Brain & Nervous System Multiple Sclerosis Symptoms An Overview of Bladder Dysfunction in MS Symptoms can impact quality of life By Julie Stachowiak, PhD Updated on July 24, 2023 Medically reviewed by Lindsay Cook, PharmD Fact checked by Sarah Scott Print Table of Contents View All Table of Contents Causes Signs and Symptoms Diagnosis Treatment Urinary incontinence is probably among the most distressing symptoms of multiple sclerosis (MS). Bladder dysfunction occurs in at least 80 percent of people living with MS, and up to 96 percent who have had the disease for more than 10 years will experience urinary complications as a result of their condition. As frustrating and embarrassing as the symptoms may be, it's important not to ignore them. There are many medical treatments available today that can improve urinary function, while simple dietary and lifestyle measures can help you better manage the condition, often with minimal stress or impact on your life. Verywell / JR Bee Causes Multiple sclerosis is characterized by an abnormal immune response that causes damage to the protective covering of nerve cells (myelin sheath). This damage results in the formation of lesions on the brain and/or spinal cord which, in turn, interfere with the nerve impulses that regulate movement, vision, sensations, thought processes, and bodily functions like bladder control. Bladder dysfunction in MS happens when electrical signals to the bladder and urinary sphincter are delayed or obstructed by lesions that develop on the spinal cord. Dysfunction can occur for three reasons: The bladder is spastic, making it less capable to hold urine.The urinary sphincter is spastic, preventing the bladder from emptying completely.The bladder is flaccid and unable to contract, leading to urine retention. Signs and Symptoms The symptoms of bladder dysfunction can vary by the extent and location of the lesions. In some cases, the symptoms will be mild and transient. In others, they may be persistent and aggravating. Urinary symptoms can present in one or more of the following four ways: Hesitancy: You may feel the need to urinate, but it may take a long time to begin or you may be unable to maintain a constant flow.Urgency: The sudden, strong need to urinate accompanied by an uncomfortable rush of fullness in the bladderFrequency: The need to urinate much more often than usual. This often happens at night, causing sleep disturbances.Incontinence: When you are less able to control urine from leaving the bladder, leading to leakage Complications If bladder dysfunction is left untreated, it can cause permanent damage to the urinary tract. Urinary stones and urinary tract infections (UTIs) can often develop if the bladder is unable to empty. Chronic leakage can also lead to localized skin infections. In severe cases, potentially deadly urosepsis may develop if a urinary infection spreads into the bloodstream. It's also important to note the impact of bladder dysfunction on a person’s peace of mind and lifestyle. It is not uncommon for people with bladder control problems to isolate themselves or restrict their daily routines, often adding to the burden of depression frequently seen in people with MS. Diagnosis When investigating bladder dysfunction, healthcare providers will ask you about your symptoms. They will want to rule out a UTIs by testing your urine. If positive, antibiotic treatment will be prescribed. If not, other tests (known as a urodynamic assessment) will be performed to evaluate how well the bladder and urethra are storing and releasing urine. A urodynamic assessment takes around 30 minutes and involves the use of a small catheter to fill the bladder and record measurements. Treatment As distressing as bladder dysfunction can be, urinary symptoms can usually be managed successfully with medications, lifestyle modifications, and other therapies. Treatment will be determined by the specific cause of the dysfunction: For patients with spastic bladder: Bladder relaxants, such as Ditropan (oxybutynin), Detrol (tolterodine), Enablex (darefenasin), Toviaz (fesoterodine), Vesicare (solifenacin), Sanctura (trospium chloride), Myrbetriq (mirabegron), and Gemtesa (vibegron) are used. For patients with an overactive bladder sphincter: Alpha-adrenergic blocking agents, such as Flomax (tamsulosin), Uroxatral (alfuzolin), Cardura (doxazosin), and Rapaflo (silodosin), are used to promote the urine flow through the sphincter. In addition, antispastic drugs, such as Lioresal or Fleqsuvy (baclofen) and Zanaflex (tizanidine), can be used to relax the sphincter muscle. For patients with a flaccid bladder: Intermittent self-catheterization, wherein a thin tube is inserted into the bladder to better enable allow urination, may be recommended. Other forms of treatment include behavioral therapies which teach people how to regulate fluid intake and strategically schedule urination while at home, work, or social engagements. Dietary strategies include the restriction of caffeine, alcohol, and orange juice (the latter of which promotes bacterial growth) and the use of cranberry juice or tablets (which inhibit bacterial growth). More severe cases may require surgical procedures, including an electrical implant, called an InterStim, which stimulates the sacral nerves and helps treat an overactive bladder. Botox can also be used to treat an overactive bladder. A Word From Verywell Having bladder problems can be upsetting, but the sooner you tell your healthcare provider, the sooner you will receive proper treatment and be able to resume your normal activities without worrying about leaks or frequent trips to the bathroom. Our Healthcare Provider Discussion Guide below can help you start a conversation with your practitioner about the specific symptoms you may be experiencing. Multiple Sclerosis Healthcare Provider Discussion Guide Get our printable guide for your next healthcare provider's appointment to help you ask the right questions. Download PDF Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Email Address Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. 15 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Mahajan ST, Frasure HE, Marrie RA. The prevalence of urinary catheterization in women and men with multiple sclerosis. J Spinal Cord Med. 2013;36(6):632-637. doi:10.1179/2045772312Y.0000000084 National Multiple Sclerosis Society. Bladder problems. National Institute of Neurological Disorders and Stroke. Multiple Sclerosis. National Multiple Sclerosis Society. Urinary dysfunction and MS. National Institute of Diabetes and Digestive and Kidney Diseases. Definition and facts of urinary retention. National Institute of Diabetes and Digestive and Kidney Diseases. Urinary retention. National Kidney Foundation. Sepsis. National Multiple Sclerosis Society. Depression. Lai HH, Shen B, Rawal A, Vetter J. The relationship between depression and overactive bladder/urinary incontinence symptoms in the clinical OAB population. BMC Urol. 2016;16(1):60. doi:10.1186/s12894-016-0179-x Milsom I, Wagg A, Oelke M, Chapple C. Which drugs are best for overactive bladder? From patients' expectations to physicians' decisions. Int J Clin Pract. 2021;75(4):e13870. doi:10.1111/ijcp.13870 Tornic J, Panicker JN. The management of lower urinary tract dysfunction in multiple sclerosis. Curr Neurol Neurosci Rep. 2018;18(8):54. doi:10.1007/s11910-018-0857-z Duque ALRF, Monteiro M, Adorno MAT, Sakamoto IK, Sivieri K. An exploratory study on the influence of orange juice on gut microbiota using a dynamic colonic model. Food Research International. 2016;84:160-169. doi:10.1016/j.foodres.2016.03.028 Jensen HD, Struve C, Christensen SB, Krogfelt KA. Cranberry juice and combinations of its organic acids are effective against experimental urinary tract infection. Front Microbiol. 2017;8. doi:10.3389/fmicb.2017.00542 National Institute on Aging. 15 Tips to keep your bladder healthy. Orasanu B, Mahajan ST. The use of botulinum toxin for the treatment of overactive bladder syndrome. Indian J Urol. 2013;29(1):2-11. doi:10.4103/0970-1591.109975 Additional Reading National Multiple Sclerosis Society. Urinary Function and MS. New York City; 2016. https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Bladder-Dysfunction Williams, D. Management of bladder dysfunction in patients with multiple sclerosis. Nurs Stan. 2012; 26(25):39-46. doi: 10.7748/ns2012.02.26.25.39.c8951 By Julie Stachowiak, PhD Julie Stachowiak, PhD, is the author of the Multiple Sclerosis Manifesto, the winner of the 2009 ForeWord Book of the Year Award, Health Category. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit