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UK Charity No 1131517
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UK Charity
No 1131517
Multiple Sclerosis
It is important to remember that MS is only one part of a person and not the person.
MS does not represent them, it is not their identity, they are as normal as the next person.
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Bladder Dysfunction
Occurs when nerve signals to the bladder and urinary sphincter (the muscles surrounding the opening to the bladder) cease or weaken because of lesions on the spinal cord. The dysfunction can be for two reasons:
- The bladder is spastic, so it isn’t holding the urine.
- The bladder isn’t emptying all the way, because the sphincter is spastic (contracting when it is supposed to be relaxing to let out the urine, or vice versa).
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.
Damage to areas of the spinal cord or brain that control phases of this process can cause different types of problems:
- Frequency -
needing the toilet more than eight times a day. - Hesitancy -
difficulty in emptying the bladder. - Retention -
a feeling of incomplete bladder emptying. - Urgency -
an urge to go to the toilet with little or no warning. - Some may experience a combination of these effects.
Complex nerve controls work to ensure that the bladder is emptied when required, when these controls are disrupted it can cause the bladder to become unstable causing urgency and frequency problems leading to urge incontinence. Nerve damage, and – or nerve message failure will result in the bladder failing to empty properly causing overflow incontinence and other problems such as infection.
The urge to empty the bladder tends to occur when it contains about 200 ml, at which point the bladder is expanded enough to stimulate nerve endings in the detrusor muscle.This sends a message to an area of the spinal cord controlling 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 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.
Left untreated, bladder dysfunction can cause permanent damage within the urinary tract. This occurs during incomplete emptying of the bladder and urine is retained, resulting in urinary tract infections (UTI’s) and formation of stones from minerals which collect. Leaking urine can result in skin breakdown and infection.
Bladder dysfunction can lead to people avoiding socialising and becoming increasingly isolated, as well as restricting normal daily activities. When a bladder problem is encountered do not assume that it is caused because of MS, it may be the cause or one of the causes, however, there are other possible reasons.
Always seek professional medical advice and ensure an accurate diagnosis is made as to the cause of the symptoms.
Keeping fit and active has a beneficial effect on the bladder, try to avoid constipation this disrupts the bladder.
Urinary tract infections (UTI’s), are common in people with bladder dysfunction, they can cause relapses, drinking plenty of fluids is helpful in preventing UTI’s. [1]
Management
Bladder problems can be managed by a nurse or a specialist continence advisor. Depending on the nature of the problem, treatment may involve:
- Bladder Training
- Catheters
- Complementary Therapies
- Intermittent Catheterisation
- Managing Incontinence
- Pelvic Floor Exercise
- Personal Hygiene Management.
Treatments
Urgency, frequency and urge incontinence may be controlled by drugs which dampen unstable bladder muscle contractions. Constipation may occur when taking drugs, preventive measures acted upon when starting a drug regime may be helpful as will bladder training.
Drugs
- Detrusitol
- Oxybutynin
- Imipramime
- Propantheline
We are currently testing a treatment for the eradication of bacteria and viral problems
with a high success rate at eradicating UTI’s -
Other web sites
continence-
1. Hinson & Boone, 1996; Litwiller et al., 1999