Incontinence in MS for the Incontinent MSer

The MSer will face a number of problems and incontinence in MS is just one of them.

Once upon a time, there was an old man who didn’t like to leave the house. He sat, for most of the day, with his laptop computer on his knee, busily typing for hour after hour.

He must have been very busy, with an enormous amount of work to do. Sometimes he would stop and make a cup of tea. Sometimes he would stop and walk out to his office, where he would sit at another computer and carry on typing.

The truth of the matter is that this little old, unsociable man is me. I have multiple sclerosis with all the symptoms and baggage this condition entails. I do go out, sometimes. Going out is fun, sometimes. But, I prefer to stay at home. I feel safer and more secure at home because I know where the toilet is.

The multiple sclerosis symptom that is foremost in my mind at the moment is INCONTINENCE. It is front and centre in my thoughts not only because I m writing this article but because I am in constant pain.

So why do I have these disconcerting bladder problems? Is it my neurological condition or is it just old age?

What is Incontinence

Bladder incontinence, urinary urgency, urinary hesitancy and bladder spasticity are all very common problems with MS. The trouble is, they can also be signs of ageing.

First of all, I am not that old. I was born in June of 1958, so do the math.

Secondly, I have had bladder problems for the last ten or fifteen years.

Thirdly, both of my parents are still alive and while they are both, quite naturally, considerably older than I am, to my knowledge, don’t have these bladder problems.

Incontinence is the inability to adequately control your bladder. This can and does cause urinary accidents where you cannot prevent passing water. Bladder incontinence may also be called urinary incontinence and can happen in MS for a number of reasons.

There are two main causes of bladder malfunction in Multiple Sclerosis:

• Urge incontinence occurs when MS disease activity prevents the correct passage of nerve signals from the bladder to the brain. This can cause overactivity of the bladder meaning you feel the urge to pass water more frequently.
• Stress incontinence is the involuntary passing of urine when you cough, sneeze or lift something heavy. This is indicative of weakened pelvic floor muscles. Specific to MS, nerve damage in the spinal cord can prevent signals reaching the pelvic floor muscles.

What is Multiple Sclerosis

A debilitating neurological condition often abbreviated to MS. Multiple Sclerosis is an autoimmune disease where the immune system, mistakenly, attacks the nervous system or CNS.

Sometimes you will see multiple sclerosis described as a demyelinating disease. This is because when MS is active the immune system targets myelin which is the fatty coating around nerve fibres.

If the myelin coating becomes damaged, nerve signals can be impaired. This can give rise to a large number of possible symptoms. These symptoms can range from tingling and numbness in the hands, face or feet to difficulty walking or vision loss.

I, personally, use a wheelchair on the rare occasions I do leave the house. I, generally, wear spectacles to watch TV and I have been forced to quit driving.

What are the symptoms of Multiple Sclerosis?

I could choose to make this a very lengthy list. Because MS affects the Central Nervous System or CNS, it can be understood why MS could interfere with any bodily function.

I recall seeing a post from a fellow MSer on their blog where they detailed over 100 symptoms because they had drilled down to the smallest of aches, pains and twinges and called them all MS symptoms.

While this approach was not incorrect, I don’t believe this level of granularity is particularly helpful.

The symptoms of MS can vary greatly in their frequency and intensity. But some MS symptoms are more common than others. Furthermore, the onset of individual symptoms can be related to the age of your condition. IE how long you have had multiple sclerosis.

I, personally, have had MS for more than 25 years and at different points of my MS journey, I have experienced every one of these symptoms at one time or another.

• Fatigue
• Vision disturbances
• Bladder and Bowel problems
• Speech and swallowing difficulty
• Tremors
• Memory lapses
• Pain
• Balance and coordination

This is by no means an exhaustive list. However, the major symptoms, from my perspective, are pain, vision problems and walking difficulty. You will note that I didn’t include my bladder issues as a major problem. \this is because I have overcome the embarrassment and choose to wear incontinence pants when I need to go out of the house.

I also make a point of knowing where the nearest toilet is, at all times. A common habit that I know other MSers adopt.

Treating incontinence in MS

Fortunately, there is a lot you can do to contend with the incontinence of multiple sclerosis. You will find many Internet articles about MS incontinence that refer to bowel difficulty and constipation issues because the two are inextricably linked.

In simple terms, a loaded bowel can exert pressure on the bladder exacerbating any bladder issues you may have.

There are a number of treatments and medications available to suit your particular bladder problem.

Diet and Lifestyle

You may be forgiven for thinking that diet and lifestyle feature in many treatment plans for MS symptoms. The reason that diet and lifestyle appear so prominently in MS treatment plans is that they are both very important factors in managing your multiple sclerosis.

It is important to eat the right food and drink plenty of water. If you have bladder urgency you might think that drinking water is the last thing you should be doing. But this is all part of the bladder training programme.

The bladder will adjust to the increased drinking and drinking plenty of water has the effect of flushing the bladder to prevent UTIs or Urinary Tract Infections.

Self Catheterisation

This is yet another embarrassing MS reality. It is important for your general health that your bladder empties, and empties fully when you urinate. But, bladder spasticity can prevent this from happening naturally.

In this situation, your GP or your urologist may suggest using self-catheterisation. This involves inserting a catheter, a thin, hollow tube, into you urethra and on into the bladder. This will allow the urine to drain from the bladder and into your toilet or another receptacle.

This can be an uncomfortable operation and requires extreme hygiene to prevent introducing UTIs or Urinary Tract Infections.

This was a treatment I followed for a number of months. It did seem to offer some relief from the normal discomfort of bladder pain. But, it was a pain-in-the-neck to implement and after a couple of months, the relief stopped, so I gave up on the self-catheterisation.

Self-catheterisation is recommended for patients with a flaccid bladder. In a flaccid bladder the bladder wall, which is comprised of smooth muscle, is unable to contract, a process that is essential to squeeze out the urine.

I know that in the past, I was of the opinion that gravity drained the bladder. This is not the case. The bladder wall contracts, reducing the size of the bladder. This forces the bladder contents to be ejected via the urethra.

Incontinence Pants

If we are not embarrassed enough by MS. It is suggested we should wear a nappy! Talk about reverting to childhood. The wearing of incontinence pants is not a treatment option. It is a safeguard against inevitable accidents.

I find that the wearing of incontinence pants gives me the security of being able to go to the shops or go out for dinner without worrying about creating a scene when my bladder decides to let-go.

These preventative measures are not foolproof. Most incontinence pants have only limited capacity. So a major bladder evacuation will still result in spillage and embarrassment.

Pharmaceutical Interventions

There are a number of drugs that you may be prescribed to help alleviate your bladder problems.

A spastic bladder may be alleviated with drugs such as oxybutynin, tolterodine, fesoterodine or solifenacin. I, personally, have mirabegron prescribed which shows some benefit.

An overactive bladder sphincter can be eased with tamsulosin. I need to make further enquiries because I thought the tamsulosin was for an enlarged prostate gland.

A flaccid bladder may require the use of self-catheterisation (see notes above)

NOTE: Caffeine drinks and alcohol should be avoided because both of these drinks can aggravate and inflame the bladder lining.

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