Bladder, bowel and sexual problems

Bladder and bowel problems occur commonly in MS, and can range frommild incontenence or constipation to more severe problems. Bladderproblems include the need to pass water frequently and/or urgently,incomplete emptying or emptying blaat inappropriate times. Bowel problemsinclude constipation and, infrequently, loss of bowel control.

For some people, MS can cause a loss of sensation in the sexual parts of the body or problems with sexual arousal and impotence.

Why does MS affect the bladder?

When MS damages myelin in the central nervous system, messages between the brain and the sectionof the spinal cord that controls the bladder can be interrupted,resulting in bladder problems. The most common bladder problems are:

  • urgency (the feeling of having to empty the bladder immediately)
  • frequency (an increase in the number of times urination occurs)
  • nocturia (frequent urination during the night)
  • incontinence (the inability to hold urine in the bladder)
  • hesitancy (difficulty in beginning to urinate)

Treating and managing bladder problems

The management of bladder problems in MS includes two key approaches:the use of clean intermittent self-catheterisation to manage incompleteemptying, and medications to treat an over-active bladder that resultsin inadequate storage of urine and urgency or frequency problems.

A comprehensive evaluation of bladder problems by an experiencedhealthcare professional and motivation on the part of the person with MScan result in successful management of these problems.

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Bowel problems in MS

Constipation is the most common bowel symptom in MS. A bowel management programme includes dietary manipulation (such as increasing fibrecontent), increasing fluid intake (which may create difficulty for thosewith bladder problems), and ensuring a regular and sufficient time for bowel movements. Varying combinations of fibre, stool softeners and peristaltic stimulants are usually needed.

MS and sexual dysfunction

The ways in which MS can affect sexuality and expressions of intimacyare generally divided into primary, secondary and tertiary sexualdysfunction.

Primary sexual dysfunction is a direct result of neurologic changes that affect the sexual response. In both men and women, this can include a decrease orloss of sex drive, decreased or unpleasant genital sensations, and diminished capacity for orgasm. Men may experience difficulty achievingor maintaining an erection and a decrease in or loss of ejaculatory force or frequency. Women may experience decreased vaginal lubrication, loss of vaginal muscle tone and/or diminished clitoral engorgement.

Secondary sexual dysfunction stems from symptoms that do not directly involvenervous pathways to the genital system, such as bladder and bowelproblems, fatigue, spasticity, muscle weakness, body or hand tremors,impairments in attention and concentration, and non-genital sensorychanges.

Tertiary sexual dysfunction is the result of disability-related psychosocial and cultural issues that can interferewith one's sexual feelings and experiences. For example, some peoplefind it difficult to reconcile the idea of being disabled with beingfully sexually expressive. Changes in self-esteem-including the way onefeels about one's body, demoralisation, depression, or mood swings-canall interfere with intimacy and sexuality.

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Why does sexual dysfunction occur in MS?

Sexual response is mediated by the central nervous system (the brainand spinal cord). Many different areas of the brain are involved inaspects of sexual functioning, including sex drive, perception of sexualstimuli and pleasure, movement, sensation, cognition, and attention. Sexualmessages are communicated between various sections of the brain, spinal cord andgenitals throughout the sexual response cycle. Since MS lesions may appear on many of these myelinated pathways, itis not surprising that changes in sexual function are reportedfrequently.

There are treatment and management options available for both men and women who experience sexual dysfunction. Find out more inMS in focus - intimacy and sexuality