It is estimated that there are over 100,000 people in the UK living with Multiple Sclerosis. Shockingly, bladder dysfunction occurs in 80 percent of people who are affected by MS.
An overactive bladder that is unable to hold the normal amount of urine, or a bladder that does not empty properly can often cause irritating symptoms that may include the following:
> Hesitancy in starting urination
> Frequency and/or urgency of urination
> Inability to empty the bladder completely
> Frequent night time urination (Nocturia)
A systematic review on the treatment of lower urinary tract symptoms in MS patients (2013) studied the impact that incontinence has on individuals’ lives. The researchers concluded, “several studies have shown that urinary incontinence has a severe effect on patients’ quality of life. 70% of patients classified the impact bladder symptoms had on their life as “high” or “moderate”.
Paying attention to your body and being proactive when treating incontinence is therefore vital. If you suffer from Multiple Sclerosis and have concerns about your bladder, it is vital to ask yourself the following questions:
> Do you leak urine or have frequent accidents?
> Have you noticed that you urinate more frequently than you used to?
> Do you ever have to rush to the toilet to avoid having an accident?
> Do you get up more than one time a night to urinate?
If the answer to any of these questions is yes, it may be useful to discuss bladder function with your physician or Doctor. Although there is the common assumption that incontinence is mainly caused by childbirth and ageing, it is likely that Multiple Sclerosis is affecting your bladder function. However, symptoms of incontinence are often treatable and should not be something that you simply learn to live with.
Why does Multiple Sclerosis cause problems with the bladder?
Incontinence can occur when lesions block or delay transmission of nerve signals in areas of the central nervous system that are in charge of controlling the bladder. Controlled urination requires a coordination between bladder muscles and the sphincter, therefore any disruption in the signals can create unwanted problems that can be embarrassing and overwhelming. When the brain and body have difficulty communicating, this causes control issues for many bodily functions, including urination and voiding. Symptoms such as hesitation, frequency and pain are reported by many who suffer from MS. These conditions can severely affect a sufferer’s quality of life. However, there is always hope for finding an effective treatment method for you. There is a vast number of treatments available to those living with Multiple Sclerosis and incontinence.
How can you treat incontinence with Multiple Sclerosis?
Incontinence can severely affect a sufferer’s quality of life, however there is always hope for successful treatment. Your physician may refer you to a urologist who specializes in treating incontinence. The following treatment methods are commonly recommended by Doctors for people with Multiple Sclerosis:
Many MS patients are less mobile, which can often lead to constipation. As a result, this then can in turn lead to overflow incontinence. To relieve constipation quickly, over-the-counter laxatives can be purchased. These can be used in order to avoid impaction of the bowel and any overflow incontinence as a result. There are a variety of laxatives available that act in different ways. Bulking laxatives such as Fybogel, which work in the same way as increasing fibre in their diet; osmotic laxatives, which work by softening the stool making it easier to pass, and stimulant laxatives such as senna, which encourages peristalsis and stimulates the gut to pass the stool.
Enemas/ Rectal Irrigation
Rectal irrigation is a method that involves emptying the bowel by ‘washing it out’ using a specialised pump, water and irrigation tube. This is an effective treatment in the management of chronic constipation and faecal incontinence. Enemas can be used to clear impaction from severe constipation and involves administering a solution such as water and sodium phosphate to clear the bowel.
There are medications available that can help you to gain better control of the bladder muscle, which can help reduce urgency and frequency incontinence associated with MS. They belong to a group of medicines known as antimuscarinic or anticholinergic drugs. Below is a list of some medications that may be prescribed and links to more information. These medications are not suitable for everyone, therefore it is important to check that it is safe for a patient to take these.
> Darifenacin Hydrobromide
> Fesoterodine Fumarate
> Oxybutynin Transdermal Patch
> Solifenacin Succinate
> Trospium Chloride
Antimotility/ antidiarrheals such as loperamide, more commonly known as Imodium can be purchased over-the-counter. They work by slowing the gut transit making your stools firmer and pass less frequently. It is important not to use this medication if the person has diarrhoea with blood and/or mucus or has a temperature. It is worth noting that some people find this type of medication increases pain and bloating in the stomach.
Betmiga is an oral medication, which acts as a muscle relaxant and can be used to treat frequency and urgency if conservative methods or traditional anticholinergic medications haven’t worked.
If you are suffering from severe faecal incontinence and your MS causes significant mobility or dexterity issues, your surgeon may recommend a bowel diversion in the form of a colostomy. This involves making a small incision in the abdomen and then pulling through a section of your colon to the surface and sewn to your abdomen, creating an artificial opening called a stoma. Your stool will then be collected in a small pouch that attaches to your stoma. This method is usually a last resort surgery if all other methods have not been successful.
Sacral Nerve Stimulation
Sacral Nerve Stimulation or Sacral Neuromodulation (SNM) is a device that is implanted under the skin in the upper buttock. It helps by correcting the messages that run along our nerve pathways.
SNM is performed in two stages. Firstly you will undergo an evaluation, and secondly, depending on your results you will be offered the implant.
Read our blog for guidance on how to talk to a Urologist about incontinence.