Multiple Sclerosis and Neurogenic Bladder: Understanding the Problem

What Impact Does Multiple Sclerosis Have on the Bladder?

Multiple sclerosis affects the bladder by disrupting the signaling system between the brain and the bladder, leading to symptoms like urgency to urinate, incontinence, reduced sensation, difficulty emptying the bladder, etc. The symptoms of the bladder typically depend on the location of the MS lesion. It can be either an overactive bladder (spastic) or a bladder that does not empty properly.

Can MS Cause Neurogenic Bladder?

Yes, multiple sclerosis can cause a neurogenic bladder. Neurogenic bladder is a condition characterized by the loss of bladder control resulting from damage to the nervous system of the brain and spinal cord. Due to the damage to the nervous system caused by MS lesions, the signalling system is blocked. Bladder issues in MS are common, and about 50 to 90 percent of MS patients may experience problems related to the bladder in their lifetime. Usually, the neurogenic bladder is managed with the help of medications (anticholinergic drugs), lifestyle modifications, physical therapy, Botox injections, intermittent self-catheterization, or surgery.

What Symptoms May Occur if You Have a Neurogenic Bladder Due to Multiple Sclerosis?

Symptoms of neurogenic bladder with MS are:

• Urinary frequency: Feeling the need to urinate increases even without a full bladder. This may occur once every two to three hours.

• Hesitancy: Individuals with MS may have difficulty in starting to urinate.

• Urgency: There may be a sudden urge to urinate.

• Incontinence: There may be an inability to control the flow of urine.

• Dribbling urine: Individuals with MS may urinate in small amounts.

• Inability to empty bladder: Because of nerve damage, MS individuals may lose the ability to empty the bladder completely. This is referred to as an underactive bladder.

• Double voiding: Individuals may feel the need to urinate again shortly after urinating.

• Nocturia: Individuals with MS may wake up at night to urinate.

• Kidney stones: Individuals with MS may develop kidney stones.

• Urinary tract infections: This can be common among MS individuals because bladder issues can lead to frequent UTIs.

• Pain: There may be discomfort or pain in the pelvic area. Pain can also occur during urination.

• Mixed symptoms: Individuals may experience both overactive and underactive bladder symptoms.

What Are the Relations Between Neurogenic Bladder and Multiple Sclerosis?

Various types of neurogenic bladder dysfunctions and urinary complications are common in multiple sclerosis. Neurogenic bladder is one of the most common manifestations of such complications. Complication like the neurogenic bladder are seen in almost 50 to 90 percent of cases of multiple sclerosis.

Demyelination of the nerve fibers is the root cause of neurogenic bladder in multiple sclerosis. The neural damage in the brain and the spinal cord often causes detrusor and external sphincter dyssynergia (abnormal movement of the muscles). This is seen mainly in medullary lesions, which are located below the level of the pons and above the level of the sacral micturition center.

However, neurogenic detrusor overactivity is primarily observed in lesions located above the pontine micturition center. The overactivity of the detrusor muscles often causes involuntary contraction of the detrusor muscles. If the lesions are intracranial and involve the conus (the tapered end of the spinal cord), they may cause inactivity of the detrusor muscle. This may lead to an incomplete voiding of urine and urinary retention. These types of complications are seen in almost 25 percent of cases.

Though urinary complications are common in patients suffering from multiple sclerosis, the symptoms associated with this appear in much later stages of multiple sclerosis. In most cases, after six years of the diagnosis of multiple sclerosis, urinary symptoms appear. However, such urinary complications may lead to severe disorders like

• Lower urinary tract infection due to the retention of urine even after urination. It is seen in almost 30 percent of cases.

• Morphological damage to the lower urinary tract is observed in approximately 30 percent of cases. These damages include bladder diverticula, trabeculae, and thickening of the parietal layer of the urinary bladder.

• In some cases, this may lead to bladder cancer.

How Do You Treat Neurogenic Bladder With MS?

Taking care of a neurogenic bladder in someone with MS requires the help of urologists, neurologists, and rehabilitation physicians. The treatment for neurogenic bladder in multiple sclerosis can be done in two ways: with medicines and with other helpful methods that don’t use medicine.

These are

• Regular drinking of about 0.39 to 0.58 gallons of water each day. But drinking a lot right before bedtime isn’t a good idea.

• Drinks like coffee and alcohol can bother the bladder, so it’s best to stay away from them.

• Regular exercise helps the body feel stronger, and pelvic floor exercises can help the bladder muscles remain relaxed.

• There are special treatments that help the bladder function more effectively. One is called percutaneous tibial nerve stimulation. In this treatment, tiny needles are placed near a nerve in your ankle to help send signals that calm the bladder. Another method is called transcutaneous tibial nerve stimulation (TTNS), where soft sticky pads are used instead of needles. Performing these treatments for approximately 30 minutes, once a week, for 12 weeks can significantly help the bladder function properly.

• Synthetic antidiuretic hormone Desmopressin can be prescribed orally. This helps to reduce nighttime urinary frequency.

• Onabotulinum toxin A is a special drug used in Botox treatment that can be useful in this condition. Intradetrusor injections of this drug help to reduce the incidence of sudden leakage of urine.

• Anticholinergic medications, such as oxybutynin or Tolterodine, may be prescribed to help relax the bladder muscles and reduce urgency.

• Bladder training through scheduled restroom visits.

• In multiple sclerosis, urinary retention treatment typically involves methods to improve bladder emptying, such as clean intermittent self-catheterization (CISC), in which a thin catheter is inserted in the urethra to help empty the bladder.

Conclusion:

MS bladder dysfunction refers to the difficulties in bladder control that occur as a result of multiple sclerosis, where nerve damage interferes with the normal functioning of the bladder. Neurogenic bladder is a common condition in multiple sclerosis. Nerve injury is responsible for bladder dysfunction in these conditions. This leads to complications like sudden leakage of urine, urinary retention, and pain during urination. Physical exercise and medications can be helpful in such cases.

Key Takeaways:

• Neurogenic bladder can be a common complication in people with MS. It occurs when nerve signals between the brain and bladder are damaged, causing the bladder to function improperly.

• Neurogenic bladder is very common in people who have MS. It can affect about 40 to 90 out of every 100 people with MS.

If you have MS and are having urinary problems, you can talk to our iCliniq urologist. They can help make a special treatment plan just for you.