People with MS can report a variety of bladder symptoms including frequency, urgency, incontinence, infection, double voiding (urinating twice in a short time), and nocturia (getting up at night to urinate several times).
Not all symptoms are a result of nerve damage from multiple sclerosis. Men and women develop bladder problems due to the aging process, prostate diseases, and from bearing children. No matter what the cause, treatments exist for the symptoms. Bladder symptoms may develop gradually. You may not realize the extent of bladder issues until they impact daily activities like shopping, going out to eat, or attending family events such as anniversaries or graduations. If you always need to know where a bathroom is located, then you should consider seeing a urologist for your bladder issues. Take this simple quiz below to see if you experience bladder problems.
Allergan Quiz
Typically, there are three reasons why bladder problems occur as a result of MS:
First, the bladder does not fill properly; it wants to empty frequently and, therefore, does not store a large amount of urine. This is the overactive bladder.
Secondly, the opposite can occur with the bladder—it cannot empty the urine. For some reason, the bladder muscle becomes less active and urine will remain in the bladder, as the bladder is not efficient in squeezing it out. This is the underactive bladder.
A third problem that can occur is a result of an overactive bladder that cannot empty. The opening of the bladder (urethra) does not stay open long enough to allow the urine to pass out of the body. As a result, urine is trapped in the bladder.
As symptoms may be similar in the three types of MS bladder problems, a urologist is a specialist who can perform testing to determine the exact cause of the bladder emptying disorder.
Actionable MS Urinary Function Screening Tool/Bladder Quiz
For the following questions, please choose a response that best describes your bladder symptoms over the past 7 DAYS.
- During the day, how often did you feel that you had to urinate right away?
- None of the time
- Some of the time
- Most of the time
- All of the time
- How often have you had urinary accidents/leakage?
- None of the time
- Some of the time
- Most of the time
- All of the time
- During the day, how strong was the feeling that you needed to urinate right away?
- Not at all strong
- A little strong
- Moderately strong
- Extremely strong
- On a typical night, how often did you wake up in the night to urinate?
- None of the time
- One time
- Two times
- Three or more times
- On a typical day, how many times did you urinate?
- 0-3 times
- 4-6 times
- 7-11 times
- 12+ times
For the following questions, please choose a response that best describes impacts from bladder symptoms you may have experienced RECENTLY.
- How much have your activities with friends and family been limited by your bladder problems?
- Not at all
- A little
- Moderately
- Extremely
- How embarrassed have you been because of bladder symptoms?
- Not at all
- A little
- Moderately
- Extremely
- How much has your ability to work (paid or volunteer) outside the home been limited by your bladder problems?
- Not at all/Does not apply
- A little
- Moderately
- Extremely
Please add each time you selected option 3 or 4 for each question. If your total adds up to 3 or more, you may benefit from talking to your doctor.
Tests that a urologist may perform:
Tests of Urine
Urine Analysis: A screening test of the urine showing overall health as well as health of the urinary tract specifically. Analysis includes pH, presence of ketones, sugar, blood, and bacteria. A positive result in any of the testing requires further assessment. This test requires a prescription and is competed in a lab draw site.
Urine Culture and Sensitivity (C & S): A test that determines the amount and type of bacteria in the urine. Urine is collected, placed in a petri dish within the lab, and monitored for bacterial growth for 48 hours. If sufficient numbers of bacteria grow, signifying an infection, the bacteria are then tested against several antibiotics to determine which medication would be most effective in treating the infection.
Urine Cytology: A method that examines urine to determine if bladder cancer cells are present. The urine is examined for abnormal cells, which may detect for bladder cancer. Patients with MS at higher risk for bladder cancer are ones who have received cyclophosphamide (Cytoxan), have indwelling catheters (urethral or suprapubic), or are smokers.
Blood tests
Blood Urea Nitrogen (BUN), Creatinine: Blood tests that provide information as to how well the kidneys are functioning.
Glomerular Filtration Rate (GFR): Test used to examine how well the kidneys are functioning by estimating the rate that blood passes through the glomeruli of the kidneys each minute. This bloodwork may be required before an MRI to make sure the kidneys are functioning properly, especially if you are age sixty or older or have a history of hypertension or diabetes.
Other Tests of Bladder and Kidneys
Bladder Ultrasound: Images the bladder to assess the amount of urine in the bladder after voiding. This test can be completed in our office.
Urodynamics: This is a combination of tests that measure bladder function and pressure and is the best test currently available for diagnosing problems with nerve damage to the bladder caused by MS and other like diseases. The cystometrogram (CMG) measures bladder pressure and volume, and the electromyogram (EMG) measures bladder activity. This test may also include a video component which will provide images of the bladder. These images are recorded and analyzed to determine the location and structure of the bladder.
Computerized Tomography (CT): Uses computers to produce detailed views of the kidneys, ureters, or bladder to assess size and structure of the tissue, kidney stone, or tumor.
Kidney and Pelvic Ultrasounds: Study identifies location of the kidneys, differences between the kidneys, and blockages or stones within the kidney or bladder.
Cytoscopy: An examination of the bladder by using a small catheter (cytoscope) with light and magnification in the bladder. This allows for the physician to directly observe the urethra and ladder for inflammation, stones, tumors, or structural damages.
Intravenous Pyelogram (IVP): Specialized x-ray of the kidneys, bladder, and ureters to evaluate for bladder and kidney infections, blood in the urine, injury, or tumors. Dye is injected into a vein and a series of x-ray images will show how the kidneys remove the dye.
Urinary Catheterization: A tube is inserted into the bladder through the urethra allowing urine to drain. This may need to be completed for collection of a sterile specimen.
Pelvic Exam: This test is for females only to examine the vagina, cervix, and uterus. The exam evaluates the strength of the pelvic floor muscles and locations of the bladder and other pelvic organs. May be completed by a health care specialist during a urologic workup or pelvic floor physical therapy.