As a urotherapist, Lis Höxbroe Hansson meets a lot of patients with Multiple Sclerosis at the Pelvic centre, University Hospital of Skåne in Sweden. In this blog post, Lis provides advice for those suffering from urinary problems as part of their MS diagnosis.
“When a patient with Multiple Sclerosis is referred to me with urinary problems, it's quite common that they don’t fully see the connection between symptoms and their cause, even if they have been present for years. In many cases, both patient and healthcare professional focus on other MS symptoms, without even touching on the issues effecting bladder and bowel. This causes the patient to think that their problem is unique, and aggravates a feeling of shame.”
”According to recent data, some 75% of MS patients develop some kind of functional issue with their urinary tract in the first 10 years after receiving a diagnosis”, says Lis. “For about 10% these symptoms appear right away, prompting the first visit to the doctor that later end in an MS diagnosis.”
”Problems can arise in many different forms depending upon where in the nervous system the damage is”, says Lis. Often it is a sudden, urgent need to void the bladder that results in leakage, which is caused by the uncontrollable muscle contractions of the bladder. A portion of MS patients suffer from impaired coordination between the bladder and urinary tract, often causing urine to remain in the bladder, which can increase the risk of developing a UTI (urinary tract infection). Leakage is the symptom with the greatest effect on the patient’s quality of life. UTIs are very common, especially for those unable to fully empty their bladder.”
”It would be desirable to send all MS patients to a urology specialist as soon as possible. It would be beneficial for the patient to get information about these issues before they even show up – because they will show up sooner or later.
- Intermittent catheterization (IC) – if the patients shows large amounts of residual urine, (100-200 ml) I normally recommend IC. It vastly improves the situation in a short time; it reduces bladder spasms, leakage and the risk of UTI.
- Sit right! – to promote more effective voiding of the bladder, to limit the amount of remaining urine in the bladder that can cause a UTI, Lis recommends the following steps when visiting the toilet:
- Relax, especially in the lower abdomen and back.
- Avoid too much force – it can cause hernia or prolapse
- Rest your feet on a small stool to elevate your knees above your hip line, this promotes more effective voiding. Most toilets are too high, preventing the knees from resting at the right angle
- Relax, especially in the lower abdomen and back.
Daily routines #1:
liquid intake – Try and find the right amount of liquid just for you. Even fruit and other food can affect your fluid levels. Tea and coffee act as diuretics, causing the body to pass water more frequently.
Drink less in the evenings to avoid having to get up in the night.
Is your medication drying your mouth? That is not the same as being thirsty! Try wetting your lips or chew on special tablets.
Daily routines #2:
Kegel exercises – if your pelvic muscle function is adequate, you can do several pelvis floor exercises to relieve urgency until you reach a toilet. Some patients will find these exercises more difficult if they suffer from muscle spasticity or reduced mobility
”It is very important to make sure you train the correct muscles to be able to contract ”, points out Lis. “I examine both men and women and see that in the later stages of the disease it is more challenging to train the pelvic muscles.
Exercises for those experiencing difficulty emptying the bladder
- You can relax the pelvic floor muscles through intensely squeezing them in a row, with a short pause between every turn. Repeat several times per day.
- This technique can be used to relieve spasm in other related muscle groups as well, for example thigh and hip muscles. Lift up your knees to your stomach without the help of your hands. You can either stand or sit during the exercise.
- Double or triple-pee! Rise once you feel you have releaved yourself, but sit back down again and urinate just a little more if possible, without forcing. This helps to stimulate the muscles in the abdomen, so all the urine leaves the bladder.
Alternative ways to relieve spasm with or without leakage
- TENS – electric stimulation
- PTNS – tibial nerve stimulation
These treatments help reduce hyperactivity in the bladder.
Normal renal function throughout life
”My wish is that my patients will continue with normal kidney function in the long term”, says Lis. ”Sometimes it can be challenging to convince younger patients to start catheterizing. However, as soon as they see the advantages, they realize it is worth it. When the problems disappear, UTI doesn’t occur and they begin to live a much more carefree life, then they embrace the new therapy. Urinary incontinence brings so much anxiety and shame in life that they often retreat from social interaction in the long run and isolate themselves.
Although learning IC demands patience in the beginning, once mastered, the reward is enormous relief from the stress that bladder dysfunction can bring.
”I had a patient who expressed his anxiety, believing his symptoms to be unique. I reassured him that this is not the case at all, for example; in Sweden there are about 13 000 people suffering from the same. 13,000!”
The four most important aspects for treating MS and bladder conditions
Name: Lis Höxbroe Hansson
Title: Licensed nurse, urotherapist
Place of work: Department of urology, University hospital of Skåne
This is an edited version of an article first published in the magazine Bladder Nr 1, 2015.