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Not all bladder problems are MS

Open Door - November 2006 page 11

Bladder problems are among the most common symptoms reported by people with MS and can have a significant effect on quality of life.

The urge to go to the toilet tends to occur when the bladder contains about 200ml of urine. At this point it is expanded enough to stimulate nerve endings in the bladder wall (the detrusor muscle). Simultaneous messages are sent to an area of the spinal cord that triggers the reflex action to contract the bladder, and to the brain, which controls when it is appropriate to do so. When the time is right, the brain passes messages back that cause the urethral sphincter (the valve at the bottom of the bladder) to open and the bladder to contract, and urine is passed. Damage to areas of the spinal cord or brain that coordinate these processes can cause different types of problem.

diagram of the messages to and from the brain that control the bladder

Types of problem

Frequency

an increase in the number of times someone needs to urinate in a day

Urgency

the feeling of having to empty the bladder immediately

Hesitancy

difficulty in starting to urinate

Incontinence

inability to hold on until an appropriate time. This can involve inability to reach a toilet in time or being unaware of the need to empty the bladder

Is it MS?

It is important to remember that not all continence problems will be caused by MS. For instance, some women find that pregnancy and childbirth can weaken pelvic floor muscles and make controlling continence more difficult. Infections in the urinary tract or in the kidneys can also make continence more of a problem. Treating the infection will usually cause the related continence problems to improve. As a result, it is important to have any bladder problems properly assessed to work out what is causing symptoms and what treatment is needed.

Seeking treatment

Primary care trusts now have a Continence Advisory service that deals specifically with bladder and bowel problems. GPs or MS nurses are able to make a referral, and many services allow people to refer themselves.

For more information see the Bladder problems factsheet

Other ideas that can help with bladder problems

If continence is a problem, it is tempting to try and control things by reducing the amount of fluid taken during the day. However, not drinking enough can increase the likelihood of urinary tract infections and worsen fatigue. It is recommended that we drink around six to eight glasses of fluid per day. Some drinks such as coffee, tea, alcohol and caffeinated drinks can irritate the bladder so replacing some or all of these with water or other liquids may help.

If urgency is a problem, consider wearing clothing with elasticated waists rather than button-flies or skirts rather than trousers.

The charity RADAR operates the National Key Scheme, which offers access to 7,000 locked public toilets around the country. Keys are available for a small charge directly from RADAR (tel 020 7250 3222, or visit www.radar.org.uk) or, in some cases, from local authorities.

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