Bladder dysfunction in MS happens when nerve signals to the bladder and urinary sphincter
(the muscles surrounding the opening to the bladder) are blocked or delayed because of MS
lesions in the brain and/or spinal cord.
There are basically two major muscles involved in emptying the bladder: the detrusor muscle
and the sphincter muscle. As a result of MS, the detrusor muscle in the wall of the bladder
involuntarily contracts, increasing the pressure in the bladder and decreasing the volume of
urine the bladder can hold. This causes symptoms of going frequently, urgently, leaking urine,
or interfering with a good night’s sleep.
In other words, the inability to store or hold urine in the bladder occurs when the bladder is
unable to retain urine when it accumulates. Instead of expanding when urine collects, the
bladder involuntarily contracts, which can make you feel as if you have an urgent need to go to
the bathroom much of the time – even when there isn’t much urine in the bladder.
The flow of urine is controlled by the sphincter in the bladder, the muscle which relaxes to
open and contracts to close. An inability to empty means that even though a person senses
that his bladder is full, the nerve impulse telling the muscle to open is interrupted and never
reaches the urinary sphincter, and the sphincter muscle closes before all the urine is emptied
from the bladder. If you’re not emptying your bladder completely, you might feel the urge to
void often but have hesitancy when you try to void. You may also wake up at night often to
void since the bladder is not completely empty during the day. Bladder infections or urinary
tract infections (UTIs) can occur if urine, which is a waste product, sits in the bladder too long.
Leakage of urine can occur in some cases when the sphincter remains at least partially open,
resulting in involuntary leaks. Sometimes the detrusor muscle and the sphincter muscle do not
work in coordination and a person with MS can experience many bladder symptoms.
Many behavior modification techniques may be used to manage bladder symptoms. Here are
a few suggestions:
Drink 48 to 64 ounces of fluid a day (one and a half to two quarts) to keep well
hydrated. Water is best.
Drink six to eight ounces of fluid at regular intervals and then urinate on a regular
schedule, rather than waiting for the urge. It takes about one and a half hours for fluid
that you drank to get to the bladder, so try to void by the clock, every one and a half to
Limit the amount of caffeinated beverages, alcohol, and orange juice. It’s okay to have
one cup of coffee or tea, but remember that caffeine can cause you to void more
frequently and more urgently. Alcohol is also a bladder irritant.
Stop smoking (yes, smoking is a bladder irritant too).
Don’t try to self-treat your bladder problems by drinking less fluid! This can lead to
constipation and/or urinary tract infections.
Assessing how your bladder works first involves a simple screening for a urinary tract infection
(UTI), which is very common in MS and can cause many of the symptoms mentioned. If you
have an infection, you will be treated with antibiotics to clear up the infection and symptoms
If you do not have an infection, then further evaluation of how your bladder works is important
before suggesting treatments. After proper assessment, medications might be prescribed to
allow the bladder to hold more urine or empty better. There are many medication options on
the market now, so don’t get discouraged if one doesn’t work or causes too many side effects.
Another intervention is to learn the technique of intermittent self-catheterization to allow the
urine to flow and empty the bladder if you are not emptying completely. Intermittent
catheterization (IC) is a safe procedure that can help bring your urinary symptoms under
control. Many people self-catheterize and report that it has improved their quality of life. It will
allow you to completely empty your bladder at regular intervals, protect your kidneys from
infection and damage, lower the risk of distending (stretching) the bladder, and eliminate the
need for wearing a continuously draining catheter. However, some individuals would benefit
from an indwelling catheter (Foley catheter) for a short period of time.
Other interventions can be offered by a urologist, including a suprapubic catheter. This is
another type of urine drainage catheter that is surgically inserted into the bladder so that urine
can drain out. Instead of urine being passed through the urethra opening as usual, the
suprapubic catheter is inserted through the abdominal wall just above the pubic bone and into
There are also other surgical procedures that might be recommended by a urologist. More
recently, Botox injections into the bladder have been approved by the FDA to help with
The message here is that bladder symptoms can be treated once these symptoms are
discussed openly and proper assessment is completed. It’s important to share your concerns
with your healthcare providers; if they are not able to help, ask for a referral to someone who
can help. You may need a referral to a urologist to treat bladder symptoms.
Septra® (sulfamethoxazole/ trimethoprim)
Macrodantin®, Macrobid® (nitrofurantoin)