Discussing bladder problems is never an easy topic of conversation, however Urinary Frequency, Urinary Urgency, Nocturia, Urinary Hesitancy and Bed-wetting; these are all symptoms many MSers will be familiar with to some extent.
Bladder Control with Multiple Sclerosis
Why is it that discussing health issues pertaining to the toilet needs, leaves one feeling awkward? I’m sure it stems from years of schoolboy humour.
Simply put, frequent micturition is the need to urinate more often than normal. Urinary urgency is the urge to urinate immediately. Nocturia is the nocturnal equivalent or bed wetting. Not generally painful, but it can be very inconvenient. For many months I would not travel anywhere.
In MS, the urge to urinate is often not actually accompanied by any urine to pass. It is just a rogue sensation, another nerve that is producing a wayward signal.
A frequent problem in MS is the inability to fully empty the bladder. Leaving urine in the bladder can lead to infection and will at least cause some discomfort. To this end, and to my horror when my MS nurse first suggested it, I now self catheterise every day.
Urinary Hesitancy is another symptom. When faced with the urge to urinate, you find you cannot, or it may take up to a minute for the flow to begin.
While these symptoms can be indicative of multiple sclerosis, there are other possible causes. In men it could be a sign of an inflamed prostate gland or, God forbid, prostate cancer. It could also be a urinary tract infection (UTI) which is simply treated.
Your doctor may recommend you having a cystoscopy, a small version of an endoscopy, where a camera is passed along the urethra into the bladder to permit its examination.
- Anticholinergics (e.g. oxybutynin or tolterodine). Desmopressin may be used for night problems or to control urinary frequency during the day, but should never be used more than once in 24 hours.
- A bladder stimulator, is a small vibrating pad which, when applied to the groin, can trigger the response in the bladder to pass water.
- Continued incontinence, despite treatment, can be treated by a course of pelvic floor exercises preceded by a course of electrical stimulation of the pelvic floor muscles.
- Continued bladder symptoms may require intermittent self-catheterisation or for longer-term urethral catheterisation. Suprapubic catheterisation is useful if active sexual function is wanted.
I have ceased using the catheter to empty the bladder; it was causing infection despite thorough hygiene care. I am still very cautious with travel as the urinary urgency can still strike without warning. I now use incontinence pants to mitigate any possible embarrassment. Doubly embarrassing is the fact that the most easily available incontinence pants are Tena Lady the local supermarket.