Bladder Control with Multiple Sclerosis
The urinary system begins at the kidneys, urine runs into the bladder through two tubes called the ureters. From here, the urine exit’s the body through the sphincter muscle and urethra.
In normal circumstances, the muscular part of the bladder, the detrusor, contracts to push the urine out, and the sphincter muscle opens up to allow the urine to pass into the urethra.
Voluntary urination is controlled by the brain. It receives the message that the bladder is full, and then impulses from the brain causes the bladder to contract and the sphincter to open, allowing urination. With MS, damage to the spinal cord and brain interrupts signal transmissions that result in storage problems, emptying problems or a combination of both.
Storage dysfunction manifests its symptoms in several ways. Urinary urgency is a strong sensation that urination cannot be postponed. Nocturia is the problem of urinating many times during the night, and incontinence- the loss of urinary control.
Medications, such as Probanthine, Ditropan or Tofranil, relaxes the detrusor muscle so that normal accumulation of urine is accumulated before the urge to urinate is felt.
Emptying problems is the inability of the bladder to fully eliminate the urine stored. The most common form of emptying dysfunction in MS is caused by a closed sphincter. The muscle contracts instead of relaxing, and although some urine is expelled, a significant amount might remain in the bladder.
When frequent urinary infections force infected urine up into the ureters tubes, kidney damage is possible. Also the chance of kidney stones are raised from such dysfunctions.
Another type of emptying problems is caused by the detrusor being weakened and unable to expel all urine. This occurs infrequently in MS, but is not so uncommon that it is overlooked by physicians.
Symptoms associated with emptying trouble includes urinary hesitancy, overflow incontinence, sensation of incomplete emptying, weak urinary streams, urgency, frequency and nocturia.
The prescription medicine Lioresal is successful in use for mild emptying dysfunction. For more serious conditions, intermittent catheterization is required to periodically drain the urine. The procedure is painless and simple, and can be done by the MS patient alone or with needed assistance. Some patients need only need to catheterize for a few weeks or months since bladder function usually comes back.
Combined urinary trouble can be managed using the previously mentioned methods. A variety of bladder function tests may be necessary to determine proper medical management. Urinalysis, post-void residual urine, intravenous urogram, radioisotope renal/residual urine scan, renal/residual urine sonogram or urodynamics is the many tests the doctor might order.
Active participation from the person with MS is essential in the proper management of bladder control problems. Most physicians will ask the patient to drink at least one quart of water a day or drink less at night. Individuals could also be asked to limit the amount of caffeine beverages.
A person with MS should seek treatment at the onset of urinary trouble, as this is the best time to gain control over symptoms. With appropriate management, prevention of urinary tract complications and preservation of normal kidney function is viable.
