Many people with MS experience bladder problems and some of these can result in occasional incontinence, where bladder control is lost and urine leaks out.
Bladder incontinence ranges from occasionally leaking urine if you cough or sneeze to having such a strong sudden urge to urinate that you can’t reach the toilet in time. Some people experience both of these.
There are many successful approaches to treating and managing episodes of urinary incontinence. Health professionals, including your MS specialist nurse, GP and continence advisor can work with you to find the solutions that work for you.
What is bladder incontinence?
Bladder incontinence (also called urinary incontinence) is a lack of control over when you empty your bladder that results in passing urine when you don’t mean to.
What causes bladder incontinence?
There are two main causes of urinary incontinence in multiple sclerosis.
- Urge incontinence happens where MS nerve damage takes place in the parts of the brain and spinal cord that control the bladder. This results in problems with your bladder storing urine or your bladder being overactive which means you may need the toilet frequently and urgently.
- Stress incontinence is leakage of urine when you exert yourself, for example sneezing, coughing or lifting something heavy. This happens when your pelvic floor muscles are weakened. In MS this weakness is a result of messages to the muscles of the pelvic floor being impaired. Other reasons for weakened pelvic floor muscles include having children or abdominal surgery.
Some people experience both of these types of incontinence.
How many people have bladder incontinence?
Studies have suggested that up to eight out of ten people with MS experience urinary incontinence at some time. One study that explored the type of bladder problems women with MS reported found that over half had stress urinary incontinence, seven in ten had urge incontinence and four in ten had mixed incontinence.
What can I do if I have bladder incontinence?
Talk to your health professionals if you are embarrassed by urine leakage, contact your MS specialist nurse, GP or continence advisor. Studies have shown that many people find it difficult to talk to their health professionals about incontinence as they feel awkward or embarrassed. All health professionals should know that MS can affect the bladder, they are experienced at talking about these issues and should be able to put you at your ease.
Get to know your bladder - Keeping a diary can give you an overview of how your bladder problems affect you over time. You can share it with your health professionals to demonstrate your bladder patterns. Write down what you had to drink and eat, any medication you take and when you go to the toilet, along with the details of any episodes of urine leakage or needing to rush to the toilet.
Make lifestyle changes
- Look at what you drink as drinking too much can make bladder symptoms worse, increasing your visits to the toilet and the need to get there quickly. On the other hand drinking too little can lead to concentrated urine that irritates your bladder and creates a good environment for infection. General advice is to drink around six to eight glasses of liquid a day (more if the weather is hot or if you are exercising).
- Maintain a healthy weight as being overweight can increase pressure on the pelvic floor muscles and result in stress incontinence.
How is bladder incontinence treated?
The way bladder incontinence is managed depends on the cause. It is important that your symptoms are assessed to determine what is causing your bladder leakage. This will include a test for urinary tract infection which can make existing incontinence problems worse.
Managing stress incontinence
Pelvic floor exercises can be helpful in MS where bladder symptoms are mild. The pelvic floor is a sheet of muscles that form the 'floor' to the pelvis and support the bladder and bowel. These muscles give you control when you urinate as they relax at the same time as the bladder contracts to let urine out. In MS nerve damage can result in weakness to the pelvic floor as messages to the muscles are impaired. Both men and women can do pelvic floor exercises. You can find out more about pelvic floor exercises from NHS Choices.
Managing urge incontinence
There are a number of treatment approaches for urge incontinence. These include medication, botox bladder injections, and nerve stimulation.
Continence products that can help
There are many different types of products available to help you manage episodes of urinary incontinence. These can be valuable as a backup whilst you are undergoing treatment and for some people these may also be useful in the long-term.
These include continence pants and pads, which come in a variety of sizes and shapes, washable and disposable pads. There are also a number of products such as penile sheaths for men (also known as external catheters or conveens) that can help contain urinary leakage, and urinals for women that you can use when you are out and about. These are non-invasive and discreet. More information about all of these products is available from your local continence service, from the Bladder and Bowel Community and from the Continence Products Advisor website.
- London: NICE; 2012. Full guideline Urinary incontinence in neurological disease: management of lower urinary tract dysfunction in neurological disease.
- International Neurourology Journal 2012;16:86-90. Summary Prevalence of stress urinary incontinence in women with multiple sclerosis.
- International Journal of MS Care 2015;17:14-25. Summary Lower urinary tract symptoms and prevalence and management among patients with multiple sclerosis.
Last updated: 06 July 2017
Last reviewed: 29 September 2015
This page will be reviewed within three years