Did you know that bladder problems are common in people who have MS? At least 75% of people will be affected. This is due to MS ‘plaques’ or ‘lesions’ blocking or delaying nerve messages to and from the brain and spinal cord that control the bladder and urinary sphincters. People with MS may be concerned that bladder problems could prevent them from going about their daily activities, but it doesn’t have to be that way. The good news is that there are ways to help the problem.

Normal bladder function

The first step in taking control of the symptoms you may experience with your bladder is understanding how your urinary system works.

Urine is made in the kidneys and travels down two ‘straw like’ tubes called ureters to the bladder where it is stored. When working properly, urine collects slowly in the bladder, causing it to expand (like blowing up a balloon), and deflates when you pee (like letting the air out of a balloon). When around 200mls of urine have accumulated in your bladder, nerves within the bladder send early signals to the spinal cord which effectively tells the brain your bladder needs to be emptied. 

In a normally functioning bladder, this is the initial message often felt when you need to pee, but you are still able to carry on with your normal activities until the feeling becomes more intense. As your bladder fills up further, the stretching of the bladder wall sends more intense messages to the spinal cord, which passes them on to the brain - this is the feeling you get when you’re desperate to go to the loo!

How does your bladder work?

As you prepare to urinate, the brain sends another message via the spinal cord to the bladder to allow you to pee (this is the ‘voiding reflex’), which causes two things to happen at the same time:

1. The bladder contracts to expel urine

2. The external sphincter, which normally remains closed (to prevent urine leaking) - opens to allow urine to leave the body via the urethra

Whilst people with MS are likely to experience bladder problems, these can vary for different people, but mainly fall into two categories:

Overactive bladder – This is where you have problems storing the normal amount of urine. This type of bladder becomes ‘excited’ (overactive) because nerve messages to the spinal cord and brain become overexcited, so the brain thinks you need to pass urine more frequently and faster than you really do. Some symptoms you may experience include:

• Peeing very regularly and often in small amounts of urine (known as ‘frequency’)

• Passing urine regularly at night (known as nocturia)

• Needing to go to the toilet urgently and sometimes not getting there in time (known as urgency)

• Having accidents (being incontinent)

• Urine infections – also known as urinary tract infections (UTIs) – where it might be painful to pee and it might be smelly

Problems emptying your bladder - This happens when the messages to empty your bladder are not getting through properly. Your bladder becomes full, and you may not realise how full it is. Sometimes you are aware, but the external sphincter won’t open to allow you to pee. A bladder that does not empty properly can cause the following symptoms:

• Inability to empty the bladder completely (urine retention)

• Needing to pass urine but you can’t, or it takes a while (known as hesitancy)

• Urine stream becoming weaker

• Urine infections

There are different ways to help improve bladder issues which you should talk to your MS nurse or GP. These include: 

• Basic diet and lifestyle advice

• Limiting or avoiding drinks that stimulate the bladder e.g., caffeinated, fizzy or acidic drinks and alcohol

• Drinking enough of the right fluids

• Doing regular pelvic floor exercises

• Good bowel habits

Sometimes other options may also be required. If your bladder is overactive, medication or Botox injections into the bladder can be used. When emptying is a problem, self-catheterisation or other kinds of catheters or nerve stimulation are options.

An MS diagnosis can be overwhelming, and you may be experiencing lots of changes to your body – some linked to your MS directly, others because of worry or anxiety. To help, we’ve developed a checklist which you can also download. Have a think about the following questions, and if you answer yes to any of them, you may wish to discuss further with your MS nurse.

• Am I finding it more difficult to start urinating when I get to the toilet?

• Do I feel as though my bladder isn’t completely empty when I’ve finished urinating?

• Do I experience frequent or recurrent urinary tract infections?

• Am I having bladder accidents, perhaps when walking, exercising or resting?

• Do I make it to the toilet in time (or just about)?

• Am I waking lots at night to pee?

• Has my urine flow and/or sensation become weaker?

• Am I using pads or any other strategies to protect my clothing from urinary leakage?

• Am I limiting the amount of fluid I drink because I worry about having to pee frequently?

• Am I planning my daily activities around my bladder symptoms?

• Do my bladder symptoms keep me from doing what I enjoy?

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