Incontinence management strategies for multiple sclerosis (MS)

Whether you’re their prescribing nurse or their friendly pharmacist, if you’re looking for an introduction to continence management for people with MS, this is the page for you.

One hand grips another hand.

If it’s part of your job to help people living with MS better understand and manage their disease, you’ll know how important the question of bladder function becomes. The good news is, with treatment paradigms evolving all the time, MS is becoming more manageable, and so is the attendant incontinence. 

This does also mean the knowledge required to develop a successful treatment strategy – including a strategy for bladder management – is expanding. Here is an introduction to the kinds of bowel and bladder problems you may encounter, and how to manage them.

How MS affects bladder and bowel control

MS is, of course, a progressive autoimmune disease that damages the nerves, causing communication problems between the brain and the rest of the body. This includes the urinary system. As a result, about three in four people with MS will experience some type of bladder dysfunction. There are several types of dysfunction that may occur:

A nurse helps a patient with MS hold a glass of water.

Bladder overactivity 

This is the most common type of bladder dysfunction in MS, with symptoms including frequency (the need to urinate in spite of having voided very recently), urge incontinence and nocturia. The bladder contracts unpredictably and sometimes uncontrollably, and the urge to urinate may be powerful after only a little urine has collected. High contraction pressures can produce incontinence, and the normal capacity of the bladder to hold urine may also be diminished, increasing the frequency of emptying to hourly or more.

Bladder emptying difficulties

A bladder that is overfilled and unable to empty completely often results in a frequent need to urinate – including at night – and may lead to urinary tract infections. Failure of the bladder to empty entirely is the result of two problems: first, when the bladder muscle contracts, the muscle surrounding the urethra also contracts, instead of relaxing as it should, resulting in interrupted flow; second, the contraction of the bladder muscle itself is weak (but may be frequent) and insufficient to completely empty the bladder.

Combined dysfunction 

Symptoms include those associated with an overactive bladder and with bladder emptying difficulties.

A young boy looks up and smiles at the nurse pushing him in his wheelchair.

Urinary tract infection (UTI) 

Bladder emptying difficulties can bring an increased risk of UTI, which, if untreated, can exacerbate MS symptoms and cause increased spasticity. It’s therefore important to identify and treat UTIs quickly. Warning signs include urgency, frequency, and urinary incontinence. Get more information on UTIs and how to prevent them.

Constipation and faecal incontinence 

People with MS often experience bowel problems, although it is frequently under-reported and unrecognized. When the nerves that control the anal sphincter muscles or those responsible for sensing stool are damaged, constipation and/or faecal incontinence may result.

Assessment and management

People are often reluctant to talk about bladder or bowel issues, so it’s important that their health professional is prepared to raise the subject, to help them move forward in best way. Successfully managing bladder and bowel problems requires a holistic, comprehensive approach that escalates interventions step by step. The first step is an assessment by an experienced health professional to determine the nature of the problem. Then comes an ongoing collaboration with the individual to build and optimise a plan that meets their specific needs.

A nurse holds the hand of a patient in bed while preparing to change her absorbent product.

Bladder health

It is important to identify bladder emptying difficulties as these must be treated in good time to avoid urine buildup in the bladder, which brings a risk of damage to bladder and kidneys. A good first step when dealing with an overactive bladder is to cut down on coffee, tea and caffeinated energy drinks as these can irritate the bladder. A proper toilet posture and double voiding may also help to facilitate bladder emptying. For individuals dealing with urine retention, intermittent self-catheterisation (ISC) is a quick and effective way to expel remaining urine. Depending on symptoms and volume, catheterizing can eventually help the bladder regain near-normal bladder function. Although behavioral therapy and pelvic floor muscle training may be helpful for individuals with bladder issues, many will require pharmacologic therapy.

Bowel health

The aim of a bowel management plan should be predictable, regular evacuations consisting of soft, formed stool, as this decreases the likelihood of constipation or faecal incontinence. People who experience bowel problems are often advised to eat a high-fiber diet, drink lots of fluids, and use enemas or laxatives. Electrical nerve stimulation may also help improve bowel health.

Absorbent incontinence products

A pharmacist advises a customer on the right TENA product to buy.

As an accessory to treatment, absorbent products can greatly improve quality of life. There are several types of absorbent product types available, including pads and liners for light to moderate incontinence, protective underwear to support self-toileting for mobile individuals, belted products for care-dependent people, and washable products in a range of shapes, sizes, and absorption capacities. 

When there has been a faecal accident, stool will invariably come into contact with the skin, and prompt removal is needed. In addition to following the right procedure for toileting and cleaning, it’s important to use appropriate skincare and absorbent products for incontinence, and to ensure regular changes of products.

Since the development of MS differs from person to person, no single product is appropriate in every case. Symptoms such as loss of manual dexterity, sensory loss, and cognitive decline will need to be considered when selecting products, as well as important factors such as the person’s goals, preferences, and the characteristics of personal and environmental care.

Audited by Josefine Grandin, District nurse, urotherapist, 2022-05-16

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