Multiple sclerosis is also known as the disease of a thousand faces, as the associated symptoms vary greatly from patient to patient. The more common symptoms include bladder dysfunction. This is how 50-80% of MS patients are affected. In 10-15% of patients, bladder dysfunction is a significant part of the initial symptoms.

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The bladder and its function

The bladder is a muscular organ and is located in the small pelvis between the ureter and the urethra. It is connected to the kidneys via the ureter. Among other things, the kidneys ensure that the body is cleansed of toxic substances. The urethra connects the bladder to the outer opening of the urinary tract.
The bladder can store between 500 ml and 1000 ml of urine. The release of urine is usually controlled by an interplay of tension and relaxation between the muscles. It is precisely this interplay of muscles that is often disturbed in MS patients.

The bladder function is controlled by relatively long nerves. Accordingly, these nerves offer a particularly large area for MS-related inflammation. The interaction between the bladder and the central nervous system is disrupted as a demyelination of the nerves takes place. This means that nerve transmission is impaired. Because the degree of damage to nerve cells can vary from person to person, there are also different types of bladder dysfunction.

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Types of bladder dysfunction

Bladder dysfunction is generally divided into three different types:

The overactive bladder

The bladder is mistakenly told by the brain to empty even though it is not yet sufficiently filled. As a result, sufferers have to urinate more frequently. On the one hand, this incorrect command can cause the bladder to release only a small amount of urine. On the other hand, involuntary loss of urine, also known as incontinence, may also be possible. This overactive bladder is the most common bladder dysfunction in MS patients.

Incomplete bladder emptying

If the bladder emptying is incomplete, the bladder wall muscles or urethral sphincter do not build up enough tension. This can result in bladder emptying being delayed and thus residual urine remaining in the bladder. In this bladder dysfunction, the urine stream is usually weaker than normal and the urination process is stopped prematurely. In addition to this premature cessation of urination, incontinence may also occur.
Incomplete bladder emptying is associated with an increased risk of bladder and urinary tract infections, as residual urine in the bladder provides a breeding ground for bacteria. This is manifested, for example, by pain when urinating as burning or flank pain. Urinary tract infections can become chronic, which is why treatment for bladder dysfunction should be started early.

The combined bladder dysfunction

The third and final bladder dysfunction is the combined disorder. This disrupts the interplay between the muscles that expel the urine and the bladder sphincters. This can result in a combination of an emptying disorder, but also an increased or premature urge to urinate.

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To avoid long-term sequelae, it is important that symptoms are identified and treated at an early stage. It is therefore very important to talk to a doctor if you have the first symptoms.

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Therapeutic approaches for bladder dysfunction

The treatment of bladder dysfunction can be differentiated between drug and non-drug therapy.

Medicinal Approaches for Bladder Problems

Different classes of drugs are used to treat symptoms with medication.

Anticholinergic drugs may be used to reduce symptoms in people with an overactive bladder. The contraction of the bladder muscles is caused by the suppression of the active ingredient acetylcholine. Side effects such as dry mouth or constipation can occur with this active ingredient.

For the treatment of incomplete bladder emptying with residual urine formation, so-called alpha channel blockers are used. This active ingredient helps the bladder muscles relax. Side effects can also occur here, such as dizziness or a drop in blood pressure.

Desmopressin can also suppress the urge to urinate. This helps those affected sleep through the night. In this way, sleep is no longer interrupted by the active ingredient, as there is no need to go to the toilet more often. But even with this medication, there are side effects such as weakness, hot flashes or headaches.

Acute bladder infections or urinary tract infections are treated with the use of antibiotics. However, if bladder infections occur repeatedly, this can contribute to a worsening of MS. It is therefore very important to always drink enough (at least 2 liters a day). Drinking enough prevents the acidification of urine in the bladder, as this inhibits bacterial growth. A small glass of cranberry juice should be able to counteract this in particular.

Alternative Approaches for Bladder Problems

As we have already mentioned above, it is essential to drink enough. A diary, e.g. in the Fimo Health app, can help to keep an eye on the water balance. Additional reminder functions, can be used to drink something regularly. Anyone who travels frequently or for a longer period of time should also plan regular and preventive trips to the toilet.

Tip: The EURO key to access disabled toilets:

Need to go to the bathroom on the go? This can be a difficult task when you're traveling or something like that. With the EURO toilet key, owners of such a key have access to over 12,000 disabled toilets, for example at motorway service areas, train stations, museums and government agencies — all over Europe.

However, not everyone is eligible to receive this key. People with severe disabilities are eligible, but so are chronic diseases, such as ulcerative colitis or multiple sclerosis patients. This key costs around 30 euros and to apply for this key, those affected need medical proof of their illness. You can order the key with an existing certificate.

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In addition, good pelvic floor training can strengthen the muscles so that symptoms can be alleviated. In the case of very severe forms, such as large residual amounts of urine, patients may also consider self-catheterization or permanent catheters.

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