Many people with MS experience bladder problems and some of these can result in occasional 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 urinate that you can’t reach the toilet in time. Some people experience both of these.
There are many successful approaches to treating and managing episodes of urinary incontinence. Health professionals, including your MS specialist nurse, GP and continence advisor can work with you to find the solutions that work for you.
What is bladder incontinence?
Bladder incontinence (also called urinary incontinence) is a lack of control over when you empty your bladder that results in passing urine when you don’t mean to.
What causes bladder incontinence?
There are two main causes of bladder accidents in multiple sclerosis.
- Urge incontinence happens where MS nerve damage takes place in the parts of the brain and spinal cord that control the bladder. This results in problems with your bladder storing urine or your bladder being overactive which means you may need 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. Other reasons for weakened pelvic floor muscles include giving birth or abdominal surgery.
Some people experience both of these types of incontinence.
How many people have bladder accidents?
Studies have suggested that up to eight out of ten people with MS experience bladder accidents at some time. One study that explored the type of bladder problems women with MS reported found that over half had stress urinary incontinence, seven in ten had urge incontinence and four in ten had mixed incontinence.
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.
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 and trying pelvic floor exercises. These are covered in more detail on our bladder problems A-Z page.
How is bladder incontinence treated?
The way bladder incontinence is managed depends on the cause. It is important that your symptoms are assessed to determine what is causing your bladder accidents. This may include a urine test to check whether you have a urinary tract infection, which can make existing incontinence problems worse, and an ultrasound of your bladder to see if you're bladder is storing and emptying urine correctly.
Managing stress incontinence
Pelvic floor exercises can be helpful in MS where bladder symptoms are mild. The pelvic floor is a sheet of muscles that form the 'floor' to the pelvis and support the bladder and bowel. These muscles give you control when you urinate as they relax at the same time as the bladder contracts to let urine out. In MS, nerve damage can result in weakness to the pelvic floor as messages to the muscles may not be being transmitted as effectively as they used to. Both men and women can do pelvic floor exercises. You can find out more about pelvic floor exercises on the NHS website.
Managing urge incontinence
There are a number of treatment approaches for urge incontinence (when you need the toilet urgently). These include medication, bladder injections, and nerve stimulation. These are covered in more detail on our bladder problems A-Z page.
Continence products that can help
There are many different types of products available to help you manage bladder accidents. These can be valuable as a backup whilst you are undergoing treatment and for some people these may also be useful in the long-term.
These include continence pants and pads, which come in a variety of sizes and shapes. Some pads are disposable, other pads can be washed and reused. There are also a number of products such as penile sheaths for men (also known as external or condom catheters) that 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. For women, handheld urinals are available that you can use when you are out and about. These are non-invasive and discreet.
- London: NICE; 2012. Full guideline Urinary incontinence in neurological disease: management of lower urinary tract dysfunction in neurological disease.
- International Neurourology Journal 2012;16:86-90. Summary Prevalence of stress urinary incontinence in women with multiple sclerosis.
- International Journal of MS Care 2015;17:14-25. Summary Lower urinary tract symptoms and prevalence and management among patients with multiple sclerosis.
Bladder problems are common symptoms in multiple sclerosis but successful treatment is available and lifestyle changes can make a real difference.
Managing your bladder
Order or download our book that looks at why bladder problems can be part of MS and provides a practical approach to their management.
Ask the expert: Bowel and bladder problems
Bowel and bladder symptoms in MS are common and often easily managed, so it’s important to be open about what you’re going through so you can get the support you need. We put some of your questions about these issues to MS specialist nurse Noreen Barker.