Tips for managing MS bladder problems

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 so you have accurate records of what your bladder patterns are.

Write down what you had to drink, eat, any medication you take, when you go to the loo, and any problems with stopping or starting. If you make any changes, for example the amount of caffeine you drink or starting a new medication, the diary can help you to see how this affects your bladder symptoms.

There are also bladder diary apps available to use on your smartphone – see store.apple.com or play.google.com

Tips to improve bladder function

There are simple lifestyle changes that can make a real difference to your bladder problems.

Food and drink

Drinking too much can make bladder symptoms worse, increasing the number of visits to the toilet and the urgency to urinate. On the other hand drinking too little can lead to concentrated urine that irritates the bladder and creates a good environment for infection. The general advice is to drink around one to two litres, or six to eight glasses, of liquid per day (more if the weather is hot or if you’re exercising).

Food and drink that can irritate your bladder and are best avoided include:

• drinks that contain caffeine (coffee, tea, green tea, hot chocolate can cause irritation directly to the bladder lining)
• alcohol (particularly white wine)
• fizzy drinks (carbonated and highly coloured drinks have been shown to make some bladder symptoms worse)
• acidic fruit and juices (including grapefruit, orange, lime, lemons and tomatoes)
• spicy foods (studies suggest that people who avoid spicy foods, like curry, chilli pepper and cayenne pepper, may reduce their bladder symptoms)

Record when you eat or drink any of these and see if they affect you.

Weight

If you are overweight this can increase pressure on the pelvic floor muscles and can result in stress incontinence. Your GP or MS nurse can give you info on ways you can manage your weight or find out about exercise options for people with MS.

Smoking

Nicotine in cigarettes can irritate your bladder, so this is yet another reason why it’s a good idea to stop smoking. Your GP can you give you info on local stop smoking services.

Pelvic floor exercises

If you have mild bladder symptoms, pelvic floor exercises can often be helpful. You can feel your pelvic floor muscles if you try to stop the flow of urine when you go to the toilet. The pelvic floor is a sheet of muscles that extend from the tail bone (coccyx) at the bottom of the spine to the pubic bone (at the front). They form the ‘floor’ to the pelvis and support the bladder and bowel. Pelvic floor muscles give you control when you urinate. They relax at the same time as the bladder contracts (tightens) in order to let the urine out.

In MS neurological damage can result in weakness to the pelvic floor. However this can also be made worse by other factors such as having children, getting older or having surgery in this region of the body. Both men and women can do pelvic floor exercises.

To strengthen your pelvic floor muscles:

• sit comfortably and squeeze the muscles 10-15 times in a row
• do not hold your breath or tighten your stomach, buttock, or thigh muscles
• when you get used to doing pelvic floor exercises, you can try holding each squeeze for a few seconds

It will take several weeks of regular exercise to regain strength in your pelvic floor muscles.

‘Holding on’: bladder training

The aim of bladder training is to increase the amount of time between going to the toilet. You gradually increase the time between urinating (this can be just by five minutes). It may take weeks or months to be effective but your continence advisor or MS specialist nurse can put together a timetable to support you to achieve this.

Working with your health professionals

Ideally before starting any treatment for bladder problems you should have the opportunity to consider all the different treatment options, ask all the questions you need to and discuss any concerns you may have. It is also really valuable to have realistic expectations of what the treatment can offer and what the drawbacks may be. Knowing clearly what you would like the treatment to achieve can be helpful in ensuring that you and your health professionals are working together towards the same goal.
It can be useful to think of questions in advance and take them to your appointment. For example:

• How long will it take to see any response?
• When will we review how things are going?
• What if the treatment doesn’t work?
• How can I get in touch if I have any problems? Is there a direct number or email?

If you don’t understand what a health professional says make sure you ask for an explanation. You can also ask for copies of any letters sent between your GP and other health professionals, including hospital consultants. This keeps you informed and helps you to remember what was said.
You should be able to discuss or review your treatment and management at regular intervals or when circumstances change. This can include changing your mind about treatment.
It is important to continue with treatment but if it’s not working ask what’s next. It can take some time to find the approach that works best for you.

Managing your bladder

This article is adapted from our new book Managing your bladder which explains why bladder problems can be part of MS and provides a practical approach to their management. It includes comments and tips from people with MS who know what it is like to live with these problems.

The MS Trust Continence Question Time

As part of MS Awareness Week, we recorded a panel of MS experts and people with MS responding to some of the common questions about managing bowel and bladder issues. Watch the MS Trust Continence Question Time.