| Managing Bowel and Bladder Symptoms |
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Many people with multiple sclerosis (MS) experience difficulty with bladder and/or bowel
function. Problems can be the result of interruption of the nerve signals controlling
these functions. In addition, bowel and bladder problems may be due to other factors
such as diet, decreased fluid intake, and reduced mobility. Common bladder problems
include infections, urgency, frequency, hesitancy and incontinence. Common bowel
problems include constipation and incontinence.
Bladder problems are generally separated into the following categories: failure to fill
or spastic, and failure to empty or (flaccid and dyssynergic). The type of bladder
problem will determine the proper treatment so it is important to identify the
‘bladder type’ before rendering any treatment. Ideally, a referral to a urologist
is best to evaluate your bladder. A urologist is a physician who specializes in
conditions of the urinary tract and can be very helpful in diagnosing bladder problems.
Many nurses have expertise in bowel and bladder dysfunction and will provide education
in the management of these problems.
A failure to fill or spastic bladder is the most common, seen in about 60% of people
with bladder problems. The most common symptoms include frequency, urgency and/or
incontinence. Treatment of this type of bladder is generally through the use of
medications which help to reduce the contractions of the bladder and allow more
time from urgency to urination. Two types of medications are anticholinergic,
such as oxybutynin and Ditropan XL and Oxytrol patches, and antimuscarinic such
as Detrol and Detrol LA.
A hyporeflexive or flaccid bladder is seen in about 20% of people with bladder problems.
The most common symptoms include frequency, urgency, hesitancy and/or incontinence.
With a hyporeflexive bladder, the bladder fills with large amounts of urine and the
person is unaware that their bladder is full. Treatment of this type of bladder is
generally through the use of specific techniques. Patients may be advised to learn
to do intermittent catheterization (a way to periodically empty urine). Men may be
able to use an external catheter (commonly called a condom catheter) which will
allow collection of the urine in a leg bag. In some instances, an indwelling
catheter may be recommended but it is not preferred if there are other options.
A dyssynergic, or mixed, bladder occurs due to a lack of coordination between the
bladder and the sphincter. Symptoms of a dyssynergic bladder will often vary and
may include urgency followed by hesitancy or incontinence. A dyssynergic bladder
is often seen in combination with a spastic or flaccid bladder. Treatment of this
bladder dysfunction is varied depending on the cause. If the sphincter is not opening
fully, a medication (alpha blocker) may be recommended such as Hytrin, Cardura or Flomax.
If the bladder fails to empty and carries a large amount of urine, it may be suggested to
learn intermittent catheterization. Sometimes people use an anticholinergic
medication to slow contractions of the bladder (to stop leaking) and catheterize
(to empty the urine).
It is important to treat bladder problems to avoid secondary complications such as
urinary tract infections (UTI) or kidney problems. Urinary tract infections are most
often a problem when urine is retained in the bladder due to incomplete emptying.
Therefore, those with a hyporeflexive bladder and mixed bladder are at greater
risk of developing a UTI. Kidney problems can occur with an untreated UTI or an
increase of pressure in the bladder because of incomplete emptying, most commonly
seen with dyssynergic bladders.
Bowel problems for people with MS can be effectively managed through proper dietary
management, establishment of a bowel program and the use of bowel medications.
Constipation is a problem which may result from interrupted nerve transmission,
immobility, sensory loss, certain medications, a fiber poor diet, as well as
decreased fluid intake. Constipation is initially treated with adjustments in
diet and establishment of a bowel program. Increasing fiber in one’s diet
through the intake of raw fruits and vegetables, whole grain breads and bran
is one step. Another important step is to increase the amount of fluids
(usually water is the best type of liquid) during the day.
These additions will significantly reduce constipation. The addition of a bowel
program is also important. A bowel program includes selecting a time of day to
have a bowel movement. This needs to be coordinated with other daily activities.
It is most effective to have a bowel movement following a meal. Therefore, it
is best to schedule time after a meal. Success with this type of program may
take time, but it is important to maintain a schedule for longer term success.
Bowel preparations for constipation can also be helpful. However, overuse of
over-the-counter medications (laxatives) should be avoided. Use of bulk agents (
Metamucil, Citrucel, Fibercon) and stool softeners (Colace) will be helpful in
making the stool easier to pass. Caution should be used if fluid intake is low as these
products can block the bowel.
Incontinence can occur in MS for many reasons such as abnormal nerve transmission,
inattention to signals, and loss of sensation. Diarrhea happens in people with MS
just as it can in anyone. A person with MS, however, has less ability to manage
the liquid stool when it gets to the rectum so it becomes a larger problem.
Bladder and bowel problems can be an embarrassing subject to talk about with
your physician. However, most of these problems can be well managed through
various interventions. If you are experiencing bowel or bladder problems,
make sure you discuss it with your physician or nurse.
Patricia Kennedy, RN, CNP
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| - reprinted with permision from- The Heuga Center. |
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