Bladder dysfunction occurs in as much as 75% of people with MS. It can usually be treated quite successfully. Bladder dysfunction develops because MS blocks or delays transmission of nerve signals in areas of the central nervous system that control the bladder and urinary sphincter. The sphincter is the muscle surrounding the opening of the bladder that either keeps urine in or allows it to flow out.

The most common bladder problems associated with MS are:

• Frequency: an increase in the number of times urination occurs within the day.
• Urgency: a feeling of having to empty the bladder immediately, combined with an inability to "hold" urine once the urge to void is felt.
• Hesitancy: difficulty in beginning to urinate after the urge to void is felt.
• Incontinence: an inability to hold urine in the bladder.
• Nocturia: frequent nighttime urination

Bladder symptoms in MS are usually the result of a “spastic” or “unstable” bladder. Spastic bladder have a limited capacity to hold urine, and have reduced compliance, so that a small increase in the amount of urine in the bladder causes an immediate need to void. MS can also cause a bladder to not empty fully, and thus always retains some urine in it. Retaining urine may lead to complications such as repeated infections or even kidney damage.

Depending on the type of problem and the cause of the problem, bladder problems may be managed with or without medications. Sometimes a referral to Urology for further evaluation and testing may be required. Treatment strategies include dietary and fluid management, medications, and intermittent or continual catheterization (inserting a thin tube into the bladder to remove urine).

Bladders that are “unstable” may benefit from medications to improve compliance of the bladder wall or improve sphincter function such as tricyclic antidepressants, Ditropan, Usipas, Probanthine, or Detrol. Bladders that do not empty fully may get worse with these medications, however. In this situation, other medications (such as Hytrin, Flomax, Zanafelx, Baclofen), timed voiding, manual compression over the bladder, or catherterization may be needed.

Bladder infections are characterized by fever, foul smelling urine, or cloudy urine. MS patients are more prone to ballder infections. Bladder infections require a urinanalysis and antibiotic treatment

Some tips for helping with MS related bladder symptoms and avoiding bladder infections include:

• Increase intake of fluids, esp., cranberry juice and water. These help flush bacteria out of the bladder.
• Avoid drinking alcohol and caffeine. These may stimulate unwanted bladder contractions.
• Do not hold urine for long periods of time.
• Take Vitamin C, up to l000 mg four times a day. This makes urine more acidic and can help prevent infections
• Avoid bubble baths
• Wear only cotton underwear
• Avoid intercourse if you have symptoms of an infection