BLADDER DYSFUNCTION is common in multiple sclerosis, in people with minimal symptoms and those with major impairments.  Effective bladder management strategies make it possible for people with multiple sclerosis to pursue daily activities and participate in the world with comfort, dignity and confidence.  With appropriate diagnosis and treatment, the incidence of bladder complications is greatly diminished.  It is important to remember that:

* Bladder symptoms may be responsible for withdrawal from social and vocational activities. 

* Frequency, urgency, and incontinence may negatively affect interpersonal interaction.
* Bladder involvement may threaten the individual’s health, with complications leading to serious morbidity.
* Bladder symptoms are often mismanaged, precipitating such problems as acute urinary retention, damage to the detrusor (primary bladder muscle) and urinary tract infections (UTIs).

NEUROGENIC BLADDER DYSFUNCTION

The demyelination of MS can interfere with nerve signals between the bladder, the spinal cord, and brain, causing urination to become less controlled.  Dysfunction may occur in the detrusor muscle (which expands to store urine and contracts to expel urine), external urethral sphincters, or in the coordination of their functions.  The detrusor can be hyperactive, signaling the urge to void at very low urinary volume, or hypoactive, allowing a dangerously large amount of urine to accumulate before signals to void are initiated.

Storage Dysfunction

Storage dysfunction may be caused by an over-active detrusor muscle that contracts prematurely, as soon as a small amount of urine enters the bladder, continually signaling the need to void.  The bladder does not fill to normal capacity, which results in the following symptoms: Urgency (inability to delay urination), Frequency (need to urinate repeatedly), Nocturia (need to urinate during the night), Incontinence (inability to control time and place of urination).

Therapies for Storage Dysfunction:

* Anticholinergics (eg. Ditropan XL, Detrol, Oxytrol, Vesicare, Sanctura, Enablex) are first-line medications
* DDAVP (desmopressin acetate), a hormone nasal spray, which temporarily reduces amount of urine produced, allowing for more restful sleep
* Pelvic floor exercises
* Behavioral techniques—limit caffeine, drink adequate fluid during the day
* Absorbent pads (men and women) and for men a condom-like sheath that connects to drainage
* Assess mobility issues (proximity to toilet)

Emptying Dysfunction

Demyelination in the spine interrupts signals to the voiding reflex, resulting in failure to empty the bladder.  The bladder fills, but the spinal cord is unable to send the signal to the brain to relax the sphincter, causing the bladder to retain urine and sometimes fill beyond normal capacity.  Emptying dysfunction can lead to: Urgency (inability to delay urination), Dribbling (uncontrolled leaking of urine), Hesitancy (delay in ability to urinate, though need to void is experienced), Incontinence (inability to control time and place of urination), Infection.