Bladder Dysfunction

How Does the Urinary System Function?

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 (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 (feeling) 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. 

Bladder Dysfunction with Multiple Sclerosis

Bladder dysfunction is a common symptom of MS because the lesions in the CNS interrupt signals to and from the bladder and urinary sphincters. This leads to problems storing and/or emptying urine from the bladder. The symptoms of bladder dysfunction can very person to person and can change overtime. It is important for individuals to be aware of the symptoms of bladder dysfunction in order to notify their provider of any changes.

Download Brochure: Urinary Dysfunction and MS

What are the Most Common Bladder Symptoms Caused by MS?

• 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 (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:
    • 1. Urge incontinence: Person develops a strong urge to empty the bladder and leaks urine on the way to the restroom.
    • 2. Overflow incontinence: When the bladder does not empty completely and the retained urine “overflows,” causing frequent leakage.
    • 3. 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. 
    • 4. Mixed incontinence: Person experiences more than one type of incontinence. 
• Urinary Retention: the bladder becomes "overfilled" with 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: 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.  

When Should I Report Bladder Symptoms to My Provider? 

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

How do I know if I have an Urinary Tract Infection (UTI)?

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 all the time (urinary frequency)

What Should I Do if I Suspect I 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.

How Can I 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 - 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.

Download PDF: Tips for a Healthy Bladder

Visit the National Multiple Sclerosis Society for more information about bladder dysfunction.