Bladder and Bowel Problems Associated with Multiple Sclerosis

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1 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 dysfunction at some stage 1

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 What is the Urinary Tract? 2

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 urine (micturition) 3

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) 4

5 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 5

6 2. Retaining Urine: Symptoms 2. Retaining Urine: Symptoms Frequency Occasional overflow incontinence Urgency Recurrent urinary tract infections Hesitancy Getting up at night 6

7 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 7

8 3. Detrusor Sphincter Dyssynergia: Treatment Medication Clean, intermittent catheterisation Urinary Tract Infection: Symptoms Burning Fever Stinging Passing small amounts of urine Concentrated, smelly or cloudy urine Increased passing of urine at night Urgency Frequency 8

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 9

10 The Normal Bowel Bristol Stool Chart 10

11 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 11

12 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 12

13 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 13

14 5. Spasticity of the Colon No regular bowel pattern: constipation diarrhoea normal bowel actions 5. Spasticity of the Colon 14

15 5. Spasticity of the Colon: Treatment regular enemas regular aperients 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 Antidiarrheal medications - Imodium, Lomotil 15

16 Where to get help Assessment by: a MS Nurse continence advisor local doctor gastro-enterologist What Happens in a Bladder or Bowel Assessment? 16

17 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 17

18 Other Helpful Titbits Continence Aids Payment Scheme Universal Key Helpful internet sites: 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 National Continence Helpline General Practitioner 18

19 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 Questions 19

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