Bladder incontinence

Some people with MS experience bladder accidents (urinary incontinence), where bladder control is lost and urine leaks out. Bladder incontinence ranges from occasionally leaking urine if you cough or sneeze, to having such a strong sudden urge to wee that you can’t reach the toilet in time.

There are many successful approaches to treating and managing bladder accidents. This can include pelvic floor exercises, medication, lifestyle changes and using a catheter.

Bladder incontinence is a lack of control over when you empty your bladder. This results in passing urine when you don’t mean to.

There are different types of incontinence.

• Urge incontinence – where you feel a sudden urge to go and you can’t reach the toilet in time.
• Stress incontinence – where you experience leaks when you cough, laugh or sneeze.
• Mixed incontinence – a combination of urge and stress incontinence.
• Overflow incontinence – where your bladder doesn’t fully empty, resulting in leaks.

Bladder accidents can occur for a few reasons.

• Urge incontinence happens when MS nerve damage takes place in the parts of the brain and spinal cord that control the bladder. This can cause problems with your bladder storing urine and your bladder being overactive. This often results in you needing the toilet frequently and urgently.  
• Stress incontinence is leakage of urine when your bladder is under pressure. For example, when sneezing, coughing or lifting something heavy. This happens when your pelvic floor muscles are weakened. In MS, neurological damage can result in weakness to the pelvic floor. This is because damaged nerves, mainly within the spinal cord, are not transmitting messages to the pelvic floor muscles as effectively as they used to.

Some people experience both of these types of incontinence (mixed incontinence).

• Overflow incontinence can happen if your bladder doesn't empty properly. The area of your spinal cord that controls the bladder emptying reflex may be damaged by your MS. If there is no signal to urinate, your bladder becomes very full but you're unaware of how full it is, so your wee leaks out. Sometimes messages from the brain are confused, so when your bladder muscle contracts to start emptying, the valve which allows urine out of the bladder (the urethral sphincter) closes at the same time. This can block or interrupt the bladder's attempts to empty. For some people, MS damage can cause the bladder muscle to stop contracting before the bladder has been properly emptied.

Studies suggest that up to eight out of ten people with MS experience bladder accidents at some time. 

One study that explored bladder problems in women with MS found that over half had stress incontinence, seven in ten had urge incontinence and four in ten had mixed incontinence.

Talk to a health professional

If you're experiencing bladder accidents, contact your MS specialist nurse, GP or a bladder and bowel (continence) service. You may feel embarrassed or uncomfortable talking about bladder issues, but your health professionals will have lots of experience talking about these kinds of symptoms. You can usually contact your local bladder and bowel service directly without a referral from your GP.

If only I had discussed this with someone sooner it would have saved years of uncertainty, worry, loss of dignity and freedom.

Get to know your bladder

Keeping a diary can give you an overview of how your bladder problems affect you over time. You can share it with your health professionals to show what your bladder patterns. Make a note of what you eat and drink, and any medication you take. You can also keep track of when you go to the loo, any problems with stopping or starting, and if you have any bladder accidents. Some people like to record the effects of exercise too.

Make lifestyle changes

There are a number of lifestyle changes you can make that may improve your bladder symptoms, such as drinking enough fluids, maintaining a healthy weight, practising pelvic floor exercises and trying bladder training.

Read more about lifestyle changes

The way bladder incontinence is managed depends on the cause. It's important that your symptoms are assessed by a health professional to determine what's causing your bladder accidents. This may include a urine test to check whether you have a urinary tract infection, as this can make existing incontinence problems worse. An ultrasound of your bladder may also be carried out to see if you're bladder is storing and emptying urine as it should.

There are a number of treatment approaches for urge incontinence (when you need the toilet urgently and frequently). This can include medication, bladder injections, and nerve stimulation.

Read more about these treatments options

Pelvic floor exercises can help improve urinary incontinence in women and men. Your pelvic floor is a sheet, or hammock, of muscles that extends from your tailbone (coccyx) at the bottom of your spine, to your pubic bone at the front. They form the floor to your pelvis and support your bladder and bowel. Pelvic floor muscles relax at the same time as the bladder contracts to let your urine out. 

Find your pelvic floor muscles by trying to stop the flow of urine when you go to the toilet. Once you've felt these muscles, you can strengthen them by squeezing the muscles 10–15 times in a row. You can try holding the squeeze for longer as your muscles get stronger. It helps to do them multiple times a day.

There are apps you can use to build an exercise plan and remind you to do your pelvic floor exercises, such as NHS Squeezy.

More about your pelvic floor exercises from the NHS

If your bladder isn't emptying properly and this is causing overflow incontinence, your health professional may suggest using a catheter. A urinary catheter is a thin, smooth, hollow tube that's used to drain urine from your bladder. There are a few different types of catheter available – intermittent, indwelling and suprapubic. They are all inserted and used in slightly different ways.

Read more about catheters

There are many different types of products available to help you manage bladder accidents. They can be valuable as a backup whilst you’re undergoing treatment. For some people, they may also be useful in the long term.

• Continence pants and pads come in a variety of sizes and shapes. Some pads are disposable, other pads can be washed and reused. 
• Products such as penile sheaths for men (also known as external or condom catheters) can help contain urinary leakage. These are fitted over the penis like a condom. A tube drains off any urine into a bag attached to your leg. 
• Handheld urinals are available for women and men that you can use when you’re out and about. These are non-invasive and discreet. Some are disposable, others can be washed and reused. 
• Bed urinals for men and women are available on prescription to avoid the need for getting out of bed at night. 
• If you need to get to the toilet in a hurry, clothing that’s easy to undo may also help prevent accidents.

You can find more information about all of these products from your local continence service, the Bladder and Bowel Community and Continence Product Advisor.

• Bladder and Bowel Community – a charity providing information and support for people with all types of bladder and bowel related problems
• Bladder and Bowel UK – a charity offering advice, support and practical help for people with bladder and bowel problems, including information resources and a confidential helpline
• Bladder Health UK – a charity supporting people with cystitis, overactive bladder and continence issues through publications, forums and an advice line
• Continence Product Advisor – a website providing evidence based information on a wide range of continence products
• NHS information on urinary incontinence