Bladder
Bladder problems are one of the most common symptoms for people with Multiple Sclerosis and can have a big impact on quality of life. Bladder issues can be divided into two main types.
- problems storing your urine
- problems emptying your bladder.
Bladder problems in MS are caused by nerve damage to areas of your brain and spinal cord which are related to your bladder. The type and severity of problem will depend on where the damage is.
There are many ways that you can be supported with your bladder. It is important you speak to your MS team if you are having problems with your bladder.
Issues Storing Urine (Urgency and Frequency)
Storage problems can show themselves as needing the toilet right away (urgency) and needing the toilet more often (frequency). You may also have bladder accidents such as incontinence or leakage of urine. These can be brought on by things such as sneezing and coughing (stress incontinence) or can be unexpected.
Issues Emptying the Bladder (Hesitancy and Retention)
Issues with emptying your bladder can show themselves in different ways.
- as being unable to pass urine when you feel you need to
- a weak or poor stream when passing urine
- the need to return to the toilet shortly after passing urine (which means the bladder may not have fully emptied)
- frequent urinary tract infections (UTIs)
General Advice for Bladder Management
There are several things you can do to help your bladder problems, as well as contacting a medical professional. These include:
- keeping a bladder diary - consider including how much and how often you are urinating and include any food, liquids or medication you are taking
- drink plenty of water – general advise is 1.5 litres per day. Healthy coloured urine is clear and the colour of straw
- avoid things that irritate your bladder – caffeine, alcohol, fizzy drinks, acidic fruit juices, spicy foods, and smoking
- maintain a healthy weight – being overweight can apply pressure to the pelvic floor
- pelvic floor exercises – the 'NHS squeezy' app can provide help with this
- avoid constipation – see our advice on bowel management if this is an issue
Other Treatment for Bladder Problems
Different bladder problems are treated differently. Certain investigations will be completed by a healthcare professional to decide the right treatment for you. These may include:
- urine test
- bladder ultrasound
- abdominal and other physical examinations (including the prostate for men)
- blood tests
- referral to urology for further investigations if needed.
Treatment for bladder urgency, frequency, and incontinence could include:
- bladder training to increase the length of time between using the toilet
- medication that may help block the messages that start bladder contractions
- bladder injections – when Botulinum toxin is injected into the bladder wall it can freeze the bladder contractions to improve continence. Catheterisation is often needed alongside this treatment
- nerve stimulation relaxes the nerve in your lower back that controls bladder function
- products that hold or catch the urine – continence pads, external catheters, handheld urinals
Treatment for bladder hesitancy and retention could include:
- catheters – different types include intermittent self-catheterisation, indwelling urethral catheter, supra-pubic catheter
- supra-pubic vibration – a vibration device placed over the pubic area that can help the urethral sphincter relax to empty the bladder
Locating a Toilet When Going Out
It is common to feel anxious about going out if you have bladder issues. If finding a toilet is something you are worried about, there are several tips which can help.
- Radar key – these can be ordered online for a small charge from Disability Rights UK. This means a person with a disability can have access to many locked public toilets around the UK
- a 'just can't wait' toilet card – can be ordered from the 'Bladder & Bowel Community'.
- map your journey – 'The great British toilet map' is an online map which can show you where all the toilets are.
Other Resources
Bladder incontinence | MS Trust
Supporting Your Bladder & Bowel Health | Bladder & Bowel Community (bladderandbowel.org)
