Multiple sclerosis and bladder dysfunction

Multiple sclerosis is an inflammatory disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. The term ‘sclerosis’ actually means scarring, and ‘multiple’ relates to the fact that the scarring can occur in many different places in the brain and spinal cord.

The central nervous system 
Consisting of many nerve fibres, the central nervous system carries messages to and from the brain and spinal cord to different parts of the body. Nerve fibres are surrounded by a protective sheath of myelin, which helps to insulate them and ensure that the messages they carry – the nerve impulses – travel quickly and correctly. In people with multiple sclerosis, the myelin sheath around nerve fibres becomes damaged or scarred. This interrupts the messages carried by the nerves and can interfere with a wide range of bodily functions. 
Multiple sclerosis can lead to:

• Bladder and bowel symptoms,
• Physical limitations,
• Fatigue,
• Cognitive impairment.

There are four types of multiple sclerosis characterised by the pattern in which the symptoms occur. These are:

• Relapsing remitting,
• Primary progressive,
• Secondary progressive,
• Benign.

In Europe and North America, multiple sclerosis affects one in 800 people, making this illness the most common cause of neurological disability in young adults. Symptoms are typically first seen between the ages of 20 and 40. Multiple sclerosis is approximately twice as common in women as in men. It is not known what causes multiple sclerosis, although it is thought to be a combination of genetic and environmental factors.

What are the symptoms?  

Some of the most common symptoms of multiple sclerosis are: 

• Vision problems 
• Fatigue 
• Thinking/ memory problems 
• Bladder and bowel problems 
• Physical limitations such as balance disorders and lack of muscle power 

Each person is affected differently depending on how much and where the nerves have been damaged. 

75% of people with multiple sclerosis will experience bladder issues. The symptoms vary from person to person.
Many people with multiple sclerosis have neurogenic bladder dysfunction, which means a decreased ability to control the bladder. Some people may find that they need to urinate more frequently or urgently, whereas others may experience difficulty emptying the bladder or a feeling of incomplete emptying.  
Bladder problems, if left untreated, can be severely detrimental to the course of the disease and subsequently have a high impact on quality of life. 
The symptoms below may be one of the first indications of having multiple sclerosis but they may also develop during the course of the illness:

• Urinary incontinence
• Urinary leakage
• Small or large amounts of urine leaking without warning or without feeling the urge to go to the toilet
• Involuntarily leakage when sneezing, coughing, laughing or exercising
• A sudden urge to rush to the toilet to urinate
• The need to get up to pass urine two or more times a night (nocturia)

Urinary retention

• Urinary hesitancy which is difficulty initiating urination
• Urgent sense to urinate but inability to start the urinary flow
• Frequent visits to toilet
• Dribble due to overflow incontinence
• Weak flow
• Bloated lower abdomen

Urinary tract infections
Urinary tract infections have a harmful effect on multiple sclerosis and may even contribute to relapse. When the body tries to fight the infection, it triggers excess immune activity and demylelination (destruction to the coating that protects the nerves). Therefore it is extremely important to regularly empty your bladder in order to avoid  urinary tract infections in the first place.