Neurogenic Bladder - Multiple Sclerosis
Multiple Sclerosis or MS is a disease in which the immune system attacks the brain, spinal cord, and optic nerves resulting in the destruction of myelin (the protective covering of nerves). Think of it as an electrical cord losing its outer covering and the inner wires are exposed. The result can be an interruption in appropriate signals in the nervous system.
The illustration on the left represents a healthy neuron in contrast to the nerve on the right that is affected by MS.
When the nerves that control urination are affected, it can result in either urinary retention (incomplete emptying of the bladder) or overactive bladder (bladder spasms).
Over 80% of those living with MS will experience bladder issues1 and symptoms may include:
- Frequency, urgency and/or hesitancy of urination
- Frequent nighttime urination
- Incontinence
- Incomplete bladder emptying
Treatment Options
Although there is no cure for MS, most bladder issues related to MS are manageable and treatable. Treatment is based on presenting symptoms but may include:
Lifestyle modifications include bladder training, diet modification, and adequate fluid intake. Reducing fluid intake in the evening can help manage nocturia (urinating at night) symptoms. Caffeine-free, noncarbonated fluids without aspartame are preferred because they are least irritating to the bladder.
Anticholinergic drugs block the action of the chemical messenger acetylcholine. Acetylcholine sends signals to your brain that trigger bladder contractions. An excess of acetylcholine in your system may result in an overactive bladder. Beta 3 Agonists work to relax the bladder muscle and can increase the storage capacity. With any increase in bladder volume, the urinary stream may be stronger and allow the bladder to empty more to completion.
A physical therapist specifically trained in the pelvic floor may use a variety of techniques and exercises to manage overactive bladders. Strategies that may assist in strengthening and controlling the muscles used during urination include biofeedback, neuromuscular stimulation, and daily home exercises.
Additional treatments for overactive bladder may include Percutaneous Tibial Nerve Stimulations (PTNS)
and InterStim
- PTNS is a 30-minute treatment performed weekly for 12 weeks by inserting a needle electrode
into the tibial nerve located superior to the ankle. The electrode transmits a signal to the sacral
plexus. The bundle of nerves of the sacral plexus controls the bladder and pelvic floor muscles.
Providing stimulation to this nerve appears to down regular the bladder. - InterStim is a small device that can be surgically placed under the skin. It stimulates the sacralnerves again down regulating the nerve endings with the goal to treat both overactive bladder and urinary retention.
Intermittent Self-Catheterization may be recommended for difficulty emptying the bladder. Catheterization is when a catheter is inserted into the urethra to empty the bladder and then removed. Self-Catheterizing one or more times per day can help control bladder leakage, urgency and frequency, and nighttime urination in people who cannot completely empty their bladder on their own.
Since there is no cure for MS, it is good to know that there are many treatment options for neurogenic bladder symptoms. Bladder health can be crucial for overall health and quality of life. Available treatment options are effective for managing most symptoms patients experience with Neurogenic Bladder due to MS.
References: 1. https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Bladder-Dysfunction
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