BLADDER PROBLEMS AND MULTIPLE SCLEROSIS
Up to 90 per cent of people with MS are affected by impaired bladder function at some time during the course of their illness. These symptoms may come and go, but should not be ignored as they can become worse.
Bladder symptoms, which may occur at the onset of MS or at any time throughout the course of the disease, interfere with vital life activities such as a person’s ability to socialise, be employed outside the home and engage in satisfying sexual activities. Serious illness and hospitalisation may occur from neglected management of the bladder problems underlying bladder symptoms.
However, there is good news. There has been a dramatic decrease in bladder-related illnesses, thanks to improved diagnostic and management measures. Distressing and disruptive bladder symptoms can be successfully managed, and bladder complications and associated serious illness can be prevented.
Two main types of bladder dysfunction happen in MS: storage dysfunction and emptying dysfunction. Symptoms of urgency, frequency, night-time awakening and bladder accidents may be present in both types. Research has shown that symptoms are not useful in determining the type of problem. Testing must be done in order to select the appropriate therapy.
A neurologist, urologist, nurse or any combination of these can diagnose bladder problems in MS. Which healthcare professional is involved in the process may depend on how a clinic, department or centre is organised in that particular country, and on opportunities for specialised professional training.
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Team work by the person with MS and healthcare professionals is important
Most people experiencing MS-related bladder problems can benefit from management techniques. Healthcare professionals can tailor strategies to suit the needs of individuals and to deal with the particular type of bladder dysfunction – storage or emptying. Strategies often include a careful balance of medication and catheterisation, worked out in consultation with the person with MS. Occasionally non-invasive strategies such as these are ineffective in managing more serious problems and bladder specialists may suggest a surgical intervention, but this is rare in MS (see page 15).
Bladder problems are usually quite disturbing for an individual. Bladder symptoms in MS can create other health-related problems, but they can also result in social isolation, early retirement from employment and decreased self-esteem. Diagnosis, treatment and regular follow-up are essential in helping the person with MS take control of his or her situation. The relationship between the individual and the healthcare team is vital in achieving successful bladder management.
The key factors are recognition of the seriousness of the problem, knowledge of appropriate tests and treatments, realistic belief in the potential for satisfactory relief of symptoms and team-work by the person with MS and the healthcare professional in all phases of management.
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