Multiple Sclerosis & Incontinence
Multiple Sclerosis is a disease of the nervous system that impairs muscle coordination and strength. Because the urinary process requires coordination of voluntary and involuntary muscles, most individuals with multiple sclerosis experience some level of incontinence. Before a treatment can be recommended, your physician must determine the type of dysfunction.
The Nervous System's Role in Urination
Proper urinary function depends on coordination of several muscle functions. The muscles must receive messages from the brain alerting them to perform their function.
Storing Urine:
In order to store urine, the detrusor muscle (or bladder) is relaxed and the sphincter muscles are contracted.
The Need to Urinate:
As the bladder fills with urine, nerves inside the bladder alert the pons area of the brain of the coming need to urinate.
Full Bladder:
The brain sends a message to the detrusor to contract and push out the urine and tells the sphincter muscles to relax so the urine may be released.
Messages:
If the messages are not sent to and from the brain, or are improperly coordinated, incontinence will occur.
Causes of Incontinence in MS Patients
A visit to your physician's office is the first step in determining the cause of your incontinence. A urine culture can be taken to see if a bladder infection, called cystitis, is the cause of your problems. If this is the case, antibiotics can be used to clear the infection. Recurrent infections may require other methods of treatment.
Following are types of dysfunctions of the nervous system that can lead to incontinence.
Storage Dysfunction:
Nerves in the bladder send a message to the brain that it is time to urinate even if there is only a small amount of urine being stored. The result may be the emptying of the bladder before you can reach the toilet.
Emptying Dysfunction:
In this case, the bladder is not completely emptied during urination. The excess urine builds in the bladder to the point where it can no longer be contained and then it overflows.
Combined Dysfunction:
In some cases, you may experience complications caused by both storage and emptying dysfunction. You may experience the urge to urinate when the bladder is not completely full, and then not be able to empty the bladder because the sphincter muscles did not relax.
Diagnosis
Several techniques may be used to determine which dysfunction is at the root of your problems. Your physician can insert a catheter (a thin tube) into the bladder after urination is completed. This will help him determine if the bladder was completely emptied. The procedure may seem intimidating, but it can be performed quickly and with little pain right in your doctor's office.
The same results can be achieved by having an x-ray of the bladder taken after you have urinated. The pictures will show any excess urine contained in the bladder immediately following urination.
Treatment Options
For Storage Dysfunction:
Medication to relax the bladder. This will allow a normal amount of urine to accumulate before the brain receives the signal of the need to urinate.
For Emptying Dysfunction:
Self-Catheterization. This allows the urine to be released. Just like in the diagnostic test, a catheter is inserted several times a day into the urethral opening to the bladder.
For Combined Dysfunction:
A combination of medications to relax the bladder and self-catheterization will be recommended for those with combined dysfunction.