The bladder
Why does multiple sclerosis cause bladder problems?
The bladder, which stores urine, is controlled by the nervous system. Because multiple sclerosis damages nerves, bladder function may be affected. Some people find they need to urinate more frequently or urgently, whereas others experience difficulty emptying the bladder. Some people with multiple sclerosis may experience occasional urinary incontinence.
How can bladder problems affect my health?
If your bladder is not emptied regularly, it can cause infections. These start in the bladder but can move back to the kidneys and cause serious damage, which can cause renal damage. Even small amounts of urine left in the bladder can cause infections.
Alternatively, if you cannot control the urge to urinate, you may leak involuntarily. Finding a way to take control of your bladder issues can help you stay healthy and confident.
What can I do to manage my bladder issues?
There are a number of methods and products available, including catheters, urisheaths (for men) and Urine bags.
What is a catheter?
The catheter is a slim, flexible tube that is inserted into the bladder through the urethra to allow the urine to drain.
Does it hurt to catheterise?
No. You might feel some pressure when the catheter goes in. If you experience discomfort or if it is difficult to slide in the catheter, take a short break. Try to relax by taking a deep breath or by coughing. Talk to your doctor or nurse if you find it painful.
Can I just empty my bladder in the morning and in the evening?
No. You should follow the schedule your doctor has given you. As a rule, the bladder should be emptied at least 4–6 times a day.
Can I drink less so that I don’t have to empty my bladder so often?
No. It is very important that you drink enough. This keeps the urinary system clean and healthy.
What if the urine looks cloudy or dark and smells funny?
You may have an infection. Talk to your doctor or nurse.
What if I get frequent urinary tract infections?
Using an intermittent catheter increases the risk of urinary tract infections. However, compared to other catheter types such as permanent (indwelling) catheters, intermittent catheters are less likely to cause urinary tract infections. There are ways to reduce the risk of urinary tract infections:
- Drink more fluid during the day – the principle is simply to wash out the urinary tract, providing you continue to catheterise
- Make sure that the bladder is fully emptied every time you catheterise
- Increase number of daily catheterisations
- Ensure you have clean hands and equipment when catheterising
- Reassess your intermittent catheterisation technique
What should I do if I am still leaking?
Urine leakage may occur for different reasons:
- A urinary tract infection may cause urine leakage and you should contact your doctor if you suspect you have one. Typical symptoms to be aware of include:
- Dark-coloured and strong-smelling urine
- Cloudy urine
- Blood in the urine
- Fever/sweating
- Bladder spasms
- Increased muscle contractions in your leg
- If you catheterise less than four times per day, the leakage may occur because you do not catheterise often enough.
- Consider catheterising more frequently to prevent the bladder pressure from building
- Make sure your bladder is fully emptied every time you catheterise. Reassess your intermittent catheterisation technique.
- If you are catheterising more than seven times per day and still have problems with urine leakage you may wish to consult your doctor (see below)
- You may leak because you have involuntary bladder spasms/contractions (not caused by a UTI).
Talk to your doctor about the possibilities of being prescribed some medication that will relax your bladder
- If the leakage mainly occurs doing physical exercise, you should consider catheterising before you start to exercise.
The bowel
Why does multiple sclerosis cause bowel issues?
Nerve endings in the rectum help to alert people of the need to pass a stool when it enters the rectum. In people with multiple sclerosis, this message may become lost or incomplete, increasing the risk of bowel problems such as constipation, bowel leakage or a combination of both. Certain drugs commonly prescribed for multiple sclerosis can also increase the likelihood of constipation.
How can bowel problems affect my lifestyle?
Bowel leakage and constipation can be very uncomfortable, and they also have a significant impact on our quality of life. Apart from the frequent physical discomfort and bloating, you may worry about having an accident in public.
Therefore it is important to find a way to manage your bowel issues.
What can I do to manage my bowel issues?
Bowel issues can often be improved by changing diet. There are also several types of medication that can help. Transanal irrigation can be used to help prevent constipation and bowel leakage. Read more about transanal irrigation.
What is transanal irrigation?
Transanal irrigation is where water is introduced into the bowel using a rectal catheter. The water stimulates the bowel and flushes out the stool, leaving the lower half of the bowel empty. It’s important to do it regularly to prevent constipation and the risk of bowel accidents.
How often should I irrigate?
For most people, every 1–2 days works well. It is important to do it regularly to prevent constipation and the risk of bowel accidents. It is best to get into a regular routine, rather than changing too much. With time and practice you’ll find out what works best for you. If you are not sure, ask your doctor or nurse for advice.
What time of the day is best for transanal irrigation?
Try to get into a routine where you irrigate around the same time of the day. Eating and drinking helps the bowel’s natural movement, so about 30 minutes after a meal is a good time. But don’t be afraid to change the routine slightly to suit your day-to-day habits.
Can I travel with the transanal irrigation equipment?
Yes – remember to bring your irrigation system along with lots of disposable catheters as they may not sell them everywhere. If you are going to use the system abroad, use bottled or cooled boiled water in places where the tap water is not safe to drink. Remember in different time zones your body may take a while to get used to a new routine. You may also be eating different types of food, which can affect the bowel.
Does it hurt?
No, transanal irrigation does not normally hurt and is perfectly safe. However it may feel a little strange at first. If it is uncomfortable when the water is pumped in, stop for a while and then continue. If you are in pain, stop irrigating immediately, deflate the balloon and remove the catheter. If the pain persists contact your nurse or doctor for help.
Are there any risks or complications?
Some people experience minor problems, such as discomfort or a little bleeding. If the catheter is not inserted correctly, it can cause a hole or tear in the bowel, however this risk is very small provided you follow the instructions you get from your doctor or nurse.
What should I do if I leak between irrigations?
If you experience bowel leakage between irrigations, the cause may be insufficient emptying of your bowel due to constipation or hard stool. Alternatively, you may be using too much water during irrigation. Contact your doctor or nurse to help you adapt to your bowel plan. A Peristeen Anal Plug may help if the problem persists.