Preventing and Dealing With Bladder Incontinence and MS

In 40 years of dealing with the symptoms of multiple sclerosis (MS), one of the most challenging and difficult to discuss has been incontinence, the occasional loss of control of the bladder. While these symptoms have improved over time, the journey to reach this point has been tough.

Multiple sclerosis and incontinence

Bladder problems are common among people with MS. Urologists believe that most MS patients will experience bladder symptoms, known as lower urinary tract symptoms (LUTS), if they reach the progressive stage of the disease. Bladders require a functioning nervous system to work properly. This is why toilet training is a significant milestone for toddlers, who must learn to control their bladder. However, MS can damage the nerves necessary for these functions.

In the early stages of MS, individuals may notice that they cannot hold as much urine. This was my first symptom of MS in 1979, although it took years to understand what was happening. I constantly felt the need to urinate (reduced storage or increased frequency), which had negative effects on my life. I had to limit my fluid intake to avoid frequent trips to the bathroom, resulting in dehydration at times. I had to plan my outings based on the availability of bathrooms, and even indoors, I had to stay close to a bathroom. As my mobility worsened, I sometimes had accidents and wet my clothes or the floor because I couldn't make it to the toilet in time.

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In addition to reduced storage, MS can cause bladders to fail to completely empty. Starting the flow of urine can be difficult, and the stream may be weak and dribbly. Retention of urine increases the frequency of urination and poses a high risk of urinary tract infections (UTIs).

As my LUTS progressed, incontinence became less of a problem compared to retention. Having a full bladder most of the time increased the risk of UTIs and put pressure on the kidneys. To relieve the pressure, my doctor advised me to practice self-catheterization four to six times a day. Self-catheterization turned out to be easier than I had anticipated, although it was still a burden and came with additional costs.

Here are some recommendations from doctors and the MS Society for improved bladder control:

  1. Pelvic floor exercises (Kegels) to strengthen bladder muscles.
  2. Limiting caffeine and alcohol intake and maintaining adequate fluid intake during the day. Avoiding fluids before bedtime.
  3. Following an acidic diet to prevent UTIs. Online resources provide lists of foods to avoid.
  4. Medications prescribed by a neurologist or urologist to increase bladder storage and prevent incontinence.
  5. Bladder training by urinating regularly and not waiting too long.
  6. Preventing constipation, as it exacerbates urinary symptoms. Eat more fiber, drink more liquids, and stay physically active. Stool softeners can be used if needed.

It is important not to be hesitant in discussing incontinence problems with your doctor, as they are familiar with these issues. Having a support system, such as a loved one or an MS support group, can provide emotional support and coping strategies. The National MS Society offers helpful resources on managing bladder and bowel problems.

To find support and connect with others living with MS, you can join iMedix's MS Facebook Support Group.