Treatment options for bladder issues

Portrait photo of Marianne, who lives with bladder issues caused by her MS. Marianne uses intermittent catheters to better manage her symptoms. — Marianne | Living with MS

You can get help to manage bladder issues caused by MS

If your bladder health is affected by MS, there are many different things you can try to begin reclaiming control over your bladder. Some lifestyle changes, such as dietary alterations, or basic bladder-training exercises may help your bladder health. There are also bladder management solutions that require discussions with your doctor before undergoing.

This article provides an overview of the range of different bladder treatments for various bladder symptoms, so you are the best informed you can be when taking the first steps to better managing your bladder symptoms.

Initial treatments you may pursue

Initial first-line treatments for an overactive bladder may consist of bladder training, Kegel exercises,¹ modification of type and timing of what you eat and drink, as well as some drug treatments. You should consult your doctor if you suspect you have a bladder issue. They will consult with you on which type of treatment(s) you should follow, as these can vary depending on your individual situation and bladder symptoms. Learn more about initial treatments below.

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Bladder retraining for better bladder control

Bladder retraining is a type of behavioural therapy that may help you develop better bladder control. Over time, bladder retraining can help you go longer periods between toilet breaks, hold more urine in your bladder, and give you more control over the urge to urinate, helping to prevent emergencies and accidental leakage.¹

Your doctor may suggest bladder retraining techniques such as:

Scheduling toilet breaks

Work out how often you go to the toilet. Noting this down on your phone or with our easy-to-use bladder diary can give you this overview. Then try and stretch the time between toilet breaks a little: e.g., if you are using the toilet every hour, schedule bathroom breaks at 1 hour and 15 minutes apart. Be strict and try to use the toilet at this scheduled time. Slowly, you may be able to increase the amount of time between breaks.

Performing Kegel exercises

Kegels can also help for both men and women.¹ These exercises strengthen the muscles you use to start and stop the flow of urine. To do a Kegel, squeeze the muscles you normally use to stop urination. Hold the contraction for 5 seconds and then relax for 5. Over time, increase your contraction time to 10 seconds, with 10 seconds of rest. Try to work up to doing 3 sets of 10 contractions every day.

A healthy diet and/or prescribed medications for better bladder health

There are also lifestyle changes and drug treatment options that can help you feel more in control.

Modify your diet and fluid intake!

You might be tempted to drink less if your bladder symptoms have worsened but actually, not drinking enough can negatively affect your bladder issues.² Instead, try to time your fluid intake as well as your bathroom visits to gain better control. Diet, diet, diet. Eating healthy foods and having a balanced diet is good for your bladder and bowel health and may improve your overall well-being.² 

Prescribed antimuscarinic drugs

Many people living with MS and who have an overactive bladder will get antimuscarinic drugs prescribed. Also known as anticholinergics, these drugs work by blocking the messages that tell the bladder muscle to contract. This then reduces the frequent urges to go to the toilet and can increase in bladder capacity, and may lead to an improved quality of life.¹

Further treatments for managing bladder symptoms

If the initial treatments outlined above do not help to improve your symptoms, there are further treatments your doctor may suggest.

Solving for when your bladder cannot empty

If you struggle to pass urine, or find that you still have urine in your bladder even after going to the toilet, intermittent catheterisation is often considered a suitable treatment for managing your bladder issues.³

Intermittent catheterisation

Intermittent catheterisation is normally performed on oneself without support from an healthcare professional. An intermittent catheter is a hollow tube which can be passed into the bladder to drain urine. Intermittent catheters are used ‘as needed’ and you insert them into the urethra when you want to urinate. Once you have voided your bladder, you then remove the catheter.

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If you live with urinary retention, intermittent catheterisation allows you to choose when you want to empty your bladder, allowing you more control.

Using intermittent catheters mirrors normal bladder function as closely as possible: the bladder still stores urine, nothing is permanently inserted, and the catheter only functions to enable the natural voiding process. 

“Catheterisation gave me my freedom back. I could go where I wanted and was no longer dependent on my bladder.”

Marianne | Living with MS

Intermittent catheterisation may sometimes be confused with other types of catheters like indwelling catheters, which are left in place on a more permanent basis. To learn more about different catheterisation types, click the link below.

Marianne | Living with MS

Solving for when your bladder is overactive

Botox or sacral nerve stimulation may be suggested if you live with an overactive bladder.

Botox injections¹,³

To treat bladder overactivity, some may use botulinum toxin (Botox) which is injected into the bladder. This will relax the bladder and avoid involuntary contractions of the bladder muscle. However, a side effect of this treatment for some is that the bladder is less able to completely empty. If the bladder retains urine after going to the toilet, this can then require the individual to use intermittent catheters to empty their bladder. Treatment with botulinum toxin is not permanent and the treatment needs to be repeated every 6-12 months.  

Nerve stimulation¹

Sometimes, stimulation of the tibial nerve or sacral nerve is used to combat bladder overactivity. The former can be administered either using a needle to deliver electrical stimulation or using an electrode patch. The latter uses a small electronic device which is implanted usually just beneath the skin in the upper buttock. A thin lead is also implanted in the lower back and connected to the device with a battery.  

Nerve stimulation can help to correct faulty electrical messages travelling between your bladder and brain and therefore modifies the way your bladder behaves. It remains debatable how successful this treatment is amongst those living with MS.  

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