Peeing is not as easy as it sounds. The act of urinating voluntarily is a very complex act requiring functions of the brain, the spinal cord, nerves directly to the bladder or urethra, normal bladder muscles, normal urethral muscles and in men, a prostate that is not blocking the outlet. Unfortunately, MS is a disease of nerve function so it has the ability to affect bladder function in many different sites from the brain down to the bladder or urethra. Bladder issues are experienced by 50-80% of all people with MS.
The normal bladder and urethral function is to hold a reasonable volume of urine until a socially acceptable time and place is found and then to empty easily and entirely. So this means you don’t have to pee too often, you don’t have to run to get to the toilet, you don’t leak urine and you empty when you want to.
Signs of bladder issues include having to urinate often (frequency), having the desire to urinate be VERY urgent (urgency), having difficulty starting to void (hesitancy), being unable to void or unable to empty (urinary retention or incomplete emptying) or any combination of the above.
Evaluation consists of listening to your story, checking how well you empty often with a bladder scanner, doing a pelvic exam in women or a prostate exam in men. Sometimes it also requires a special bladder function test, (a cystometrogram also known as a CMG or urodynamic testing) or a cystoscopy (a look into your bladder) or evaluation of your kidneys with an ultrasound or other radiographic study.
Sometimes bladder problems can cause kidney problems, either due to high pressures in the bladder or due to infections. We want to prevent the social issues associated with bladder problems as well as health issues concerned with kidney injury.
Treatment can be as simple as urinating more often or multiple times at the same setting, controlling your fluid intake or avoiding sodas and coffee. Treatment can also mean requiring a single medication or be much more involved by requiring multiple medications, self catheterization, nerve stimulation, Botox injections in the bladder, an indwelling catheter or surgery.