Bladder issues such as frequent urination, incontinence, bladder urgency, or urinary tract infections (UTIs) affect up to 90 percent of people living with multiple sclerosis (MS). Urinary problems and MS can be frustrating, but they should be addressed quickly because untreated bladder dysfunction can lead to complications down the road, such as kidney stones.

One MyMSTeam user lamented, “Bladder issues keep me close to home.” Another said, “I’ve had some embarrassing accidents, but I have made the adjustments that I need to.”

To better understand the link between MS and bladder dysfunction, MyMSTeam talked to Dr. Barry Singer. Dr. Singer is the director and founder of The MS Center for Innovations in Care at Missouri Baptist Medical Center in St. Louis. His award-winning MS website, MS Living Well, launched in 2007 and has been a valuable resource in more than 190 countries. He is also the host of the "MS Living Well Podcast," available on Apple Podcasts and Spotify.

The Causes of Bladder Issues for People With MS

A few factors shed light on the link between MS and bladder problems. MS is an autoimmune condition, which means that the immune system attacks the body’s own tissues. For those with MS, the attacks are aimed at the central nervous system. In people with MS, the body breaks down myelin, a substance that coats the nerves. By damaging the myelin sheath of the central nervous system, messaging may be suspended between the part of the spinal cord that transmits information from the bladder to the brain, leading to the urinary symptoms that people living with MS commonly experience. These include:

• Urgency — The feeling of having to urinate right away
• Incontinence — Difficulty controlling urination
• Hesitancy — Challenges in starting the urination stream, or in continuing it after it starts
• Frequency — The need to urinate often

In some cases, people with MS have such strong urgency issues that they aren’t able to access the bathroom quickly enough due to their other MS symptoms affecting mobility, Dr. Singer noted. “They’ve got to hightail it to the bathroom, and they may not make it because some people have disabilities, so it’s hard to get there fast, and incontinence can happen,” he said.

The severity and timing of these symptoms can vary, and most people develop lower urinary tract symptoms about six to eight years after their MS diagnosis. The severity of symptoms is typically related to the disability status of the person living with MS.

MS Bladder Treatments

Before determining which type of treatment to use for issues involving incontinence, Dr. Singer asks people with MS, “Is this manageable?”

Some people can mitigate bladder impairments by ensuring that they stay close to a bathroom at all times and others cannot. “It’s harder if you’re a teacher and you’ve got to go all the way down the hallway and you can’t leave your kindergarteners in the class alone,” Dr. Singer said. “Or if you’re an operating room nurse, it’s kind of hard to get to the bathroom.”

Medications

Your health care team will tailor any potential drug recommendations to the specific symptoms that you’re having, while also considering how any medications may interact with your overall treatment plan. Depending on these factors, medications such as anticholinergics can help manage bladder contractions, leading to less frequent urinary urgency. These medications can be helpful, but they may have side effects including dry mouth.

Catheterization

If you tend to get UTIs, antibiotics often provide relief, but if UTIs become frequent, catheterization may be necessary. “Sometimes, the only way to manage this is with catheterization,” Dr. Singer said. “Some people learn how to self-catheterize, which becomes kind of routine. You go to the bathroom about four times a day and you do a catheterization to empty the bladder, and it helps prevent UTIs.”

During the self-catheterization process, you’ll insert a catheter — which is a thin, hollow tube — into your urethra, and the urine will flow through the tube and into either a bag for collection or into the toilet.

The reason UTIs are common among people with MS is because if you aren’t emptying your bladder completely when you urinate, it can overgrow with bacteria. “The catheterization allows you to empty it. It seems kind of overwhelming at first, but most people get quite used to it, and it becomes routine,” Dr. Singer said.

Another option, suprapubic catheterization, involves a urologist surgically inserting a tube into the bladder through an opening in the lower abdomen. This allows urine to bypass the urinary tract and drain into an external bag.

“No more self-catheterization, no more bladder medication or supplements,” said one MyMSTeam member who underwent the procedure. “I just pull the plug every few hours. I even change the catheter tube myself. And no urinary tract involvement means no UTI.”

Bladder Relaxers

In some cases, your health care team may recommend injections of Botox (onabotulinumtoxinA) into the bladder wall to relax the bladder. This procedure halts the nerve signals that lead to the bladder muscles, which can improve symptoms like urinary incontinence.

“For severe problems, Botox can work great,” Dr. Singer said. The benefits from Botox injections typically last up to a year, after which you may require another Botox treatment. One study showed that Botox injections allowed people with MS to experience increased bladder capacity and a decrease in both frequency and urgency.

“A few years ago, I started getting my bladder Botoxed, and it really changed my life,” one MyMSTeam member said.

Electrical Stimulation

A variety of nerve stimulation techniques are available that may help give you more control over your bladder muscles. For example, some providers recommend neuromuscular electrical stimulation to strengthen the muscles surrounding the bladder. In other cases, the tibial nerve might be stimulated with electrical currents to calm an overactive bladder. These treatments are noninvasive and have been found effective in treating bladder issues for people with MS, particularly when combined with pelvic floor exercises.

Additional Bladder Treatment Options

Some people with MS find success by pursuing at-home options to treat bladder issues. For example, if you make it a point to urinate every two hours or so (other than while sleeping), you may be able to train your bladder so it doesn’t overfill.

Pelvic Floor Exercises

Performing pelvic floor therapy, also referred to as Kegel exercises, can help strengthen the muscles that support the bladder and urethra. One study of women with MS showed that participants who performed pelvic floor muscle training twice weekly for three months reported a better quality of life and experienced fewer voiding and storage symptoms than those who didn’t perform the exercises.

Cranberry Supplements

Some people with MS report that they experience fewer UTIs by keeping up with a regular regimen of cranberry supplementation. Although you should never use cranberry juice or supplements to treat an existing UTI, these options may help reduce the bacteria that cause these issues, allowing you to potentially prevent future infections.

Acupuncture

Acupuncture is a complementary or alternative treatment that involves inserting very thin needles into the skin, placed at specific points to stimulate the body’s natural healing abilities. Acupuncture may help alleviate certain MS symptoms, including bladder problems. If you’re interested in pursuing acupuncture for bladder issues, talk to your health care provider first and find a licensed acupuncturist.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 187,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you found solutions to bladder issues? Share your experience in the comments below, or start a conversation by posting on your Activities page.