the bladder completely
- Continued sensation of pressure on the bladder
- Discomfort in the lower abdominal area
- Nocturia (waking up frequently during the night to urinate)