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A to Z of MS Bladder problems

Bladder problems are among the most common symptoms reported by people with MS. There has been considerable research into bladder symptoms, and, as a result, many problems can now be effectively managed.

The wall of the bladder consists of muscle called the detrusor muscle, which stretches to store urine. At the base of the bladder is a valve called the urethral sphincter, which opens to let urine out of the bladder.

The average capacity of the bladder is between 300 and 500ml (about three quarters of a pint). On average, people produce about 1ml of urine every minute. The urge to empty the bladder tends to occur when it contains about 200ml, at which point the bladder is expanded enough to stimulate nerve endings in the detrusor muscle.

This triggers a message to an area of the spinal cord that controls the reflex action that causes the bladder to contract. A message is sent to the brain, signalling the need to urinate. When it is appropriate to do so (ie access to a toilet), the brain passes simultaneous messages back through the spinal cord telling the valve to open and the detrusor muscle to contract, and urine is passed. Normally this occurs four to six times a day.

Damage to areas of the spinal cord or brain that control phases of this process can cause different types of problem.

  • urgency - a desperate urge to go to the toilet with little or no warning
  • frequency - needing the toilet more than eight times a day
  • hesitancy - difficulty in emptying the bladder
  • retention - a feeling of incomplete bladder emptying

Many people experience a combination of these effects

Treatment

A UK consensus on the management of bladder problems in multiple sclerosis was published in 2009. The document makes recommendations on the assessment and most appropriate management techniques for the different presentations of bladder problems in MS. Management techniques may be as simple as reviewing fluid intake and bladder retraining. In other cases medication may be prescribed or catheterisation required.

Bladder problems can be managed by a nurse or a specialist continence advisor. Depending on the nature of the problem, treatment can involve medication, bladder retraining, catheterisation or finding ways to control the effect of the symptom

Reference

Fowler CJ, et al.
A UK consensus on the management of the bladder in multiple sclerosis.
Journal of Neurology Neurosurgery & Psychiatry 2009;80:470-477.
abstract

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