John R. Corboy, M.D., is director of the University of Colorado Multiple Sclerosis Center and associate professor of neurology.
Q I have multiple sclerosis, and I'm now having bladder-control problems. Are there any treatments for this?
DR. JOHN R. CORBOY ADVISES:
A Bladder incontinence is very common in patients with MS. There are several causes for the problem.
Early in the disease, it's often due to bladder hyperactivity. In this situation, the patient can't hold very much urine in the bladder.
Treatments for this type of incontinence include oral medications that slow down the bladder so it's not so active. There is also a patch that works quite well. An advantage to the patch is that it needs to be changed just a couple of times a week. There are also fewer side effects associated with the patch than with oral medications.
Later on, there are several other causes of bladder-control problems. Sometimes the bladder becomes overstretched and fills up too much. This can be caused by the degeneration of nerves that control the bladder. When this happens, the bladder does not contract normally, as it must to expel urine. Nerves also control the urinary sphincter, which acts like a faucet. When the nerves are damaged, the sphincter doesn't open properly. This also can contribute to the bladder remaining overfilled. Sometimes people have a combination of these problems.
It's important to see your doctor about this because there can be serious complications if your bladder stays too full. For example, the urine can back up into your kidneys and damage them or bladder infections can develop.
If your doctor concludes the problem is caused by a faulty sphincter, he can give you a medication to relax the muscles of the sphincter and you'll be able to empty your bladder more fully. He'll have to work to find the right dose, though, because you can end up with urine leakage if the dose is too high.
When it comes to bladders that accumulate too much urine, the available medications don't work very well. In this case, the best solution may involve a catheter — a tiny tube that may be inserted into the bladder intermittently as needed or as a permanent drain.