Why bladder symptoms in multiple sclerosis?
Most people living with multiple sclerosis develop bladder symptoms at some point during the course of their illness. The most common symptoms are frequency (having to go to the bathroom often), urgency (having to go right now), and incontinence (not making it in time).
The most common reason for all of these symptoms in people with MS is called detrusor overactivity (Ginsberg D. Am J Manag Care 2013;19[10 Suppl]:s191-196). The detrusor is the muscle that lines the bladder, and as the muscle relaxes the bladder fills with urine. Contracting the muscle allows you to empty the bladder. This is a highly complex process. In fact, three separate areas of your body control the voiding function. One is located at the base of the spinal cord (in an area called the sacral micturition centre), another is in the brain where it connects to the spinal cord (in an area called the pontine micturition centre), and the third is the cerebral cortex. The sacral centre coordinates sensations of bladder fullness and emptying, the pontine centre controls the outlet valve (called the sphincter) so it’s in synch with bladder emptying, and the cerebral cortex oversees the whole procedure. But this fine coordination of muscle and sensory activity among these three centres can be affected by the MS disease process.
The sensation of a full bladder and bladder muscle tone are controlled through messages sent from local nerve inputs (the peripheral nervous system) and relayed along the spinal cord to the brain (the central nervous system or CNS). This works in both directions so that messages are also sent by the brain and received by the bladder. For bladder function to work normally, the two nervous systems need to act together so everything is coordinated. However, as inflammatory lesions flare up in the brain from MS, the signalling that goes on between the CNS and the bladder becomes disturbed.
The type of bladder symptoms a person experiences provides some clue to the source of the problem. In MS, one of the most common is a lesion in the spinal cord, which can cause the bladder muscle to become overactive and which may lead to incontinence. The sphincter can also become uncoordinated. This can make it more difficult to urinate, or it may mean you stop urinating before the bladder is empty so you have to go to the bathroom more often.
Bladder symptoms have an enormous impact on a person’s daily life, so it’s important to report any problems to a neurologist. The full work-up includes a neurological exam, a physical exam to rule out any mechanical problems (such as an enlarged prostate in men), and lab tests of a urine sample to investigate other problems such as kidney damage and urinary tract infection. A visit to a urologist may also be needed to further evaluate the specific problem you’re having.
There are many treatment approaches that can help bladder symptoms, such as medications, periodic Botox injections, and self-catheterization (inserting a tube into the bladder to drain it). All of these options can be effective in relieving symptoms and should be explored with your neurologist or MS nurse.
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