Managing 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 and Bowel Community can give you details of your nearest service. You can also speak to a specialist nurse - calls are confidential.
Exercises for bladder problems
Training your pelvic floor can help with some bladder issues. We worked with physiotherapist Ruth on a set of simple exercises for your pelvic floor that you can try at home. There is an audio desribed version of this video.
Read more about pelvic floor exercises below.
Ways to manage
First line treatment
There is a good ‘first-line’ treatment route for managing bladder problems in MS. It works well for most people.
Step 1 – do you have an infection?
Your health care professional will check for infection. If a urinary tract infection (UTI) shows, it will be investigated and treated.
Step 2 – is your 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 – they may prescribe medication to reduce bladder contractions and relieve both frequency and urgency.
- If the residual volume is high – more than 100ml – then you'll need to take steps to improve bladder emptying (for example by self-catheterisation) before taking medication to reduce urgency.
Several can be used to treat an overactive bladder and make bladder contractions less unpredictable.
Many belong to the same family of 'anti-cholinergic' drugs. Dry mouth is a common side effect of these drugs. But if you have side effects that are difficult to deal with, or if one drug doesn’t work for you, there are other types of drugs that you can try.
Read more in our booklet on Managing bladder problems.
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. Most people will want to do this two to four times a day.
A specialist nurse or continence adviser can teach you how to do this. You might feel nervous at first, but your health care professional will support you until you feel confident to catheterise yourself.
Botox (botulinum toxin)
Botox injections are highly effective at reducing urgency and urgency incontinence in people with overactive bladder caused by MS. The effects are quite long lasting – between 6 and 10 months – but not permanent.
The treatment involves having between 20 and 30 injections into different sites in the bladder wall, and works by stopping the bladder wall from contracting.
Once the effect has worn off, you can have the treatment again: studies have shown that repeated Botox injections are both safe and effective.
Following treatment with Botox, you may find you’re unable to empty your bladder completely. Because of this, to have the treatment you will need to be able to self-catheterise.
Treatment with Botox is carried out by a urologist, so you will need a referral from your GP.
Nerve stimulation is usually offered if the first-line treatments haven’t worked, and you don’t want Botox.
This treatment uses a small needle electrode, placed on the ankle and connected to a battery-powered stimulator, to stimulate a nerve in the leg called the posterior tibial nerve. This then indirectly stimulates the nerves that control bladder function.
Speak to your GP or continence adviser if you think nerve stimulation might help with managing your bladder problems.
Vibrating bladder stimulators
If you have problems with emptying or hesitancy, then holding a battery operated vibrating device or buzzer against your lower abdomen while going to the toilet may help. It’s thought to work by relaxing the sphincter muscle.
A continence adviser can advise you on using a bladder stimulator.
Pelvic floor exercises
Pelvic floor exercises can help with control by improving the ability to ‘hold on’.
You might have heard of women doing pelvic floor exercises after childbirth, but they can be done by men as well as women.
A physiotherapist or continence adviser can help you to learn how to exercise these muscles.
Managing day to day
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.
RADAR key scheme
Disability Rights UK runs the RADAR National Key Scheme to allow access to toilets across the UK.
Some people find that using protective pads can help with managing bladder problems day-to-day. For men, penile sheaths can be helpful. These fit over the penis, and carry urine away through a tube to a small bag attached to the leg. Information is available from the Bladder and Bowel Community.
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.
More severe bladder problems
Why might bladder problems get worse?
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 more lesions affect the spinal cord. The level of bladder problems people with MS experience is often connected to the level of difficulty they experience in walking.
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.