Managing bladder problems

This page covers a range of management techniques for bladder problems, including:

• first line treatment
• drug treatments
• self-catheterisation
• Botox
• other tips to manage bladder problems

There are also techniques for managing more severe bladder problems.

Virtually every area in the UK has a specialist continence service with at least one adviser. Continence advisers can provide information, for example, about products available, as well as confidential advice. You can ‘self-refer’ to most NHS Continence Advisory Services.

The Bladder & Bowel Foundation can give you details of your nearest service. Calls are confidential and you can speak to a specialist nurse.

For more detailed information, see our MS Essentials publication on Bladdder Problems in MS.

First line treatment

There is a good ‘first-line’ treatment route for managing bladder problems in MS. It works well for the majority of people, particularly those with less severe MS and people who, if they need to self-catheterise, do that as well as take medication. 

• Step 1 - check for infection. If a UTI shows up on tests, it needs to be investigated and treated.
   
• Step 2 - is the bladder emptying? Your continence nurse or advisor will measure the residual volume – the amount of urine left behind after emptying.

• If the residual volume is low – less than 100ml – then medication can be prescribed to reduce the bladder contractions and relieve both frequency and urgency.
• If the residual volume is high – more than 100ml – then it's necessary to find some way of improving bladder emptying – for example, by self-catheterisation – before any medication can hope to be effective in reducing urgency incontinence.

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Drug treatments

A number of drugs can be used to treat an overactive bladder and make bladder contractions less unpredictable. Many belong to the same family of 'anti-cholinergic' drugs.

All of them are likely to cause a variable degree of dry mouth. Some people have side effects with one and may then switch to another that they find more suitable. You can read more on the types of drugs and treatments available in our MS Essentials publication on Bladdder Problems in MS.

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Intermittent self-catheterisation

Intermittent self-catheterisation is the most effective solution for incomplete bladder emptying and many people find it useful.

It means inserting a thin plastic tube (the catheter) into the urinary opening to drain the bladder. For most people, this is done two to four times a day. A specialist nurse or continence adviser can teach you how to do this.

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Botulinum toxin ('Botox')

A newly emerging, highly effective treatment involves injecting botulinum toxin (sometimes called ‘botox’) into between 20 and 30 different sites in the bladder wall. Research, including work funded by the MS Society, is discovering more about this therapy which works by blocking muscle contractions in the bladder wall.

The treatment results in quite long-lasting benefits (generally up to around 10 months) during which urgency and urgency incontinence may be greatly reduced.

At the moment, only people with MS who can self-catheterise are using it because it is likely that it makes any disorder of bladder emptying worse. The treatment is minimally invasive and has few side effects, but is not yet licensed.

A number of specialists around the UK have learned how to carry out the procedure. If ‘first-line’ treatment is not working for you, you can ask your GP for a referral to the local urologist to discuss it.

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Cannabis-based treatments

In recent years there has been considerable interest in researching cannabis-based medicines to treat MS symptoms, including bladder problems. Some research trials have shown benefits for some people with urgency and urgency incontinence.

However, issues over long-term safety and possible dependency problems associated with the use of cannabis in young, otherwise fit people, are still to be clarified. To date, no cannabis-based medicine has been specifically licensed for treating bladder problems in MS.

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Tips on bladder management

Drink more not less

It may seem illogical, but drinking more does tend to make bladder problems better. When you drink less, your urine becomes more concentrated. This can irritate your bladder, making it more likely to contract, and it can also make urinary tract infections (UTIs) more likely.

If you need to get used to drinking more, it is best to increase your intake gradually, for example on days when you are at home or when it is easy to get to a toilet.

Problems when emptying?

If you have problems with emptying, a continence adviser may suggest you try holding a small vibrating device against your bladder when you go to the toilet. It does not work for everyone, but this vibration technique helps some people to empty their bladder more effectively.

Commercially available, battery powered massagers can be effective for this. If you have problems getting the stream going, you may want to try pulling your pubic hair or running a tap.

RADAR key scheme

The disability charity RADAR runs a National Key Scheme to allow access to toilets across the UK.

Pelvic floor exercises

Pelvic floor exercises can help with control by improving the ability to ‘hold on’. Their main use in the general population is to help with stress incontinence following childbirth, but they can be done by men as well as women. More on these exercises

A note on cranberry

Cranberry juice and cranberry extract tablets have both been studied in a number of research trials. But there is no conclusive evidence that they can help prevent or treat urinary tract infections for people with MS.

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More severe bladder problems 

While the first-line treatment route works well for many people, it doesn’t work for everybody.

Bladder symptoms in MS tend to become more difficult to manage as spinal cord disease progresses and causes decreasing mobility. The level of bladder problems people with MS experience is often connected to the level of difficulty they experience in walking.

Continence products

Some people find that using protective pads can be a satisfactory answer to bladder problems, but there are a range of products that might help. Your continence advisor can help, or the Bladder & Bowel Foundation has more information.

Indwelling catheters

For people with severe mobility problems, an indwelling catheter – one that is left in place – might be considered. There are two kinds of indwelling catheter: urethral and supra-pubic. It is important to discuss with a urologist (your GP can refer you) which would be more suitable for you. There are also some kinds of surgery that can also help. Find out more in Managing bladder problems.

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