ALL ABOUT

BLADDER PROBLEMS

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WHAT ARE THEY? Bladder problems are defined as all those symptoms that result from inadequate functioning of the bladder.

Two kinds of urinary dysfunction are most common in people with MS:  torage dysfunction. This condition is known as “overactive bladder” and is S characterized by the feeling of having to urinate often, but only being able to do so in small quantities.  mptying dysfunction. This occurs when the bladder does not empty completely. E The sphincter (muscle that closes the bladder exit) contracts, causing the flow of urine to become reduced and intermittent. Emptying ends up being incomplete. The urine that remains in the bladder can continue causing new contractions.

WHAT ARE THE SYMPTOMS? The most common symptoms in people with MS are: U  rgency/rush to urinate: A very strong sense that urination is imminent and cannot be delayed. Incontinence: Loss of urinary control. Nocturia: Need to urinate several times during the night. Hesitant or delayed urination: Difficulty initiating urination.

Overflow incontinence: Loss of urinary control due to an overfull bladder that does not empty. This is usually described as “dribbling.” F eeling of incomplete emptying: The feeling that a small amount of urine remains in the bladder after emptying. Sometimes MS causes a loss of feeling in the bladder and a person may not empty their bladder completely but not be aware of doing so. Weak urine flow: The flow of urine is thin and slow.

WHY DO THEY OCCUR? Normally, when the bladder is full, the brain receives a warning message. The person then consciously reacts to the feeling and sends, when he or she decides to urinate, a message through the spinal cord to: • The muscle that controls the functioning of the bladder (detrusor muscle) • The muscle to the opening of the bladder (sphincter). Coordination between these two muscles allows urine to be expelled from the bladder. As with all symptoms associated with MS, bladder problems are the result of progressive degradation of the myelin (insulating external layer that surrounds the nerve cells and fibers and allows them to function properly) and the nerve fibers themselves. This results in a corresponding degradation of the signal that is transmitted by the neurons responsible for carrying impulses from the brain and the spinal cord to the muscles, thereby causing excessive activation. The lack of coordination between the muscles means that urine is not expelled correctly from the bladder

HOW FREQUENTLY DO THEY OCCUR?  rinary changes (increased urgency, incontinence, incomplete emptying...) are just U one of the most common symptoms experienced by MS patients during all stages of the disease, and which can vary throughout the disease in the same person. Between 30 and 50% of people affected with MS will experience urinary changes at some time during their disease.

TREATMENTS In order to effectively treat bladder problems, it is crucial that healthcare professionals carry out an exhaustive examination and that the patient follow their recommendations. Your doctor will determine whether any of them are appropriate for your situation. There are different treatments: 1. Drug-based treatment: treatment of a hyperactive (excessive activity) bladder. One of the common treatments includes the use of anticholinergic medications. Before beginning this treatment it is important to confirm the residual volume of the bladder, since these treatments can reduce the emptying efficiency and increase the amount of urine that remains in the bladder. 2. Training the bladder: a technique used to modify habits, which can be useful to improve bladder function. The patient and healthcare professional must establish, if appropriate, a fixed daily program for urinating, like, for example, urinating every two hours. The person should resist the need to empty the bladder at times that are not on the urination schedule. The specialist will also give instructions on how to properly train the bladder and will monitor the patient to see how he or she is progressing.

3. Intermittent catheterization: used as a rehabilitation technique to train the bladder. It involves introducing a small tube, called a catheter, into the bladder through the urethra, to allow the urine to exit through the tube. Intermittent self-catheterization increases patient independence and helps with self-esteem. However, it requires having a certain level of manual dexterity in order to avoid associated problems like sores and infections. The patient takes control of urination and is more independent. 4. Regulating liquid intake: consists of reducing the amount of liquids that are drunk in order to decrease urinary frequency and prevent incontinence. However, it is important that patients not drink too little liquid, since other problems, like constipation, may result.

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