Continence management in MS: What works and what to ask for?

Damage to the myelin, which insulates and protects nerves, disrupts the communication between the brain and the rest of the body. This can result in neurogenic bladder and bowel problems, including urinary and faecal incontinence, urgency, nocturia and constipation. Addressing these symptoms is crucial for improving quality of life for those living with MS.  

At MSWA, our Nurses are committed to providing coordinated multidisciplinary support and services to manage continence issues as well as the full spectrum of MS symptoms. Our nursing care is designed to empower people with MS to live life the way they want and not be bound by limits, whatever their goals may be. 

Neurogenic bladder is the term for what happens when neurological (nervous system) conditions affect the way your bladder works. There are two major types of bladder control problems linked to neurogenic bladder. Depending on the nerves involved and the nature of the damage, your bladder becomes either overactive (spastic or hyper-reflexive) or underactive (flaccid or hypotonic). 

The most common symptom of neurogenic bladder is being unable to control urination.  

Other neurogenic bladder symptoms include: 

• A weak or dribbling urinary stream.
• Frequent urination (eight or more times a day).
• Overactive bladder and/or urgency (a feeling or need to urinate immediately).
• Underactive bladder and/or urinary retention.
• Painful urination, which may mean there us an existing urinary tract infection.  

Below is a list of ways to control an overactive bladder. Note that this advice is general in nature; for more invasive solutions like Botox and electrical stimulation, consult a healthcare professional first.  

• Train your bladder. You can do this by squeezing your pelvic floor muscles during the day (Kegel exercises).
• Hold it, if you can. Delayed voiding is when you wait a few minutes to urinate after you feel the urge. The goal is to extend this time to a few hours.
• Toilet on schedule. You might avoid accidents if you urinate at certain times of the day.
• Keep a healthy  weight. Extra body mass can add pressure to your bladder.
• Change your diet. Speak to an MSWA Dietitian for more advice on how certain foods and drinks can irritate your system.
• Use electrical stimulation. This is done with a device under your skin that sends electricity to the nerve that controls your bladder. These painless pulses help stop overactive signals that tell your brain to urinate.
• Get Botox if needed. Your doctor can inject this neurotoxin into your bladder to temporarily stop it from contracting too much. If you have problems emptying your bladder or have urinary tract infections often, this treatment isn't an option. 

If you have under active bladder, here are some interventions that can help you manage continence issues:  

• Timed voiding: This is a technique of voiding at timed intervals (e.g. every three to four hours).
• Pharmacological management: A path that can be recommended by your healthcare professional. Certain medications will help individuals address continence issues linked to an underactive bladder.
• Intermittent self-catheterisation (IMC): A technique whereby the patient is taught to empty the bladder by passing a catheter into the bladder to drain out urine, which is then immediately removed.
• Permanent indwelling catheters: Ideally a permanent indwelling catheter (IDC) should be avoided except in cases in which intermittent catheterisation cannot be performed by the patient or a caregiver as indwelling catheters are associated with more infections and long-term problems than intermittent catheterisation. Alternatively, a long-term suprapubic indwelling catheter (SPC) includes entering the bladder through the abdomen rather than through the urethra and is a better long-term option than a urethral catheter as it prevents complications. 

Neurogenic bowel is the loss of normal bowel function caused by a nerve problem. Many different and unrelated conditions other than MS can cause neurogenic bowel disorder. A spinal cord injury or diabetes, for example, may damage the nerves that help control the lower part of your colon.  This is the part of the body that sends solid waste out of the body. This condition gets in the way of your normal ability to store and get rid of stool waste. It often causes constipation, urgency, stool leakage or accidents. 

Eat and drink well 

• Have plenty of fluids.
• Eat plenty of vegetables, fruit, legumes (beans), grains, nuts and seeds. This will increase your fibre and help you go to the toilet regularly.
• When increasing fibre in your diet, drink more water to help prevent constipation. 

Healthy lifestyle 

• Quitting smoking.
• Keep active, exercise for 30 minutes most days or advised by your doctor.
• Activity such as brisk walking may help keep your bowel regular. 

Look after your pelvic floor muscles 

• Keep your pelvic floor muscles strong with pelvic floor muscle exercises.
• Try to avoid putting extra strain on the pelvic floor muscles during toileting.
• See a MSWA Physiotherapist or MSWA Continence Nurse to check that you are exercising your pelvic floor muscles the right way.  

Additionally, you can call the National Continence Helpline 1800 330 066 and ask for information on pelvic floor muscle exercises. If you still have any bowels related concerns, it’s important to talk to your neurologist, MSWA Nurse or GP about your symptoms.  

If you are experiencing ongoing bladder and bowel functioning concerns mentioned above which are not resolved by utilising above mentioned strategies, ensure you seek help from your MSWA Continence Nurse, MSWA Physiotherapist (who can assist with pelvic health) and medical practitioner. 

The MSWA Nursing team has introduced continence clinic services at our metro and southwest hubs (Wilson, Butler, Bunbury and Albany). Please feel free to discuss any concerns with a Continence Nurse at MSWA.