Managing bladder problems

The first step to managing bladder problems is to talk to a specialist. Try not to worry about talking about bladder problems with your doctor or nurse. Health care professionals are used to talking about these issues and can offer help.

Who can help with MS bladder issues?

Health care professionals who can help with bladder issues are:

your GP. They can give you a referral to a specialist like a urologist or local bladder and bowel service. Get referrals through your GP if you don’t have an MS nurse, or if you don’t regularly see a neurologist.
your MS nurse. They can give you advice, information and support. They might give you bladder scans or give advice on catheters and medications. They can refer you to a local bladder and bowel service.
your local bladder and bowel service

Bladder and bowel services

Bladder and bowel services are sometimes called continence services. They’re based in a hospital, clinic or health centre. Your GP, MS nurse or neurologist can give you a referral. You can often contact them yourself.

In these services specialist nurses (or 'advisors') can assess your problem and carry out tests. They can give you information, support and treatments. They can fit or change catheters or get you any equipment and products you need.

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 muscles can help with some bladder issues. We worked with physiotherapist Rachel on a set of simple exercises for your pelvic floor muscles that you can try at home. There is an audio described version of this video.

Read more about pelvic floor muscle exercises below.

Tests for MS bladder problems

A bladder specialist can use tests to help identify what your bladder problem is, including:

a test on a sample of your pee. This will show (or rule out) if an infection is the cause of your problem. A nurse or doctor will send it off to a lab for the result
an ultrasound scan. This measures how much pee is left in your bladder after you go to the toilet
a urine flow test. This shows what your ‘flow rate’ is. That measures how much pee comes out and how fast. You pee into a funnel connected to a computer. Often you’ll have an ultrasound scan afterwards.

A bladder diary, physical examination and you describing your symptoms will also help a nurse or doctor identify what your issue is.

Dipstick tests

A dipstick test is something your GP can use to check for bladder infections. If the dipstick changes colour, your test is ‘positive’ and you have an infection that needs antibiotics. Your GP will then send your sample to a lab for more tests. These will find out what the infection is and what antibiotics will work against it.

You can buy dipstick tests in chemists, to rule out an infection. But there are some things to remember:

the colour can change for reasons other than an infection. So no matter what the colour, don’t ignore any symptoms you have
it’s easy to interpret dipstick test results wrongly. Ask your doctor or nurse for advice if you’re thinking of using one
if you or a health professional suspect an infection, a sample of your pee will still need to go to a lab for more tests
dipstick tests aren’t recommended if you’re over
dipstick tests mustn’t be used if you have a catheter.

When your bladder doesn’t hold pee like it should

The tests for this problem include an ultrasound scan and urine flow test.

If things like changing how much you drink and what you eat don’t help, first line treatments are offered. These treatments are the ones most likely to work for most people. They include:

bladder training
drugs

You’ll also get advice on how much liquid to drink and what you eat. Losing weight and not getting constipated can also help as a first step. Cutting out caffeine might help, as might drinking less fluid (but drinking less might cause other problems).

You can train your bladder on your own. You’ll do this with the help of your bladder and bowel nurse, MS nurse or a bladder expert. You can train your bladder at the same time as you have drug treatments or electrical stimulation.

There are different types of bladder training a specialist might suggest. These include:

Bladder retraining

With bladder retraining, you put off peeing for longer and longer periods. You start by waiting an extra five minutes, then gradually add more time. Over months this stretches your bladder so that it holds more.

Training can include timed voiding (see below).

Find out more about this and training in general

Timed voiding

Timed voiding is when you learn to empty your bladder at set times during the day, such as every two hours. This eases the sudden, strong need to pee. It also makes you less likely to leak. You won’t be asked to fight the urge to go to the toilet

Pelvic floor muscle training (PFMT)

Pelvic floor exercises can make you hold your pee better if you have mild symptoms of an overactive bladder or stress incontinence. That’s when you leak pee when you laugh, cough, sneeze or strain yourself. Both men and women can do them.

Pelvic floor muscles support your bladder and bowel. These muscles are meant to stay tightened all of the time. They only relax to let you pee. These muscles help stop your bladder leaking.

You can do the exercises on their own. Or you can do them with biofeedback and/or electrical stimulation such as neuromuscular electrical stimulation (NMES). The Squeezy app can help you learn pelvic floor exercises.

If your pelvic floor exercises don’t seem to be helping, you should be offered training from a physiotherapist or trained nurse (like a bladder and bowel nurse). Your GP or MS nurse can refer you to one.

Antimuscarinic drugs (or anticholinergic drugs)

Antimuscarinic drugs block messages that go down nerves to your bladder and tell it to squeeze and empty. They’re sometimes called anticholinergic drugs. These drugs make your bladder less irritable and overactive. You won’t feel the need for the toilet so often. There are more than half a dozen different antimuscarinic drugs you might be prescribed for MS bladder problems:

oxybutynin (brand names: Ditropan, Lyrinel XL, Cystrin and Kentera patches)
propiverine (Detrunorm)

Two drugs are especially suitable with advanced MS:

trospium chloride (Regurin)
darifenacin (Emselex)

Newer drugs with fewer side effects are:

tolterodine (Detrusitol, Neditol)
solifenacin (Vesicare)
fesoterodine (Toviaz)

Many people notice a difference within a week. But it might take about a month before you get the full benefit. With some drugs it can take even longer.

All of these antimuscarinic drugs are tablets that you take one to three times a day. Oxybutynin also comes as a patch you wear on your skin.

Antimuscarinic drugs have some common side effects, including a dry mouth and constipation. They’re not always suitable for older people because there could be a bigger risk of side effects, including effects on the heart. Your doctor can explain the side effects to you.

Side effects are less likely with the newer drugs. Older drugs like oxybutynin can affect your memory and thinking. You might be offered the choice of one of the newer drugs which don’t have this side effect.

Mirabegron (Betmiga) and Vibegron (Obgemsa)

Mirabegron and Vibegon are beta 3-receptor drugs. They also relax the muscle in your bladder. Their brand names are Betmiga and Obgemsa. Studies on people with MS have shown they help with urgency, frequency and incontinence.

These drugs come as a tablet. You might get them if antimuscarinic drugs don’t work (or if their side effects are too much). Mirabegron and Vibegon tend to cause fewer side effects than antimuscarinic drugs. You might take these beta 3-receptor drugs with an antimuscarinic drug or another drug called desmopressin. You might also have follow-up scans of your bladder, for example, to check how your bladder now empties.

Side effects of beta 3-receptor drugs can be high blood pressure, cold-like symptoms and your bladder not emptying fully.

Desmopressin (Desmotabs, DDVAP or DesmoMelt)

Desmopressin is a drug that treats an overactive bladder. You take it if you pee a lot (day or night). The brand names of desmopressin are Desmotabs, DDVAP or DesmoMelt.

When you take this drug, you make less pee. So it cuts down on bladder accidents, and you can sleep better at night. It can give people on average an extra two hours of uninterrupted sleep a night.

Desmpressin comes as a nose spray, a tablet, or as a tab that melts under your tongue. You shouldn’t use it if you’re over.

Desmopressin can have serious side effects. So you need frequent checks from your health care team to look out for these. Side effects can be:

headache
stomach ache or feeling sick
your bladder not emptying fully
low levels of sodium in your blood.

Symptoms of low sodium include:

feeling or being sick
tiredness or weak muscles
confusion
headache
restlessness
spasms or cramp
seizures or passing out

You may need blood tests to check your sodium levels.

If for any reason you get vomiting or diarrhoea, stop taking this drug until you’re well again.

If first line treatments don’t help your bladder to hold your pee like it should, then there are second line treatments. These include:

botulinum toxin (Botox)
electrical stimulation

You usually see a neurologist for further tests before you get these. This can include ‘urodynamic’ tests to check how your bladder is working. The doctor might suggest you start intermittent self-catheterisation.

Botulinum toxin is better known by the brand name Botox. Another brand name is Dysport. After giving you a local anaesthetic, a bladder doctor (urologist), in one session, injects it up to 30 times into the muscle in the wall of your bladder.

Botox stops messages reaching your bladder that tell it to squeeze and empty. After Botox injections your bladder will hold more liquid. So you won't feel like going to the toilet as often.

Botox can be very good at treating an overactive bladder. It's made a big difference to many people's lives.

Eventually the effect of Botox will wear off. So you usually need more injections every six to 12 months. Botox doesn’t work for everyone, but most people with MS find it makes a big difference.

We don’t know for sure if Botox will work throughout your life. If your MS gets worse over the years, Botox is likely to stop working like it used to. Sooner or later about half of people with MS stop using Botox because it stops working for them. Often they switch to another treatment like neuromodulation.

An important side effect

Botox is good for treating an overactive bladder and problems with holding pee or incontinence. But for some people Botox creates a new problem. It can stop their bladder emptying properly. So you might need to use a catheter each time you pee. So, before you have Botox, you must agree that you’ll use catheters if you need to. Before you start Botox treatment, a bladder and bowel nurse can show how you do this.

Read more about catheters in our section on bladders that don’t empty properly.

Some people can still empty their bladder normally after Botox treatment. But they’ll need tests to measure how much pee is left in their bladder after they empty it.

Three kinds of electrical nerve stimulation you might be offered for MS bladder problems:

neuromuscular electrical stimulation
tibial nerve stimulation
sacral nerve stimulation

These treatments aren’t available everywhere and they don’t suit everyone. But you could ask your doctors or nurses about them if other options aren’t working.

Neuromuscular electrical stimulation

In neuromuscular electrical stimulation mild electrical signals are sent to nerves that affect your bladder. You may be offered this if you can’t squeeze the muscles of your pelvic floor.

For a set period you use a small battery-powered device to send electrical signals to nerves in your pelvic floor muscles. These signals make these muscles squeeze. This way you learn to have more control over the muscles you use when you pee.

Stimulation of your tibial nerve

Tibial nerve stimulation is a safe treatment that can help with incontinence (leaking), frequency, urgency and an overactive bladder. It might be available if bladder training, drugs and Botox don’t work, or aren’t right for you.

The tibial nerve runs up your leg. A mild electrical current is sent up this nerve. That relaxes nerves in your lower back that control your bladder. This helps relax and retrain an overactive bladder.

There are two ways of sending the electrical current up the tibial nerve:

a needle is put into the skin above your ankle, near the tibial nerve. A patch with an electrode in it is put on your foot. The needle and electrode are connected to a stimulator device. This is called percutaneous tibial stimulation (PTNS)
a patch with an electrode in it is placed on the skin near the tibial nerve. This is called transcutaneous tibial nerve stimulation (TTNS). There’s no need to pierce the skin with a needle like with PTNS.

This treatment takes about half an hour, once a week for 3 months. After those 3 months, some people need extra treatments to keep it working (around once every 3 weeks).

Stimulation of the sacral nerves (sacral neuromodulation)

Sacral nerve stimulation might be an option as an alternative to Botox if you’ve got an overactive bladder. Or if other treatments like bladder training or tibial nerve stimulation don’t work. It’s sometimes called sacral neuromodulation (SNM).

The sacral nerves are in the bottom part of your spine, at the top of your buttocks. They control your bladder, sphincter and pelvic floor muscles.

Stimulating the sacral nerve doesn’t work for everyone, so you start with a test phase. Under a local anaesthetic a specialist puts a very thin wire into the skin in your lower back. This wire is connected to a small device that you wear on a belt. The wire inside the device sends mild electrical signals to your sacral nerves. This cuts down how often the nerves send messages that tell your bladder to empty.

After two weeks the specialist checks how well it’s worked, and how you find it. If it works and you’re happy with it, you can have a permanent implant put under the skin in your buttock. That has a wire and battery inside it and is the size of a USB stick. Implanting it happens with a general anaesthetic.

It's safe to have an MRI scan with this implant in you.

Sacral neuromodulation is quite a new treatment. But it’s had good results in people with nerve-related bladder problems.

There are no official guidelines about using this treatment with people with MS, but some have had it. It’s not seen as the best kind of treatment for people with MS. For example, bladder problems in MS tend to get worse over time. So this treatment might not work in the long term.

When your bladder doesn’t empty like it should

A test called an ultrasound scan will show your if bladder isn’t emptying properly. A handheld scanner is passed over your belly. This measures how much pee is left in your bladder after you’ve been to the toilet. This is called your PVR (postvoid residual volume) measurement. It’s a good way of telling if you have an overactive or underactive bladder.

If your PVR is under about 100ml, your bladder symptoms are more likely to do with how it holds pee. If your PVR is lower about 100ml, the problem is more likely to do with how your bladder empties. 100ml is about a third of a can of fizzy drink.

You might need to go for this test with a full bladder. This means drinking a litre (or four glasses) of water an hour before your visit. But only do this if the hospital tells you to when they give you your appointment.

The usual treatment for an underactive bladder is to use catheters to let your bladder empty properly. Some people find holding a vibrating device near their bladder might also help it empty. There aren’t any effective drug treatments for an underactive bladder.

A catheter is a small, flexible thin tube. They can be made from soft plastic, silicone rubber or latex. You put it into your urethra, the pipe that takes pee from your bladder and out of your body. It can be a very good answer to a bladder that doesn’t empty properly.

You might hear this called 'self-catheterisation' which means you do it yourself. When it’s called 'intermittent catheterisation, it means you put the catheter in on regular occasions when you need it. If you hear the two names together in ‘clean intermittent self-catheterisation' (CISC), that describes the need for good hygiene for using a catheter. This stops bacteria getting on the catheter and into your urethra and bladder.

Your nurse will support until you’re confident enough to put a catheter in on your own. To make using a catheter more comfortable, it might already be covered in lubricant gel. If it’s not, you put lubricant on it. Using a catheter isn’t painful. Many people with MS find it improves their quality of life a lot.

When you use a catheter, it takes pee out of your bladder, down the tube and into either a bag on the end of it or into the toilet. You then take the catheter out. You usually throw it away, and use a fresh one each time.

A bladder and bowel nurse or district nurse will teach you how to use a catheter. An MS nurse might do this if you have no bladder and bowel service in your part of the country.

You use a catheter up to around six times a day 35, depending on how much you drink. You use a fresh catheter each time.

Read about using a catheter

Indwelling catheters

Indwelling catheters are inside the bladder all the time. These can be helpful if you can’t move around easily. Or you can’t or don’t want to put a catheter in yourself. For example, if MS affects your dexterity and how you can use your hands.

An indwelling catheter goes in like a regular catheter but stays inside the bladder, held in place by a small balloon. This balloon is blown up after the catheter is in your bladder.

The catheter drains into a bag, usually attached to your leg with Velcro-style straps. When the bag’s full, you empty it into the toilet.

When you go to bed you use a night bag to collect the pee. It’s bigger and hangs by your bed on a stand.

Instead of using a draining bag, some indwelling catheters have a valve that you can open and close. This lets you empty your pee straight into the toilet.

Indwelling catheters need changing at least every three months by a nurse. Leg bags and valves need changing every seven days. You can be taught to do this yourself, or a district nurse can do it.

Your doctor puts the catheter in for you using a gel that numbs the area. A healthcare professional who’s been trained in this can also put one in.

Indwelling catheters come with a bigger risk of infections. There’s also a risk of stones growing in your kidney and bladder.

Tips for dealing with bladder problems

Fluids

You might be tempted to cut down on how much you drink. But the latest MS and bladder guidance says there’s no evidence that this makes a big difference to bladder symptoms. So experiment and see if it works for you

Drinking lots of liquids will help flush urinary tract infections out of your bladder.

But drinking too much can make bladder issues worse for some people

About 6 to 8 glasses or cups a day is the recommended amount to drink (1.5 to 2 litres). You need more if you’re exercising or if the weather’s hot

You might drink less so that you don’t need the toilet so often. But when pee gets too strong, it can irritate your bladder and cause infections.

And not drinking enough causes constipation. And that puts pressure on your bladder

Through the day your pee should be pale yellow. Any darker means ‘drink more’. First thing in the morning it’s normal for pee to be darker. That’s especially true if you’ve not been to the toilet in the night.

Have your last drink no later than two hours (or even longer) before going to bed

Caffeine

The latest MS and bladder guidance says drinks with caffeine only have a small effect on bladder symptoms. But giving caffeine up might help some people, so it could be worth trying

Caffeine can irritate the bladder, making urgency and frequency worse. Fizzy drinks, smoking and alcohol can do the same

Cranberry and other food

Spicy foods, citrus fruits and juices (oranges, grapefruit, lemons, also tomatoes) can irritate the bladder. Try avoiding them to see if it helps

Some people drink cranberry juice or take cranberry tablets to help avoid bladder infections. Evidence for this is mixed. A study in 2014 found it made no difference in people with MS. When all studies of cranberry were looked at in 2023 and 2024, cranberry did help some people. But cranberry didn’t help all types of people and these studies weren’t of people with MS

Try to keep to a healthy weight. Being too heavy puts pressure on your bladder and pelvic floor muscles. This makes leaks more likely. If you’re overweight, losing weight can help.

Carry our free ‘I have MS’ card. It tells people you need a toilet because of our MS.

Find a public toilet at Toilet Map or download one of the public toilet apps.

Join the National (RADAR) Key Scheme. For a few pounds you get a key that lets you into over 9,000 locked accessible toilets in the UK.

Find toilets that are bigger than standard accessible ones, or have hoists on the Changing Places website.

Contact your council to see if there’s a Community Toilets Scheme locally. It lets you use toilets in shops, restaurants and pubs without paying.

Going to the toilet

These tips can help you pee:

try to relax. Don’t strain
run a tap. Running water will encourage your bladder to empty
after you’ve had a pee, stay an extra minute and try to pee some more. This is called ‘double voiding’. Standing up and sitting down again can help. Men need to sit down to pee to double void
if you can do it safely, lean forward on the toilet and rock from side to side
tapping over your bladder with two fingers may help it squeeze and empty
or stroke your inner thighs, belly or lower back
a bladder and bowel nurse can tell you more about double voiding and ways of using your hands or fingers to help you pee.

Record what's going on

Keep a bladder diary. Record what you drink and eat, how often you pee, how many ‘accidents’ you have, and any problems stopping and starting. This will help you notice what makes things worse or better.

You could do this with pen and paper, typed or using your voice on your computer or phone. You might use an app set up for this purpose.

Share what’s in your diary with whoever is looking after your bladder.

Use a bladder function phone app to record how much you drink and pee. Use it to set goals if you’re training your bladder. Examples are the iUFlow app (women) and Bladder Journal (men and women)

The NHS-approved Squeezy app for men and women helps you train your pelvic floor muscles

Some apps let you send a report to your continence nurse.

A ‘reasonable adjustment’

If you work, would being nearer a toilet help? You can ask for this as a ‘reasonable adjustment’. This is a change that the law says your employer has to make.