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Bladder & Bowel Problems
Bladder
 Up to 80% of people with MS experience bladder problems (often being one of the first signs of MS). However this fact should be taken in the context that incontinence is a common problem within the general population. For instance it is suspected that there are between 12 and 25 million incontinent people in the USA.
Bladder problems in the MS individual are very variable and this may be related to fatigue, medication, onset of an illness and decrease in general function. Urinary symptoms are disruptive, interfering with the social, vocational and sexual areas of daily living. A functional model of neurogenic bladder dysfunction relates to the bladder's ability to fulfil its function of storing urine between voidings. In this model there is Storage dysfunction, Emptying dysfunction and Combined dysfunction. The symptoms can be manifested as urgency, frequency, urge incontinence, hesitancy, interrupted stream, sensation of incomplete bladder emptying and nocturnal enuresis.
Effective management is available for most people experiencing MS related bladder dysfunction. Bladder problems can be distressing and occasionally disabling, but can be controlled with effective interventions including education, thorough diagnostic testing, medications and self-care activities. Careful expert evaluation is needed to identify the cause of the problem and select appropriate treatment measures. Management includes:
- medications (such as anticholinergic drugs for storage dysfunction)
- intermittent catheterisation for emptying dysfunction
- exercises to strengthen muscles in the floor of the pelvis and abdominal muscles
The management of bladder function should have the goals of protecting upper urinary tract infection, improving sleep, normalising toilet patterns, conserving energy and preserving independence. Initial treatment should include reviewing and optimising medications, fluid intake and environmental conditions.
Bowel
Constipation is the most common bowel symptom in MS. A bowel management programme includes dietary manipulation (such as increasing fibre content), increasing fluid intake (which may create difficulty for those with bladder problems), and ensuring a regular and sufficient time for bowel movements. Varying combinations of fibre, stool softeners and peristaltic stimulants are usually needed.
References
- Paty DW & Ebers GC. Multiple Sclerosis FA Davis Company Philadelphia 1998
- Kraft GH & Catanzaro M. Living with Multiple Sclerosis - A Wellness Approach Demos New York 2000
- Holland N. Bladder Management in Multiple Sclerosis. MS Management Vol1 No2 Sep 1994
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