MS Society of Canada - Calgary Chapter

Symptom Management

Page 15

Bladder and Bowel

Bladder dysfunction is usually treated very successfully. Treatments may include dietary change, medications, mechanical aids to help control the flow of urine and intermittent or continual catheterization—inserting a thin tube into the bladder to remove urine.

Bladder dysfunction develops because MS blocks or delays transmission of nerve signals in areas of the CNS that control the bladder and urinary sphincter. The sphincter is the muscle surrounding the opening of the bladder that either keeps urine in or allows it to flow out.

Symptoms of bladder dysfunction may include:

the need to urinate frequently and urgently
a hesitancy in starting urination
the need to awake frequently at night to urinate (nocturia)
incontinence (the inability to hold in urine).

These symptoms may be caused by a “spastic” bladder—one that does not hold the normal amount of urine—or a bladder which does not empty properly, and thus always retains some urine in it. Retaining urine may lead to complications such as repeated infections or kidney damage.
Left untreated, bladder dysfunction may also cause emotional and personal hygiene problems that can interfere with normal activities of living and socialization. It is therefore important to seek appropriate medical evaluation and treatment early, so that the cause of the bladder symptoms can be determined and treated, and complications avoided.

Bowel Problems

Constipation is a particular concern among people with MS, although diarrhea, incontinence (or loss of control), and other problems of the stomach and bowels, are also not uncommon. Causes of constipation include not drinking enough liquids, reduced physical activity and mobility, and decreased “motility”—or movement of food through the intestinal tract. Certain medications such as antidepressants or drugs used to control bladder symptoms, can also cause constipation. Loss of bowel control in MS may be related to constipation and should be evaluated by a physician.

Bowel dysfunction can cause a great deal of discomfort and humiliation, and may aggravate other MS symptoms such as spasticity or bladder dysfunction. A physician can help establish an effective bowel management program. Occasionally, it may be necessary to consult a gastroenterologist, a physician specializing in the stomach and bowel.

Guidelines for Bowel Regularity

Bowel regularity can generally be maintained by following a few simple guidelines:

Drink adequate amounts of fluids, at least 48 oz. or 6-8 glasses of fluid daily
Include plenty of fiber in the diet. Fiber can be obtained from fresh fruits and vegetables, whole grain breads and cereals, and dietary additives such as powdered psyllium preparations
Use stool softeners as recommended by your physician

Establish a regular time and schedule for emptying the bowel. Wait no more than two to three ays between bowel movements. Enemas, suppositories and laxatives may be used in moderation to facilitate a bowel movement. Continuous or regular use of laxatives is generally not recommended.