Bladder and Bowel Problems Associated with Multiple Sclerosis

(1)

Multiple Sclerosis Limited

Bladder and Bowel Problems

Associated with

Multiple Sclerosis

Bladder Dysfunction

Bladder dysfunction is one of the most

common symptoms associated with Multiple Sclerosis

Surveys have indicated that 60 - 90% of people with Multiple Sclerosis have bladder

(2)

Bladder Dysfunction

Bladder and or bowel problems have a flow-on effect with other symptoms of MS:

• needing to wake several times each night to go to the toilet or the fear of being

incontinent can affect fatigue, sleep problems and anxiety

• in reverse, mobility changes can affect the ability to remain continent

(3)

What is the Urinary Tract?

Bladder Dysfunction

Bladder dysfunction associated with Multiple Sclerosis is caused by the

interruption of nerve pathways / impulses that control the passing of

(4)

Bladder Dysfunction

What affects the level and type of dysfunction?

• the health of the person with M.S. • where the myelin sheath is

damaged along the various nerve pathways associated with the bladder

Bladder Dysfunction Associated

with MS

1. An unstable bladder (detrusor instability)

2. A bladder that retains urine - doesn’t empty properly (retention-detrusor failure)

3. A bladder that combines the 2 types of dysfunction as above (detrusor sphincter dyssynergia)

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1. Unstable Bladder: Symptoms

•Frequency •Urgency

•Getting up at night to pass urine •Urge incontinence

1. Unstable Bladder: Treatment

• Anticholinergic medications:

• Oxybutnin (Ditropan) (Oxytrol patches) • Tolterodine (Detrusitol)

• Solifenacin (Vesicare) • Trans vesicle phenol injection • Botox injection

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2. Retaining Urine: Symptoms

Frequency Urgency Hesitancy Getting up at night Recurrent urinary tract infections Occasional overflow incontinence

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2. Retaining Urine: Treatment

Medications

• Flomaxtra

• Prazosine (Minipress)

• Phenoxy-Benzamine (Dibenylline)

When medications fail:

• clean, intermittent catheterisation • if unable to do this, a supra-pubic

catheter will be needed

3. Detrusor Sphincter Dyssynergia:

Symptoms

• Frequency • Urgency

• Recurrent urinary tract infection • Sudden flooding incontinence • Getting up at night to pass urine

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3. Detrusor Sphincter Dyssynergia:

Treatment

• Medication

• Clean, intermittent catheterisation

Urinary Tract Infection: Symptoms

Burning Stinging Concentrated, smelly or cloudy urine Passing small amounts of urine Frequency Urgency Increased passing of urine at night Fever

(9)

Recommendations

Bowel Dysfunction

Bowel dysfunction is another common

symptom associated with Multiple Sclerosis Surveys have indicated that 75% of people

with Multiple Sclerosis have bowel dysfunction at some stage

(10)

The Normal Bowel

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Bowel problems associated with MS

1. Loss of, or very reduced, peristalsis 2. Loss of the gastro-colic reflex 3. Spasticity of the anal sphincter

4. Loss of sensation in the anus and rectum 5. Spasticity of the colon

Bowel Symptoms

• Constipation • Diarrhoea

• Bowel incontinence (solid or wind) • Pain

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1. Loss of Peristalsis: Treatment

• Regular aperients, either daily or second daily • No added fibre

• fibre in the diet is alright but, as the bowel has lost most of its movement, any excess bulk cannot be pushed through the bowel

• this may increase constipation or cause impaction

• If constipation continues, then a regular enema (Microlax or Bisalax) may be necessary

2. Loss of the Gastro-colic Reflex:

Treatment

• Try to empty bowels every day, even though the urge to empty the bowel may not be present • If necessary, a regular aperient may be used

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3. Spasticity of the Anal Sphincter:

Treatment

• If the sphincter does not relax, use a gloved finger to stimulate the bowel to open

• alternatively, a glycerine suppository can be used • If the sphincter does not close properly, constant

soiling will occur

• if this happens, you may then need to see a colo-rectal surgeon

4. Loss of Sensation in the Anus or

Rectum: Treatment

A glycerine suppository before exercise will reduce the risk of faecal

incontinence

Most people do not have a problem with

this when they are at home

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5. Spasticity of the Colon

No regular bowel pattern:

constipation diarrhoea

normal

bowel

actions

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5. Spasticity of the Colon:

Treatment

regular

enemas aperients regular

reduced faecal accidents

The Medication Maze

Stool softeners

• Docusate (Dulcolax, Coloxyl), Metamucil (Psyllium), Lactulose • Osmotic laxatives • Movicol Stimulant laxatives • Senna • Bisacodyl • Castor Oil Suppositories Enemas Anal irrigation

(16)

Where to get help

Assessment by: • a MS Nurse • continence advisor

• local doctor • gastro-enterologist

What Happens in a Bladder or Bowel

Assessment?

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Basic First Aid for Bladder and

Bowel Problems

• Review caffeine intake • Review fluid intake • Elevate feet

• Avoid constipation • One change at a time • Diet and exercise

• Talk to a doctor, a MS Nurse or a continence nurse

Basic First Aid for Bladder and

Bowel Problems

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Other Helpful Titbits

• Continence Aids Payment Scheme www.bladderbowel.gov.au/caps/ • Universal Key www.masterlocksmiths.com.au

• Helpful internet sites:

www.continence.org.au www.bladderbowel.gov.au www.toiletmap.gov.au

• Useful apps for smart phones:

 Wheelmate - tells you where the nearest accessible toilet is to your current location

 Cathnow - an alarm reminds you to catheterise  National Public Toilet Map

How to source advice for all

continence issues

• MS Connect 1800 042 138

• National Continence Helpline 1800 330 066 • General Practitioner

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Summary

• Anatomy of the urinary system

• 3 different types of bladder dysfunction – symptoms and treatments

• Anatomy of the bowel

• 5 different types of bowel dysfunction – symptoms and treatments

• Where to get help