Bladder problems in MS – causes and how to deal with them
Bladder dysfunction is one of the most common and perhaps also one of the most underestimated symptoms of multiple sclerosis. It can be assumed that up to 80 percent of those affected develop problems with their bladder during the course of the disease, and this is often accompanied by a significant reduction in quality of life. The main cause is damage to the spinal cord caused by the disease, which disrupts the control of the bladder. This is why these disorders are also called neurogenic bladder disorders. However, how these problems can be addressed is well researched.
Bladder problems are often an early symptom
In MS patients, the bladder is the first organ, along with the eyes, to be affected by the disease. Neurogenic bladder dysfunction is the only initial symptom in two percent of cases and a significant part of the initial symptoms in around ten percent. After ten years of illness, more than two thirds of MS sufferers also have bladder dysfunction. This is one of the most debilitating MS symptoms. Involuntary loss of urine or incontinence are real problems and far more serious than the commonly known “sixth bladder”. Repeated bladder infections can actually lead to a worsening of MS.
Urgent urination and its consequences
The most common form is the so-called spastic bladder (detrusor hyperreflexia). What most people are probably familiar with is the so-called imperative urge to urinate - the urge to empty the bladder immediately. This situation can also occasionally lead to urge incontinence, i.e. involuntary urination. Patients with detrusor hyperreflexia therefore usually immediately look for the nearest toilet in an unfamiliar environment - a significant reduction in quality of life. But the opposite (bladder hyporeflexia) can also occur. In this case, the bladder cannot be emptied properly, only a small amount of urine can be released, dribbling and residual urine formation occurs. If the bladder cannot empty properly, this promotes infections, which can lead to further symptoms and worsen MS.
Strong pelvic floor against bladder problems
It is important to flush the bladder well in the case of a neurogenic bladder disorder. Regular trips to the toilet and not suppressing the urge to urinate are also essential. A diary can help to keep track of the amount of liquid and urine. Depending on the type of disorder, certain medications can be used. But pelvic floor training can also support the treatment of a neurogenic bladder disorder, as researchers from Brazil have been able to prove. They investigated the effect of pelvic floor training with or without vaginal electrotherapy on women with moderate MS who were prescribed outpatient rehabilitation. A total of 30 women took part in the rehabilitation program. The scientists investigated the effect of the training on an overactive bladder, the strength of the pelvic floor and the quality of life of the women. The evaluation of the training results showed that both programs brought benefits to the participants in terms of bladder problems and quality of life. The additional vaginal electrotherapy further increased the improvement in the pelvic floor muscles and quality of life. Especially in the early stages of the disease, regular training - ideally with the help of a physiotherapist - can demonstrably lead to a significant reduction in imperative urge to urinate.
medications for an overactive bladder
Drug treatment is particularly effective in the early stages of the disease. Anticholinergics are usually given, which inhibit the contractile force of the bladder muscle and thus reduce the overactivity of the bladder. These drugs suppress the effect of the messenger substance acetylcholine in the parasympathetic nervous system, which is responsible for the contraction of the bladder muscle, among other things. As these drugs do not act selectively on the parasympathetic nervous system of the bladder, they often cause side effects such as dry mouth. You should always discuss the dosage and frequency of these drugs with your doctor.
