Understanding Multiple Sclerosis and Incontinence
by Gary Sattin on Sep 25, 2022
One reason urinary incontinence is broadly prevalent is because it develops from one of several possible root causes. Physical activity, obesity, a poor diet, and nerve damage can all trigger it. Multiple sclerosis (MS) in particular develops from nerve damage that inhibits the bladder and related urinary muscles from receiving your brain’s neurological signals and urinating properly.
A hallmark characteristic of this lifelong condition is damaged myelin, which encompasses nerves and helps funnel nervous signals to different parts of the body. A person’s own immune system attacks the nervous system and causes this deterioration. Over time, this condition expresses itself through hardened, or “sclerotic,” nerve tissue that develops over time. Healthline estimates that 2.3 million people worldwide suffer from multiple sclerosis, and many of these people have to cope with incontinence. If you or someone you love has MS and you want to better cope with or support others with incontinence, read our guide to understanding multiple sclerosis and incontinence.
MS is a generally disruptive disease, but its symptoms are not readily predictable person-to-person. That said, there is a loose grouping of symptoms that many people with MS have in common.
- Muscle spasming and stiffness
- Vision and memory impairment
- Chronic pain
- Poor balance and coordination
- Urinary and bowel incontinence
Incontinence Symptom Causes
When considering urinary incontinence, symptoms manifest because nerve signals don’t reach the bladder and associated muscles, but there’s more to it than that. To urinate successfully, the bladder muscle that holds and expels urine and the urethral muscle that relaxes to let urine pass must work in tandem. They cannot work together when nerves through which signals pass don’t function properly, causing those with MS to not hold urine or fail to expel it. When your urethral muscles relax and your body cannot hold urine as a result, urination increases in frequency. Meanwhile, when your bladder does not contract, you risk developing a urinary tract infection, which exacerbates urinary incontinence problems.
Specific Incontinence Expressions
For those with MS, incontinence expresses itself in several ways that are specific to those with MS or other neurological disorders that damage nerve cells.
As you may guess by the name, those who experience nocturia wake up frequently during the night to go to the bathroom. People with MS face this nighttime disruption because they don’t fully empty their bladder during the day or are in the habit of urinating frequently. Nocturia is very prevalent in those with MS.
Urination hesitancy is another facet of incontinence for many with MS. Also self-explanatory, this term encompasses the inability to initiate urination, no matter the severity. This chronic issue is likely due to nerve signals not properly traveling from the brain to the bladder and urethral muscles when someone attempts to urinate.
The final MS-specific expression of incontinence we will cover is sphincter dyssynergia. The root issue is an inability to coordinate the bladder and urethral muscles. What sets it apart from other issues is that, with sphincter dyssynergia, muscles contract when people try to relax them and relax when they attempt to contract them.
UTIs are one noteworthy consequence of chronic incontinence that complicate a person’s overall health.
Risk of UTI
One risk that’s magnified in someone with MS is the risk of developing a urinary tract infection (UTI). People develop UTIs because they hold urine too long and infectious bacteria grows, irritating the bladder. Before going into how UTIs affect those with MS, it’s important to get some background on MS first. As people with multiple sclerosis suffer nerve damage, they go through “relapses.” These occur when nerve inflammation worsens significantly due to new nerve damage. Another similar symptom is the pseudo-relapse, which arises from existing harm rather than signaling new nerve deterioration. These pseudo-relapses can result when people develop a UTI, meaning that it has wide-ranging consequences relative to others’ UTI experience. During these pseudo-relapses, memory can worsen, the body weakens further, and general fatigue sets in.
Another facet to understanding multiple sclerosis and incontinence is knowing how treatment works. While many people cope with incontinence, there are a few methods those with MS should keep in mind that afford greater control over their bladder issues.
Using a catheter to release urine is one common way to prevent incontinence episodes and regulate urination. Those who struggle to empty their bladders are eligible for this treatment. Unlike some treatments for MS symptoms, this method allows the individual direct control over their urination. As a result, self-catheterization affords people a good tool for regulating their urine release as long as they’re sure to cleanse properly and learn how to self-catheterize appropriately.
Sacral Nerve Stimulation
Your doctor may recommend that you try sacral nerve stimulation to ease symptoms. With this, a neuromodulation device implants in a patient’s lower back. This device corrects the disrupted or unclear neurological signals sent to your bladder in order to restore correct functioning.
Peripheral Tibial Nerve Stimulation
Peripheral Tibial Nerve Stimulation, or PTNS, is a noninvasive corrective measure that can help those with MS and incontinence. People whose doctors recommend this option elevate one foot as they sit so a doctor can place an electrode near their tibial nerve. When active, impulses from this electrode travel to the sacral nerves that control your bladder muscles and regulate urination.
If someone with MS happens to have a caregiver, they can become a resource for regulating a person’s bladder functioning. To establish a routine, support staff can remind and assist their clients’ trips to the bathroom at specific times.
Though these specific treatments are largely effective, many people with multiple sclerosis can handle their symptoms with generally applicable strategies. Dietary changes are a great place to start. Avoiding coffee, soda, and other sources of caffeine prevents bladder irritation and helps you feel more comfortable as you go about your day. Also, you can take steps to retrain your bladder. Because incontinence is behavioral as well as physiological, addressing symptoms this way is effective and allows people to take control of their day and increase their confidence in their ability to manage their incontinence. Pelvic floor exercises, called Kegel exercises, are always a good way to strengthen the pelvic muscles and increase overall muscular control. Additionally, as you navigate your symptoms, using adult incontinence products is a sure way to eliminate the chance of having an accident that derails your day. Using them gives you a backup plan that you probably were sorely missing before.
Try all these coping methods, and you will begin to experience relief from incontinence symptoms that complicate your overall journey in your life with MS. In the end, implementing these changes gets your focus off your symptoms and on your life.