Many people with multiple sclerosis (MS) experience urinary problems at some point. Common problems associated with MS, often caused by neurogenic bladder, include frequent urination, urinary urgency and/or hesitancy, urinary incontinence, difficulty urinating, incomplete urination, and recurrent bladder infections. Conservative treatments include adjusting fluid intake, pelvic floor exercises, oral anticholinergic medications, avoidance of certain foods/alcohol, and self-catheterization.
Hoommon are urinary problems in MS?
In a survey of 1,047 people with MS conducted by the North American Research Committee on Multiple Sclerosis (NARCOMS), 966 participants (92 percent) reported experiencing at least one lower urinary tract symptom, the most common being post-void dribbling (64.9 percent), urinary urgency (61.7 percent), and a feeling of incomplete emptying (60.7 percent). Eight hundred twenty-six participants (79 percent) reported having some type of urinary incontinence.
In MS, bladder problems occur frequently alongside sexual or bowel problems because they share common neural pathways along the spinal cord. Lesions in the cervical and/or thoracic spine can often affect bladder, bowel, and sexual function. Chronic constipation can also cause bladder dysfunction as large amounts of stool in the colon puts pressure on the bladder, preventing it from filling or emptying as it should or causing the bladder to contract when it shouldn’t.
Should I talo my neurologist about problems?
Although the majority of people with MS experience urinary symptoms, they do not always discuss these problems with their doctors. Of patients reporting urinary symptoms in the aforementioned survey, 70 percent had previously discussed urinary symptoms with a healthcare provider, but only half had done so in the prior year. Researchers found that patients experiencing urgent urinary incontinence were more likely to seek treatment.
I remember one of the first times I experienced an embarrassing case of urinary urgency. I had just left my dentist’s office and was getting in my car. I felt a mild urge to go to the bathroom, and stopped to consider whether to stay in the car or go back inside the building. I got out of the car, and soon felt a warm wetness travel down my legs under my jeans. A steady stream hit my shoes. I was frozen right there in the parking lot. No matter how hard I thought about it, I couldn’t stop urinating until my bladder was empty.
Fortunately, I had some newspaper in the car that I could sit on to keep from soaking my seat, and went straight home to shower.
After wetting the hallways or bathroom floors in my house several times, I finally mentioned the problem to my neuro nurse practitioner. She gave me medication samples for overactive bladder. They seemed to help; but like many MS symptoms, the issue seemed to get better on its own. When my MS flares, urinary symptoms may come back, but overall my symptoms have not become bad enough to warrant referral to a urologist.
I asked my MS nurse when she typically refers patients to a urologist.
“In general, I believe it’s best to try to reduce the number of health care providers a patient with MS needs to see,” said M. Adamson, D.N.P., F.N.P.-B.C. “Too many 'cooks in the kitchen' can unnecessarily complicate patient care. When we’ve tried conservative measures and they prove insufficient, then we’ll refer to a urologist.”
What is a urologist?
A urologist is a physician who specializes in the male and female genitourinary tract system (kidneys, adrenal glands, ureters, bladder, and urethra) and male reproductive organs. Urologists are trained in the surgical and medical treatment of diseases involving these organs. Besides surgery, urologists have specialized knowledge of internal medicine, pediatrics, gynecology, and neurology. Seven subspecialties in the field of urology have been identified by the American Urological Association:
• Pediatric Urology (children's urology)
• Urologic Oncology (urologic cancers)
• Renal (kidney) Transplant
• Male Infertility
• Calculi (kidney stones)
• Female Urology
• Neurourology (nervous system control of genitourinary organs)
How do I find a urologist?
The Urology Care Foundation, sponsored by the American Urological Association, hosts a “find a urologist” feature on their website, as does U.S. News & World Report Health Care. Your insurance company should be able to provide you with a list of urologists who participate in your insurance plan. Also, if your neurologist or primary care doctor suggests that you consult with a urologist, ask them for recommendations of physicians to whom they’ve sent other patients with successful and satisfactory outcomes.
For additional information about bladder and bowel symptoms in MS, check out these resources from the National MS Society:
Khalaf KM, Coyne KS, Globe DR, Armstrong EP, Malone DC, Burks J. Lower Urinary Tract Symptom Prevalence and Management Among Patients with Multiple Sclerosis. Int J MS Care_._ 2015;17:14-25. doi:10.7224/1537-2073.2013-040.
Massot C, Khenioui H, Agnani O, Guyot M-A, Hautecoeur P, Donze C. Stress Urinary Incontinence in Women With Multiple Sclerosis. Int Neurourol J. 2016;20:224-231. doi:10.5213/inj.1630490.245.
Tracey JM, Stoffel JT. Secondary and tertiary treatments for multiple sclerosis patients with urinary symptoms. Investig Clin Urol. 2016;57:377-383. doi:10.4111/icu.2016.57.6.377.