Symptom Management

Bladder Problems and MS

By Laura McCatty, RN, MSCN, CCRN

Let's talk about bladder problems. Probably not your favorite topic, but ignoring them won't make them go away. There are techniques for managing bladder problems. Educate yourself so that you determine the quality of your daily life -- not your bladder!


Of those with MS, 50 to 80 percent may experience change in bladder function, which is called neurogenic bladder. This is due to loss of myelin in the central nervous system, which may interrupt communication between the bladder and the brain, resulting in various urinary symptoms. Difficulties in storage, emptying, or a combination of these problems may arise.


In order to understand neurogenic bladder, it is helpful to first examine normal bladder function. As a normal bladder fills, nerves send messages to alert the brain of the need to urinate. Like a balloon, the bladder stretches as it fills. Meanwhile, the sphincter muscles keep the urethra (the opening from the bladder to the outside of the body) closed. When the bladder retains 200-300cc of urine, sensations are sent up the spinal cord, alerting the brain that it's time to urinate. The brain messages may delay urination for a short time, with the sphincter closed, to prevent leakage. Then, when at a toilet, the bladder squeezes, the sphincter opens, and urine is released as the bladder empties. Then the sphincter closes, and the process begins again.

The first thing you need to do is inform your physician that there is a problem, even though it might be embarrassing to discuss. Document your symptoms to see if there is any type of pattern and if there is anything specific that aggravates your symptoms.


If you have symptoms of a UTI, (fever, sudden increase in spasticity or other MS symptoms, an odor or dark color to the urine) don't delay in contacting your doctor. Those with MS may not experience the typical flank pain or burning upon urination that typically accompanies UTIs. A urinalysis may be done to determine if a UTI is present. UTIs must be treated quickly to avoid an infection higher up in the urinary system.


Your doctor may suggest a post void residual (PVR), to determine urine volume after voiding. A PVR is usually conducted with an ultrasound machine or straight catheterizing, with a tube inserted into the bladder. The results of a PVR will determine options for treatment or a referral to a urologist. Each person is unique and may require a different treatment for their specific urinary problem.


If your medical regimen is not working, follow up with your health care provider. You may need further tests or a referral to a urologist familiar with MS. It is also possible that something besides MS is causing your urinary symptoms. This will need to be looked at as well.

Most neurologists advocate early treatment with a disease-modifying therapy to prevent further damage to the nerves and axons. Disease-modifying therapy must be sustained in order to diminish the frequency of MS attacks and prevent the loss of myelin to the nerves. Talk to your doctor and do your homework. Continue to educate yourself about neurogenic bladder so that you determine the quality of your daily life - not your bladder!


If you would like to speak with a MS nurse, call toll-free BETABLUS (formerly MS Pathways) 800-788-1467

Other pharmaceutical-sponsored programs include:
MS LifeLinesTM 877-447-3243
Shared Solutions 800-887-8100
MS ActiveSource 800-456-2255

Laura McCatty, RN, MSCN, CCRN is a B.E.T.A. Nurse in the Tampa, Florida area. She is also a MS-certified nurse. She provides education and training to more than 400 people with MS.

(Last reviewed 7/2009)