Bladder Dysfunction

The purpose of the urinary system is to remove waste from the blood. The urinary system includes the kidneys, ureters, bladder, sphincter muscles, and the urethra. There are two kidneys, one on either side of the body. The kidneys filter blood of waste products and water to create urine. Urine flows from the kidneys through the ureters to the bladder.

The bladder collects and holds the urine until it is time to urinate. The bladder stretches as it fills with urine, and then shrinks when it is empty. There are sphincters (muscles) in the bladder that close to keep urine in or open to let urine drain out of the bladder.

The urethra is the hollow muscular tube which allows urine to drain from the bladder to the outside of the body.

The bladder empties through the process of urination when the brain sends messages through the spinal cord telling the bladder to contract so the sphincter muscles will open. When the sphincter opens, the bladder drains.

Process of urination

1. The bladder stretches as it fills with urine.
2. This stretching pushes on a bundle of nerves to send a sensory message to the sacral nerves and then up through the spinal cord.
3. The message splits and part of it sets off a bladder reflex, which causes the bladder to contract.
4. The other part of the message travels up the spinal cord to the brain with the urge to urinate.
5. The brain decides if it is the right time to urinate.
6. If it is a good time to urinate, the brain sends a message back down the spinal cord for the bladder’s muscles to contract and sphincter to open to allow urine to drain out the body.
7. If it is not a good time to urinate, the brain sends a message back down the spinal cord to keep the bladder relaxed and the sphincter closed to keep urine in the bladder.

• Urinary frequency: The urge to empty your bladder more than you consider to be normal. This is a type of urinary storage dysfunction because the bladder cannot hold urine. The bladder is overactive, signaling the need to urinate even before it is actually full. Individuals with urinary frequency may experience incontinence.
• Urinary urgency: Strong, sudden urges to empty your bladder despite have very little urine. This is a type of urinary storage dysfunction because the bladder cannot hold urine. In some cases, urgency can cause leakage of urine, or urge incontinence, on the way to the bathroom.
• Urinary incontinence: The inability to hold urine in the bladder with some stressor leading to an unexpected leakage of urine. This is a type of urinary storage dysfunction because the bladder cannot hold urine. There are four types of urinary incontinence:
  • Urge incontinence: Person develops a strong urge to empty the bladder and leaks urine on the way to the restroom.
  • Overflow incontinence: When the bladder does not empty completely and the retained urine overflows, causing frequent leakage.
  • Stress incontinence: The bladder muscles are weak and unable to hold the bladder sphincter closed during a stressor, such as coughing, sneezing, or jumping, and urine leaks out. This often occurs in women after childbirth.
  • Mixed incontinence: Person experiences more than one type of incontinence.
• Urinary retention: The bladder becomes overly full of retained urine, causing it to stretch and become floppy over time. People with MS may have diminished ability to send and receive messages to either identify the need to urinate or the ability to effectively empty the bladder. This is a type of urinary emptying dysfunction because the bladder cannot get rid of urine. If urine stays in the bladder too long, it builds an environment where germs grow. This can lead to a bladder infection. The infection can also travel from the bladder up to the kidneys, causing a kidney infection.
• Urinary reflux: This occurs when urine flows backwards from the bladder up into the kidneys. One cause of reflux is from an overfull bladder because there are high pressures in the bladder. This causes urine to reflux or back up into the kidneys. Another cause of urinary reflux is from an overactive bladder. The bladder muscles will inappropriately contract to increase the pressure, causing urine to flow backwards.

Any new or worsening bladder symptoms need to be reported to your provider. There are many reasons someone can develop a change in bladder function and it is important to make sure it is not a result of an infection or progression of MS disease.

Report new or worsening bladder symptoms, including:

• Urinary frequency
• Urgency to urinate
• Urinary incontinence
• Inability to empty your bladder or urinate

Call the doctor or go to urgent care with symptoms including:

• Fever greater than 101°F
• Loss of appetite
• Achy or feeling sick
• Unresolved pain or burning with urination
• Increase in spasticity
• Change in mental status

A UTI is an infection which develops within the urinary system, such as the bladder or kidney. It also can be referred to as a bladder infection. Frequent infections can be a sign of bladder dysfunction because the bladder is not effectively emptying, which allows germs to grow. Urinary tract infections are one of the most common causes of an MS pseudo-relapse.

Symptoms of a UTI include:

• Fever greater than 100°F degrees
• Blood in urine
• Cloudy or foul-smelling urine
• A sudden increase in muscle spasticity, pain, fatigue, or other MS symptoms
• Urinary incontinence or leaking urine, if this is abnormal for you
• Burning pain when you urinate
• Feeling like you have to urinate frequently

If you suspect you have a UTI, call your doctor to see if you need to get your urine tested for an infection. This is done by collecting a sample of urine and sending to the lab for a urine culture. The lab monitors the urine for several days to see if any bacteria (germs) grow and determines which antibiotics will kill the bacteria to treat the infection. It is important not to wait to report new symptoms because a urinary infection can travel to the blood stream to cause sepsis.

Here are ways to prevent a UTI:

• Stay on a bladder schedule to prevent an overfull bladder and decrease the risk of urinary incontinence.
• Allow enough time to completely empty the bladder.
• Drink enough fluid to keep your urine clear to light yellow in color, approximately 6 to 8 glasses of water per day.
• Wash hands before emptying the bladder.
• Keep dry. Change clothing and/or urinary pad after becoming wet.
• Use clean technique and clean supplies.

Three keys to a healthy and happy bladder

1. Stay hydrated
2. Keep clean
3. Identify and treat symptoms early

The balance of fluids

The body uses water to perform all of its daily tasks and to get rid of waste products. When the body does not have enough water, it shows signs of dehydration. An easy way to check to see if you are hydrated is by looking at your urine. Normal urine is clear to light yellow with some white flakes. When you are dehydrated, your urine is dark yellow to brown in color and you may have other bladder symptoms.

The recommended amount of fluid to consume to stay hydrated is 64 ounces, or 2 liters, per day. This number may be a little higher or lower for you. The amount of fluid you need to stay hydrated is dependent on your daily activities and the food you eat.

The first thing to do if you notice your urine is darker or if you develop any new or worsening bladder symptoms is to hydrate. The fluids will flush out the waste products and germs which are often the cause of your bladder symptoms. By intervening early, you can also prevent further complications.

Normal urine is clear to light yellow in color and may have some white flakes. Signs of dehydration include:

• Amount: Less urine output, slow stream, blocked or clogged catheter
• Color: Dark yellow to brown, concentrated, flecks of blood in urine or catheter, blood-tinged or pink urine with or without blood
• Smell: Sweet or musty-smelling urine
• Symptoms: Urinary frequency, pain with urination, new or increased bladder spasms, incontinence or leaking urine around catheter, sediment in urine or catheter, frequent urinary tract infections (UTI), kidney or bladder stones, constipation, thirst

All fluid is not the same. Water is the best to drink to stay hydrated. Some types of fluids you may need to limit because they are dehydrating or cause bladder symptoms. High-sugar soda, tea, and juice can irritate the bladder, leading to bladder symptoms. Caffeine and artificial sweetener can also irritate the bladder, causing bladder spasms, urgency, frequency, and incontinence.

The key is to drink enough to keep your urine light in color without any blood clots or sediment.

No matter how you empty your bladder, the goal is to stay clean to prevent infection.

• Clean your hands. Before and after emptying your bladder.
• Schedule time to empty your bladder. Do not allow the urine to sit in the bladder for a long time because germs can grow. By sticking to a schedule, it is easier to identify signs of dehydration like dark-colored urine or a small amount of urine out.
• Stay hydrated. The fluids you are drinking flush out the waste products, blood clots, and germs.
• Empty your bladder completely. After urinating on the toilet, stand up and sit back down or reposition yourself to try to urinate more. After the urine stops flowing through the IC, gently press on your bladder area to see if there is any more urine.
• Keep catheter free of kinks. With an indwelling or condom catheter, keep the catheter and connected tubing free of kinks to allow the urine to flow into the collection bag.
• Use clean supplies. Clean perineal area before and after emptying bladder. Only use urinary catheters that are either new or have been properly cleaned before use. Change out indwelling catheters as frequently as ordered by your doctor. Remove soiled pads and garments as soon as possible to prevent infection and skin breakdown.
• Keep a packed bag in the car. Include a change of clothes, bladder program supplies, cleaning wipes, and waste bag for emergencies.