Bladder, bowel, and sexual dysfunctions when living with MS

Some people find that when living with Multiple Sclerosis, they experience some level of sexual dysfunction. Simply put, issues may arise that interfere with you enjoying sexual activity. This, as well as bladder and bowel problems, is frequently linked to a lower quality of life.¹

This article explores the connection between the bladder, the bowel, and sexual dysfunction in MS, and explains how sexual problems may manifest in both women and men living with MS. If you think your quality of life is impacted by sexual dysfunction, you can reach out to your doctor for support.

Multiple Sclerosis is a neurological disease which can have many symptoms, including bladder, bowel, and sexual problems. It can cause lesions in areas of the central nervous system which are home to the control centre for pelvic organs such as the bladder, bowel, and sex organs.¹

 
When talking about sexual dysfunction in MS, it can refer to both the impact MS can have on how your body reacts during sexual activity, as well as further symptoms of MS that can indirectly complicate your sexual relationships.¹

Types of issues – an overview

At times, MS can lead to physical altered genital sensation, problems with arousal or orgasm, decreased libido (i.e., desire for sex), decreased vaginal lubrication, and erectile dysfunction.^1,2

Nonsexual symptoms may also affect your sexual responses³ and can cause further challenges when maintaining a healthy sex life. This could include symptoms like fatigue, tremor, or bladder and bowel issues which may interfere with sexual responses.¹

 
Together, these issues may complicate a sexual relationship. It is possible they can lead someone to develop a negative self-image or make it harder to communicate with your partner.¹ For some, opening up about concerns regarding intimacy in a relationship is hard, and these negative feelings can add an extra challenge.³ It is therefore important to recognise these symptoms and try to address these concerns where possible. In some cases, seeking professional support together with your partner can help address dissatisfaction in a relationship and discussing these concerns with your nurse or doctor can help you get practical advice on how best to proceed.

A common problem regarding a healthy sex life when living with MS can be a lack of sexual interest. This can affect both men and women.^1,3 A reduction in your desire for sex may not be something you immediately notice, but reflecting on your sexual functioning before your MS diagnosis and comparing this to your recent activities may help you to see if your libido has weakened.

 
If you have a significant other, sexual problems and reduced libido can be a major stressor. Sexual counselling may therefore aid in the treatment of any psychological factors that are inhibiting intercourse and also help to develop a better understanding between partners.¹

 
Non-sexual changes to the body such as decreased mobility, spasticity, or fatigue can also add constraints on sexual activity and affect both men and women. If you have an understanding and stable partner, you may wish to include them in discussions with your MS nurse or doctor. These symptoms can play a role in both what positions are physically possible for you as a couple and the levels of sexual desire.¹ Discussing these topics together may help to get you both on the same page and increase your understanding of each other’s concerns and experiences.

Living with bladder and bowel issues may add complexity to your sex life.¹ You should always consult your nurse or doctor if you have concerns about your bladder or bowel symptoms, and they can work together with you to find an appropriate solution.

 
Worries about incontinence may lead you to avoid physical intimacy.⁴ Transanal irrigation and/or treatments for urinary incontinence may therefore be sought out to manage these symptoms and can be discussed with your healthcare practitioner.

 
Restricting fluid intake for an hour or two before sex, performing intermittent catheterisation or voiding just before sexual activity, and avoiding alcohol, caffeine and tobacco, may also help to reduce urinary incontinence.³

 
Raising your concerns about your bladder and/or bowel health with your doctor may also lead to discussions regarding potential sexual problems, as well as how to potentially alleviate these and help increase comfort during physical intimacy.

Multiple Sclerosis can lead to bodily changes that may impede intimate relationships. But, as male and female bodies are different, the effect MS can have on physical sexual functions can also differ, meaning different treatments may be sought out.

Sexual concerns for women living with MS

A common physical barrier to sexual activity for women living with MS is urinary incontinence.⁴ If this prevents you from being intimate, you may want to consult your nurse or doctor about your options.

 
For women living with MS, decreased sensation, decreased or absent orgasm, and difficulty with arousal can happen. A sexual response for women can be more intertwined with relationship dynamics than for men. Time may be spent considering how you relate to any sexual partners, both physically and emotionally. Sexual counselling can support.¹

 
Also, physical issues, such as reduced vaginal lubrication can occur. Additional lubricants may be used. Issues with positioning and spasticity may also complicate physical intimacy.⁴

 
Urinary tract infections may also be more common,¹ so it is important to practice good sexual hygiene. Passing urine and washing gently with warm water

Sexual concerns for men living with MS

Some sexual symptoms are also specific to men with Multiple Sclerosis. These include premature ejaculation, erectile dysfunction, and decreased sensation.² Some men take medicines to help them achieve erections¹ and this can allow you to be more spontaneous. Other alternatives may include vacuum erection devices or a penile prosthesis.¹

 
For specific information regarding the treatment of these symptoms and what may be most suitable for you, it is recommended that you seek advice from your doctor.

It can be hard to recognise when intimacy and sexual relationships in your life are impacted by your MS. Whilst symptoms of sexual dysfunction are rarely life threatening, they nonetheless can have a significant impact on your quality of life.² Reflecting on your own experience by asking the following questions may help you to make sense of how your MS affects your sexual relationships:

• How was your sexual functioning before your diagnosis and has your experience changed?
• Are you able to have orgasms? 
• Do you have decreased genital sensation?¹

Women may further want to consider: 

• If intercourse is painful for you¹ 
• If you have problems with vaginal dryness during intercourse¹ 

Men may further want to consider: 

• If your erections are firm enough to have penetrative sex¹ 
• If you can maintain an erection during penetrative sex¹

Recognising how MS affects your sexual health, as well as your bladder and bowel health, can be an important first step toward improving your comfort and confidence in intimate situations. Importantly, you don’t have to navigate these challenges alone, your healthcare team can offer guidance, support, and practical solutions to help you move forward.

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