How Does Multiple Sclerosis Affect The Body
MS creates inflammation inside the central nervous system . This immune system-based attack can damage the myelin sheath that protects nerves, thereby damaging the nerves themselves. Unfortunately, this causes the usual messages in the bodys central nervous system to become scrambled or even stop completely.
According to the National MS Society, the symptoms can sometimes resolve over weeks or months, but sometimes the symptoms become permanent.
The severity of each persons symptoms varies on an individual basis. While some people will never become severely disabled from living with MS, others may eventually have to be in a wheelchair or using a walking aid.
Some symptoms of MS may include:
- Fatigue
- Impairment of bladder or bowel function
Consider A Bowel Training Program
These programs are similar to the concept of emptying your bladder at regular intervals. A doctor can work with you on when you could more comfortably go to the bathroom each day.
Its possible for some people to train their bowels to move at designated times. This program can take up to three months to see results.
Planned Times For Drinking And Urinating
Drink water at designated times during the day, and plan bathroom breaks afterward.
Bladder training can be helpful, too. This technique involves keeping a journal and scheduling times to urinate, whether or not you feel the urge, says Epstein.
Double voiding is another technique that can help, the Urology Care Foundation says. To double void, urinate, wait a few minutes, then try to urinate again.
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Types Of Bladder Problems In Ms
Multiple sclerosis patients can experience a variety of bladder problems, including nocturia, urinary urgency, incontinence, and urinary hesitancy. Nocturia is a condition where a person frequently must awaken during the night in order to urinate. Urinary urgency is when a person feels a strong urge to urinate and yet only a small amount comes out. Incontinence is the loss of bladder control that causes leaks, while urinary hesitancy is when it is difficult to begin urinating.
Bowel problems, too, can be an issue for multiple sclerosis patients, as they can experience constipation and fecal incontinence. Fecal incontinence is the loss of control over ones bowel movements.
Can Multiple Sclerosis Cause Incontinence
While many people with MS may never experience urine leakage or loss of control of their bowels, others might. Neurogenic bladder and neurogenic bowels are both fairly common when damage in the nervous system affects these particular areas of the body.
The most common type of urinary incontinence that occurs with MS nerve damage is urge incontinence. In other words, someone with MS who gets urge incontinence may have problems with their bladder or their bowels holding on to their urine or stool until its time to go.
Some people living with MS may experience a kind of fecal incontinence that stems first from constipation. In other words, they stay constipated for a length of time until the impacted stool is pushed out. This is also called overflow incontinence.
In summation, incontinence of both kinds will sometimes happen with the nerve signals between the brain and the bladder or bowel are disrupted.
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How Can Bowel Function Be Affected With Multiple Sclerosis
Bowel dysfunction is also a common symptom for patients with MS. One study of 77 patients with clinically definite MS showed that bowel problems are not associated with bladder dysfunction, patient’s age, degree of disability, or duration of disease.
The most common bowel complaint from a person with MS is constipation, but the most distressing bowel complaint is probably that of involuntary bowel/fecal incontinence. Because MS interrupts or slows the transmission of signals to and from the brain, the electrical impulses to the muscles that are involved in emptying your bowel can become disrupted.
Depending on your particular bowel problem, helpful suggestions can be made. General interventions for bowel dysfunction include:
- Education about the causes of bowel dysfunction
- Encouraging dietary changes to include more fiber and fluid
- Consulting with your healthcare provider to adjust medication regimens that may be contributing to bowel dysfunction
- Establishing a regular bowel routine, individualized to the patient
- Encouraging regular physical activity
Bladder and bowel symptoms are common in MS and can be effectively managed. Speak with your healthcare provider about what you can do to help keep these symptoms under control.
Treatment Options For Multiple Sclerosis
First, the wisest course of action is to seek your doctors medical advice. We suggest scheduling an appointment with your prescribing healthcare practitioner and letting them know a little more about some of the symptoms youre experiencing.
From there, your doctor can determine the best course of action of incontinence treatment for your individual situation. Some treatment options may be as easy as diet and lifestyle changes, such as avoiding certain types of bladder or bowel irritants like caffeine. Another example might be to include regular pelvic floor muscles exercises to strengthen the muscles that help control and support the bladder and bowel.
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Urinary Incontinence And Unemployment In People With Multiple Sclerosis
Judy Wollin RN, Nancy Spencer Urinary Incontinence and Unemployment in People With Multiple Sclerosis. Int J MS Care 1 June 2007 9 : 143147. doi:
This article presents an important finding identified when establishing the validity and reliability of the Multiple Sclerosis Disability Profile. The research found that the intermittent use of pads to manage urinary incontinence was linked to unemployment, particularly in women with MS. A total of 103 participants completed a survey and participated in semistructured interviews. Urinary incontinence in people with MS is common, with reports of 89%. Twenty percent of the participants in the current study used pads to manage urinary leakage. Response to the question, Do you use any appliances to assist with bladder function/control? indicated that intermittent pad use was a precursor to unemployment and is offered as an important indicator of impending unemployment in people with MS. This simple question could be used by clinicians to identify the need for more detailed assessment and appropriate interventions to optimize the management of urinary incontinence, thereby reducing the risk of job loss related to incontinence.
What Are Some Bowel Management Points To Remember If I Have Multiple Sclerosis
- The goal is a comfortable bowel movement either every day, every other day, or every 2 to 3 days. For regular bowel movements you need fluid , fiber and activity.
- One-third of a cup of Fiber One®, All-Bran® or 100% Bran Buds® gives you half the fiber you need for the day.
- Greasy foods, spicy foods, or food intolerances may cause loose stool and may result in involuntary bowel movements.
Plan of action
- Eat regularly for regular bowel habits. Plan for a bowel movement each day about ½ hour after eating or drinking something warm . Sit on the toilet about 10 minutes, and try to have a BM. You may want to gently rock back and forth on the toilet. If nothing happens, leave the bathroom and try again later.
- Use a suppository to help stimulate bowel activity. Occasionally, it might help to take milk of magnesia or citrate of magnesia to stimulate bowel activity.
- It may take two to three months to establish a regular bowel regimen.
Last reviewed by a Cleveland Clinic medical professional on 01/28/2019.
References
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Multiple Sclerosis And Nocturia
As mentioned earlier, nocturia is frequently waking up throughout the night in order to urinate. This can be quite troublesome for those with multiple sclerosis, as it causes greater fatigue, which can increase flare-ups and can be dangerous if mobility is compromised.
Nocturia is caused by urinary frequency, which is commonly seen in MS patients along with urinary tract infections. Additionally, consuming caffeinated beverages or alcohol prior to bedtime can increase the risk of nocturia.
Speaking to your doctor can help offer insight into better managing nocturia. You may have underlying reasons as to why you are staying awake at night including anxiety or stress. Or maybe your symptoms related to MS are worse at night. Whatever the reason, talking to your doctor is a good step in getting your nocturia under control.
Finding Toilets When You’re Out
Carry our free ‘I need some help’ card. It explains you have MS and urgently need the toilet. Get it by calling 0300 500 8084 or email .
Find a public toilet at Toilet Map or download one of the public toilet apps.
Join the National Key Scheme. For a few pounds you get a key that lets you into over 9,000 locked accessible toilets in the UK.
If you need a public toilet bigger than standard accessible ones, or you need a hoist, check out Changing Places.
Contact your council to see if theres a Community Toilets Scheme locally. It lets you use toilets in shops, restaurants and pubs without paying.
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Pathophysiology Of Lower Urinary Tract Symptoms In Ms
MS plaques can be found anywhere in the CNS, including the spinal cord. Their exact location will profile unique features of lower urinary tract dysfunction . Intracranial lesions occur in up to 90% of MS patients nearly everywhere along the white matter. Lesions in cortical regions related to urinary tract regulation are thought to be the cause of detrusor overactivity . Spinal cord, and particularly suprasacral lesions, are common in MS patients, as described by Oppenheimer. The prevalence of cervical cord plaques is almost 80% in these cases, predominantly in the lateral corticospinal and reticulospinal tracts. Lumbar and dorsal cord involvement is less frequent . Suprasacral spinal lesions may cause DO by impacting the descending inhibition of bladder contraction. On the other hand, damage to the reticulospinal tracts may lead to detrusor-sphincter-dyssynergia . Sacral cord lesions are less common and their role in LUTD is still questionable. Plaques in efferent or afferent pathways may impair emptying and urinary retention. Although 63% of patients with sacral lesions show detrusor hypocontractility, only 5% present bladder areflexia.
Pelvic Floor Muscle Training
Pelvic floor muscle training may be used solely, or in combination with other therapies, to treat LUT dysfunction in patients with MS. PFMT is effective in patients who demonstrate the ability to contract pelvic floor muscles. The proposed mechanism of action is through the activation of an inhibitory reflex on detrusor activity when the pelvic floor muscles are voluntarily contracted . The benefits of PFMT are modest and studies are limited by low patient numbers and heterogeneous outcome measures. A recent study demonstrated that PFMT alone or in combination with neuromuscular electrical stimulation or transcutaneous tibial nerve stimulation improved storage symptoms in women with MS . Due to its non-invasiveness, PFMT should be continued whenever possible throughout the treatment course.
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What To Watch Out For
It is important to pay attention to any changes you notice in your urination pattern. Noticing that you urinate more frequently than you previously did is a main warning sign of incontinence. Finding you leak urine and cant reach the toilet on time is another key issue that should not just be ignored. Additionally, finding you wake more than once a night to urinateis something that shouldnt be classed as normal.
The treatment method for you depends greatly on your type of incontinence. However, the most common treatment method is sacral nerve stimulation, which helps by correcting the messages that run along our nerve pathways. It consists of a device being implanted under the skin in the upper buttock. Found out what kind of urinary incontinence you have in our advice sections:
Sometimes, medications may be needed for your circumstance and you will be prescribed the most suitable option for you.
Symptoms of incontinence are often treatable and should not be something you simply learn to live with. Healthy bladder function is essential for long-term kidney health, prevention of infection, self-confidence and quality of life. It is therefore vital to see a Doctor about your problems to improve your quality of life.
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tips and advice on living with faecal incontinence.
Pelvic Floor Physical Therapy
Exercises that engage the pelvic floor muscles are often recommended for incontinence, according to the National MS Society. A pelvic floor physical therapist can teach a person to contract, relax, and coordinate the muscles involved in bladder and bowel control, helping to normalize these functions.
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What Can I Do If I Have Bladder Accidents
Talk to your health professionals if you are embarrassed by urine leakage, contact your MS specialist nurse, GP or continence advisor. Studies have shown that many people find it difficult to talk to their health professionals about incontinence as they feel awkward or embarrassed. All health professionals should know that MS can affect the bladder, they are experienced at talking about these issues and should be able to put you at ease.
Get to know your bladder by keeping a diary. This can give you an overview of how your bladder problems affect you over time. You can share it with your health professionals to demonstrate your bladder patterns. Write down what you have to drink and eat, any medication you take, when you go to the loo, any problems with stopping or starting, and if you have any bladder accidents. You could use a notebook or there are smart phone apps available to help you monitor your bladder function.
What Are Some Bladder Management Points To Remember If I Have Multiple Sclerosis
- Adequate fluid intake is 1½-2 quarts of fluid a day. The urge to urinate comes about 1½ -2 hours after drinking something.
- Caffeine, aspartame, and alcohol are all bladder irritants.
- Smoking also is irritating to the bladder.
- Limiting fluid is harmful.
- It is not normal to leak urine, wake up more than once at night to urinate, or to have frequent urinary tract infections.
- Bladder infections in people with MS may result in an increase in MS symptoms, spasticity, and fatigue.
Plan of action
- Drink fluids all at once . If you sip, sip, sip you will feel the urge to urinate frequently. Try to go about 1½ to 2 hours after you drink.
- Stop drinking fluids about 2 hours before bedtime urinate right before bedtime.
- If you tend to get frequent bladder infections you are probably not emptying your bladder completely.
- Taking cranberry pills may keep your urine more acidic and decrease the bacteria in your urine.
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How To Manage Incontinence In People With Multiple Sclerosis
This article is evidence-based, verified by Dr. Ahmed Zayed.
People with multiple sclerosis often experience problems with their urinary tract. These issues can be concerning and even embarrassing for the person.
Even though urinary incontinence can be problematic among people with multiple sclerosis, there are ways to treat these complications effectively. These range from managing the intake of fluids to strategies that help with bladder retraining. There are medications and therapies that can also help.
Continue reading if you want to learn how you can help manage urinary incontinence in a loved one who suffers from multiple sclerosis.
Contents
Multiple Sclerosis And Urinary Incontinence
The prevalence of urinary incontinence in women who have multiple sclerosis is dramatic, according to research recently publishedin the International Neurourology Journal. The authors conducted the study within a treatment center that is dedicated to the care of patients with MS. Out of the 143 women surveyed, stress UI occurs in 55.9%, urge symptoms in 70.6%, and 44.8% had both stress and urge symptoms, also known as mixed incontinence. The authors report that the condition of UI significantly impacts quality of life The Urogenital Distress Inventory and the Incontinence Impact Questionnaire were utilized to collect data about both stress and urge urinary symptoms and QOL impact. Women in the study ranged in age from 20-72 years of age, and the subjects who reported stress urinary incontinence were older and tended towards a higher body mass index . The women with complaints of stress UI also scored higher on the Incontinence Impact outcomes survey as it related to physical activity. This article is available for free in full-text format by clicking here.
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The Less Talked About Symptom: Urinary Incontinence
When the brain and body dont communicate effectively, this causes control issues for bodily functions such as urination and voiding. Continence also requires a coordination between bladder muscles and the sphincter, so any disruption in the signals can create unwanted problems that can be embarrassing to manage. Nerve damage from MS can even affect how the body interprets the signals between the brain and the bladder. The muscles that store the urine and the muscles that empty the bladder are therefore often affected. Unwanted leakage can occur when lesions block or delay transmission of nerve signals in areas of the central nervous system that are in charge of controlling the bladder. This can cause sudden leakages. Mark, Multiple Sclerosis blogger and campaigner asserts, during the journey I suddenly felt the need to pee. Not the slow, rising need everyone normally feels after a few drinks. No, a sudden switch. From no need at all to desperation. The most common types of incontinence caused by Multiple Sclerosis are urge incontinence and stress incontinence.Many MS patients are less mobile, which can often lead to constipation. As a result, also sometimes lead tooverflow incontinence.
Gaining Control Of Ms
You should talk to your provider right away if you experience urinary symptoms so that the appropriate therapy can be prescribed, says Epstein. Early intervention leads to fewer complications and improved quality of life, she says.
Your doctor may refer you to a urologist a specialist in diseases of the urinary tract for a complete checkup, diagnosis, and treatment plan. A urologist may perform urodynamic testing, or urodynamics, which examines the lower urinary tract function, including pressure, volume, and how the bladder is storing and releasing urine, according to Stanford Health Care.
This can range from simple observation to precise measurements using sophisticated instruments to better measure how the bladder and urethra are working, says Kaplan.
Bladder problems can often be managed effectively with certain lifestyle adjustments, medication, physical therapy, or devices. The following are some treatment options.
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