The medical view - Toilet World - treating multiple sclerosis-related incontinence

Inside MS, Jan-March, 2003 by Nancy Holland

Staying dry

Most people with MS will have bladder problems at some point. These problems are not restricted to advanced MS. Bowel problems are also quite common, but unlike Hank Brandli, people tend to experience constipation rather than bowel incontinence.

If you have any problems with bladder or bowel function, including feelings of urgency, loss of control, frequent waking in the night, or feeling the need to void but nothing happens, see your doctor. A great deal has been learned since Hank Brandli turned to the heavy cloth diapers available in the 1960s. Staying dry is not just a social requirement. There are essential health reasons for regaining control.

Preventing permanent damage to the urinary tract

We now know that the permanent and progressive damage to the urinary tract that was once believed to be an inevitable consequence of MS is, in fact, preventable. In MS, incontinence, or the uncontrolled leakage of urine, often results from incomplete bladder emptying. The urine that remains despite efforts to eliminate it provides an environment favorable to urinary tract infections (UTIs). These pose a serious threat to health. Stagnant urine also allows particles of calcium and other minerals to collect and form stones. These, in turn, cause both infections and direct damage to the urinary tract.

Preventing skin breakdown

Skin that is chronically moist from leaking urine is strongly susceptible to skin breakdown, more commonly called "pressure" or "bed" sores. Once established, these sores can be extremely hard to heal; they can cause extensive tissue loss and even become life threatening.

Good bladder management makes sense not only from the perspective of preventing serious complications, but also because it contributes so powerfully to an individual's quality of life. The management methods include diet and lifestyle modifications, the use of various drugs, and use of a catheter to drain the bladder.

Intermittent self-catheterization

The phrase has a chilling sound, and many people are reluctant to begin this procedure. Most discover the comfort and security it provides. Initially women are less resistant than men because of their experience inserting tampons, but men generally have an easier time because of the greater accessibility of the urinary opening.

Regular intermittent self-catheterization, called ISC, actually acts like physical therapy for the bladder. Some people find their bladder function becoming more normal after several weeks or months. They can discontinue ISC at that time. For others, the practice remains a regular part of everyday life, promoting effective bladder drainage and preventing complications.

The process begins by washing one's hands and urinating. Then the urinary opening area is washed with ordinary soap and water. The catheter has a slender tip that can be inserted without pain. Urine simply drains into the toilet, after which the catheter is washed in soap and water and stored in a plastic bag. No other antiseptic measures are needed.

Staying clean

People with MS tend to have more problems with constipation than with uncontrollable bowel movements. Constipation often starts with loss of the sensations we usually rely on as signals to use the toilet. Reduced physical activity also contributes. Moreover, people may self-treat bladder problems by drinking less fluid. We recommend treating bladder problems first, since protecting kidney function is essential.

If a physician rules out other causes, and MS is indeed triggering overactive bowel functioning, it may be calmed by prescription medications such as Pro-Banthine or Ditropan. Diarrhea can also be managed with bulk-formers such as Metamucil or Perdiem, taken without any additional fluid. If bulk-formers don't relieve diarrhea, your doctor may suggest short-term use of medications that slow the bowel muscles, such as Kaopectate or Lomotil.

Anticholinergic drugs can be helpful when a hyperactive bowel is the underlying cause of incontinence. These drugs also affect bladder function, so they require careful monitoring by the individual with MS and the health-care team.

Total loss of bowel control happens only rarely, but if bowel incontinence becomes even an occasional problem, work closely with your doctor and nurse to establish a good bowel program. A regular schedule of elimination is the key. When the bowel becomes used to emptying at specific intervals, accidents at other times become less likely. Don't be discouraged. It usually takes many weeks before the body responds. Dietary irritants such as caffeine or alcohol should be considered contributing factors and eliminated. In addition, the dose or timing of medications that reduce spasticity, such as baclofen (Lioresal) and tizanidine (Zanaflex), may need to be adjusted.

You needn't restrict your life in the meantime. Disposable undergarments can prevent accidents or simply provide peace of mind. For more information on bowel or bladder problems, call your chapter.

Dr. Nancy Holland is an authority on urinary problems in MS as well as vice president of the Society's Professional Resource Center.