How combined bladder and bowel care improves the health and happiness of MS patients

Worse bladder symptoms often mean worse bowel symptoms. Yet they are rarely addressed together, despite the evidence for better clinical outcomes and significant improvements in quality of life.

Lee, 30, living with MS
The first step of this combined approach is talking. Four out of ten MS patients have never been asked about bladder and bowel problems – and they may be too embarrassed to talk about the issue themselves.

"I used to have a bladder issue and now I don’t. I wasn’t aware at the time that my bowels were affecting my bladder. When my bowel problems were solved my bladder seemed to function better as well.” – Kerry, 49, living with MS

Bladder and bowel dysfunctions in MS patients are often less discussed and addressed than more well-known symptoms like walking difficulties, vision problems and fatigue. But, as well as the potentially serious medical risks if these conditions are not diagnosed and treated, they can have a huge impact on the quality of people’s lives, and lead to anxiety, depression and social isolation.

4 out of 10 patients are never asked …

First things first, let’s start with the main challenge to overcome: Making sure that MS patients’ bladder and bowel issues are even discussed and diagnosed so that they can be treated. Despite the fact that 66% of MS patients report combined bladder and bowel dysfunction¹, four out of ten patients have never been asked about problems during contact with their healthcare providers¹.

What’s more, with the social stigma surrounding these conditions, many patients often endure their symptoms rather than face the embarrassment of talking about them. So it’s vital to be proactive and ask patients to help them take the first step on the road to treatment.

What are the typical symptoms to look out for?

As the central nervous system controls both bladder and bowel function, it’s not surprising that most people with MS have some problems. Depending on where the neurological damage is, patients can suffer separate bladder or bowel dysfunction, coexisting dysfunction or interacting dysfunction where the symptoms can aggravate each other:

Bladder dysfunction

• Overactive bladder with urgency and sometimes also urinary incontinence
• Incomplete emptying caused by detrusor sphincter dyssynergia or weak contraction
• Urinary tract infection (UTI) as a result of residual urine

Bowel dysfunction

• Constipation due to neurological damage and/or limited mobility
• Incomplete evacuation causing recurrent visits to the toilet
• Fecal incontinence

Interacting dysfunction

• Mechanical – urinary urge incontinence and increased frequency due to constipation and mechanical pressure
• Neurological – bladder and bowel functions are controlled in the same way, both centrally and locally
• Pharmaceutical – some medications for decreasing bladder symptoms may worsen bowel problems

A combined treatment approach pays off

The good news is that therapies that relieve one condition often ease the other at the same time.^{2, 3} For example, the number of urinary tract infections (UTIs) and urinary incontinence episodes may decrease significantly with the addition of a bowel management program for people with bladder dysfunction.^{2, 4}

But, at heart, a combined approach is the best way to treat the person. Firstly, it helps ensure that people with MS are asked about both their bladder and bowel dysfunction to aid diagnosis and treatment. And successfully dealing with all symptoms then has the greatest impact on patients’ quality of life. When both bladder and bowel are working or are manageable, it makes people confident to leave the house, go to work, and have intimate relationships. Of course, this reduces the risk of depression, anxiety and social isolation. But it can also give people with MS a vital boost to their confidence and well-being that helps them not just survive but thrive.

“It was such a relief when I found my bladder and bowel therapies. Now I can leave the house, and start living my life again.”
– Lee, 30, living with MS

Explore how MS affects the bladder and bowel and how to help patients manage it:

In these films, Sophia Starke, MS Clinical Nurse Specialist speaks to Nicky Abel, Lecturer Practitioner and asks her about how MS affects the urinary tract, urinary tract infection and bladder management in MS.

In these films, Nicky Abel, Lecturer Practitioner is talking with Bev Collins, Clinical Nurse Lead at Wellspect HealthCare about neurogenic bowel in MS, bowel dysfunction in MS and conservative vs inserts and TAI for bowel management. 

Interested to find out more?

If you would like to learn more about how MS can affect the bladder and bowel, please download our user guides: 

References

1. Wang et al. Multiple Sclerosis and related disorders. 2018;20:16-21.
2. Radojicic et al. BJU Int. 2018. doi:10.1111/bju.14414
3. Rasmussen et al. Ugeskr. Laeger. 2011;173(39):2412-2415.
4. Radojicic et al. J. Pediatr. Urol. 2018. doi: 10.1016/j.jpurol.2018.05.025