Bladder dysfunction is a common problem in multiple sclerosis (MS), but it is still under-reported despite its significant effect on quality of life. Most estimates suggest that 75 to 80% of people with MS have bladder symptoms, but many don’t talk about it.1-4 With preventive measures and treatment, bladder symptoms can be effectively managed.
“About three-quarters of the people that I see in clinical practice have bladder dysfunction,” agreed Megan Weigel, DNP, ARNP-C, MSCN, clinical MS nurse at Baptist Neurology in Jacksonville Beach, FL, and the incoming President of the International Organization of Multiple Sclerosis Nurses (IOMSN), “and I’ve read that as many as 90% can expect some symptoms within 10 years after the diagnosis.”
Identifying Symptoms of Bladder Dysfunction
Development of a neurogenic bladder associated with MS occurs in these patients as lesions in the brain and spinal cord interfere with signal transmission to the urinary system, producing a range of lower urinary tract symptoms (LUTS) involving urine storage, emptying, or both. The primary symptoms are urgency and incontinence, with frequency and nocturia signaling a storage dysfunction, while dribbling and hesitancy are problems associated with improper emptying.4
Secondary LUTS symptoms may develop at any time over the course of MS, the frequency and severity of which are known to increase with disease duration.5 Often symptoms become most noticeable to patients when they begin to develop gait difficulties that slow or hinder their ability to readily reach a bathroom.
“Sometimes it’s when people have trouble with their legs—when their lower extremities start to get in trouble—that they become more aware of bladder concerns,” explained Marie Namey, APRN, MSCN, Advanced Practice Nurse at the Cleveland Clinic Mellen Center for MS in Cleveland, OH, and Past-President of the International Organization of Multiple Sclerosis Nurses (IOMSN). Most patients never actually complain about bladder problems. “A lot of times women in particular think it’s just a normal part of being a woman—part of having kids. It’s also embarrassing to patients to bring up in a visit,” she said.
It is important for the MS clinician to become comfortable with making inquiries about bladder symptoms, as left untreated, the condition is likely to cause significant distress for the MS patient. According to Ms Weigel, it is common for patients to start restricting intake of fluids in order to exercise some control over an overactive bladder and reduce frequency and urgency to urinate. “Somewhere along the spectrum people start isolating themselves. They start avoiding physical activity, they start restricting fluids to the point where they become dehydrated and constipated, they get more UTIs, and they’re symptomatic.” From there, urinary symptoms begin to influence all aspects of a patient’s life at home and away, including work and social events, as well as sex life. Additionally, bladder dysfunction often leads to urinary tract infections (UTIs) among people with MS.
Initiating Discussion of Bladder Dysfunction
Several tests can be useful in determining the type and degree of bladder dysfunction a patient is experiencing, but the most important diagnostic factor is a full review of symptoms, including questions aimed specifically at urinary symptoms. In the office visit, Ms Namey will ask, “So, tell me about your sleep. Tell me about fatigue. Tell me about your bladder. If they say it’s fine, I ask if they have leaks, use pads, or if they have bladder infections. If they answer yes to any of those, then they are probably having MS-related bladder problems and they need further evaluation.”