Treatments For Neurogenic Bladder

Treatment Options For Neurogenic Bladder

Having a neurological condition, such as Multiple Sclerosis or Parkinson’s disease can be overwhelming, both physically and emotionally.  But one thing many people may not realize is how it will affect their bladder. Luckily, there are treatments available that can help to minimize symptoms of neurogenic bladder and allow you to live without the fear of an accident. Today, we’re going to discuss what neurogenic bladder is, and 2 ways you can treat it.  

What Is Neurogenic Bladder? 

Neurogenic bladder affects many Americans and occurs when there is a problem with the way your brain communicates with your bladder. People who have a neurogenic bladder usually experience a bladder that is either overactive (spastic) or underactive (flaccid).

 

What are the symptoms of a neurogenic bladder?

There are many symptoms of a neurogenic bladder. These include: 

  • Incontinence

  • Urinary Tract Infections (UTIs)

  • Frequent urination

  • An urgent need to use the empty the bladder immediately

  • Painful urination

  • The inability to completely empty the bladder

  • A weak urine stream

  • Nocturia, the need to empty the bladder more than once per night

 

What treatment options exist for Neurogenic Bladder?

Luckily, there are many treatment options for Neurogenic Bladder.

Behavioral modifications.

Certain foods and drinks are known bladder irritants and may contribute to an overactive bladder. Try keeping a bladder diary to identify any triggers that may be causing your bladder problems and then work to avoid them. Additionally, maintaining a healthy weight through diet and exercise can help ease pressure placed on the bladder and also strengthen the pelvic floor muscles used to control bladder function. 

Self Catheterization.

Many people with neurogenic bladders use a catheter to control their bladder. A catheter is a thin tube that is inserted into the urethra and then into the bladder to allow urine to drain from the bladder.  While using a catheter may sound a little intimidating at first, most people are able to master the process quickly and it can provide a great deal of freedom for those struggling with bladder control.

Pharmaceutical Options.

There are a number of pharmaceutical options available – both prescription and over the counter. Always talk with your doctor before trying something new.   

Botox Injections.

It’s not just for wrinkles!  Botox is also approved for overactive bladder (spastic bladders). Your doctor will inject botox into the bladder muscle, where it helps to block the nerve signals that trigger OAB, or spastic bladder.  Many people find this reduces leaks and the number of times you need to urinate each day. It also helps with that urgent feeling of needing to empty the bladder. 

Surgery

If all else fails, there are different surgeries available to treat neurogenic bladder.  Bladder augmentation is a surgical procedure to make the bladder larger. This helps reduce the pressure in the bladder, and reduce leaks.

If you’re living with Neurogenic Bladder, talk with your doctor about treatment options. Need help finding a qualified specialist? Try our Doctor Finder!

 

Can MS Cause Incontinence?

Can MS Cause Incontinence?

March is Multiple Sclerosis Awareness Month here in the US and we’re taking a moment to talk about MS and it’s effect on the bladder and bowel.

What is Multiple Sclerosis?

Multiple Sclerosis (MS) happens when the body’s immune system attacks the protective coating around the nerve fibers in the central nervous system (CNS), damaging the nerves. This alters or stops the messages within the CNS and can produce a variety of symptoms in people.

What are the symptoms of MS?  

While symptoms of MS vary from person to person, and even within the same person at different points throughout their lifetime, some of the more common symptoms of MS are fatigue, pain, numbness or tingling, weakness, walking difficulty, vision problems, sexual problems, dizziness and vertigo, bladder and bowel problems, thinking difficulty, emotional changes and depression.1  Luckily, many of these symptoms are treatable with medication.

How does MS affect bladder function?

In a healthy bladder, the nerves in the bladder communicate through the spinal cord to the brain, notifying it that the bladder needs to be emptied. For this process to work smoothly, it requires a coordination between the bladder muscles and the sphincter.

For people with MS, bladder function can be impaired when the signal from the bladder to the brain is delayed or blocked. This can cause the bladder to be either overactive (often referred to as a “spastic” bladder), or under-active, resulting in the inability to empty the bladder completely.  Either of these conditions can lead to a variety of problems, including:

  • Urinary Urgency (The need to urinate frequently and urgently.)

  • Nocturia (Needing to wake to use the bathroom more than one time per night.)

  • Difficulty urinating.

  • Sphincter Dyssynergia A problem where there is both a storage dysfunction and an emptying dysfunction. The bladder is trying to contract and empty, and the urethra contracts instead of relaxing, allowing little or no urine to pass.

  • Under-active Bladder: The nerve signals from the bladder to the brain are damaged and the signal for the bladder to contract and release urine are blocked. This can cause the bladder to eventually overflow and leak urine, or, if the bladder cannot empty completely, results in urinary retention.

In addition to disease related complications, some medications for MS can also cause bladder problems.

How can bladder problems with MS be treated?

Luckily, there are various treatment options that can be used to address bladder problems associated with multiple sclerosis. 

Behavioral modifications, such as avoiding bladder irritating foods and drinks, and bladder retraining can help to manage problems in some people. Pelvic floor physical therapy can also work by strengthening the pelvic floor muscle, providing greater muscle control.

Intermittent self-catheterization, in which a small tube is inserted into the urethra to empty the bladder, can prevent the bladder from overfilling and help prevent urinary infections.

There are many pharmaceutical options available for bladder control. In addition, PTNS, Interstim, and Botox are all in office procedures that can have a positive effect on bladder control for many patients.

Talk to your doctor about your options to find one that works best for you.

References: 1. National MS Society: https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms

But You Look So Good

A Guest Blog Post from Alice Thomas

In the early days of my MS I regularly heard ‘But, you look so good.’ While I have always been happy to have my good looks admired, rather than feeling like a true compliment, this statement often came across as one of disbelief that there could possibly be anything wrong with me.

I have even been skeptically asked ‘Are they sure you have MS? You don’t look sick.’ To which I am tempted to reply ‘You don’t look ignorant’. Because the question is inherently impudent and compels us to provide proof we actually have a disease. As patients, we don’t want pity but we do wish to be understood and we shouldn’t have to explain. So, what’s the answer?

One of the barriers to negating this confusion is that invisible symptoms can be difficult and even socially unacceptable to talk about. Amongst the many aspects of MS that aren’t obvious to the casual observer, bladder and bowel dysfunction are some of the most distressing. During my own looking so good days, this may have been the most troubling of my symptoms. I didn’t understand it so how could I talk about it and furthermore, why would I want to? It didn’t seem right to answer the old ‘But, you look so good?’ raised eyebrow with the truth that actually I was up all night doing laundry and crying because I’d peed the bed.

Adding to the frustration and confusion that looking good doesn’t necessarily equal feeling good, is that we as patients already question this ourselves and sometimes we are the most unforgiving accusers of all. We too can’t clearly see our own fatigue, nerve pain, numbness, muscle weakness or heat sensitivity. Consequently, we repeatedly set ourselves up for failure by not recognizing or respecting these unseen forces and then feel angry and defeated when we can’t accomplish what we’ve set out to do. We are the unwilling soldiers in our bodies’ civil war and it is a physical battle but also an emotional one. The physical struggle might be about the strength of our legs on any given day but the mental one is often an argument to simply will ourselves to do that which, based on how we look, we think we should be able. What we need to tell ourselves is the same thing we need to hear from others. MS is real. MS is hard.  

The answer to the dreaded ‘looking good’ statement isn’t to defensively list off every manifestation of the nasty disease that exists within us. You don’t owe anyone an explanation of something as intimate as your health. Nor should you have to prove your condition. But the question isn’t going away. Determining what is caring inquiry and what is idle curiosity can inform your response in these interactions. I’ve often found myself uncomfortably blurting out more than I wanted with someone who didn’t really care anyway. Rather than referencing my latest MRI, I’ve learned to point to some resources. Now when someone remarks on my striking countenance I say ‘Thanks, I inherited my mother’s flawless skin. MS is a complicated illness. If you want to know more, may I suggest checking out the MS Society website?’.

We are all curious from time to time. Let us act out of compassion and before we glibly assess the state of someone else’s health, of which we actually know nothing, pause a moment and instead of saying ‘but, you don’t look sick’ admit that we don’t really know much about the problem and ask how we could find out more.

Alice Thomas lives in Toronto with her husband and dog. She is an avid traveler, an arts enthusiast and a cheese fanatic. She is the author of the blog Tripping on Air - My trip through life with MS.  
Alice Thomas lives in Toronto with her husband and dog. She is an avid traveler, an arts enthusiast and a cheese fanatic. She is the author of the blog Tripping on Air - My trip through life with MS.  

I am not MS, by Alice Thomas

MS is not a suffix at the end of my name. My life with MS, is just my life. 15 years after my diagnosis an MS-free existence is as foreign to me as all night study sessions and the days when my RDA of fruit could be met with grape jello-shots and strawberry pop-tarts. That was another life. One that would hopefully seem strange and remote to me now regardless of my health status. My life with MS is not a separate thing. My life with MS is just my life.

When I was diagnosed I expected everything I knew about myself to change. Suddenly I was a Person With A Disease. I didn’t know what that meant but I was convinced I was about to become someone else. A statistic. A sick person. Irrelevant. Nothing else about me would matter. The first and most important thing people would learn and know about me would be that I had MS. I was terrified of how others would perceive me but more importantly of how my own sense of self might be lost to a new reality. This identity crisis which threatened to convince me I was ‘less than’ for simply having a disease, was as disabling as any physical symptom I’d experienced. 

The early years of my diagnosis brought about massive changes to my life. Optic neuritis meant I was no longer able to drive a car. Weakened legs caused me to change apartments because of stairs and I was forced to leave my job. MS introduced tremendous challenges to my world. But that’s not the whole story. It seems at best cliché and at worst sacrilegious to admit but there have been some positives. Eventually I took the crisis as an opportunity to re-assess what is important to me. It helped me clarify my priorities. I do what I love.

Over time I have adapted to my changing physical body and circumstance and surprisingly I haven’t stopped being me. I didn’t become ‘less than’. In fact in some ways it could be argued I became more me. The things that are fundamentally Alice cannot be altered by a disease. I am incontrovertibly a story-teller, a traveler and a lover of life. A singer, a volunteer, an art loving, wine drinking, dog mum. I am empathetic, enthusiastic, creative and kind. I am curious about the world. I am an advocate and an ambassador. I am a foodie, a fun time, a baker and a homemaker. An optimistic, advisor, a student and a teacher. My life as an artist, a wife, daughter, sister, aunt, friend, these are the things that define me. I am not my job, my car or some stupid apartment. MS is not the most important thing about me, nor is it the most interesting. I am not MS. 

Peace didn’t arrive overnight. Every loss has been mourned. I must consider X, Y and Z each day and while it’s true most may not, they have their own alphabet soups to contend with, full of realities and problems completely foreign to me. As novelist Tom Holt says, “Human beings can get used to virtually anything, given enough time and no choice in the matter whatsoever.” We can adapt. The degree to which we are able to reconcile and coexist with calamity is the degree to which we are able to find our peace.

Grieve the changes. Adjust expectations. Live your life. 

Life with MS is complicated. We argue a lot. But it’s my life and I’m grateful for it.

Alice Thomas lives in Toronto with her husband and dog. She is an avid traveler, an arts enthusiast and a cheese fanatic. She is the author of the blog Tripping on Air - My trip through life with MS.  
Alice Thomas lives in Toronto with her husband and dog. She is an avid traveler, an arts enthusiast and a cheese fanatic. She is the author of the blog Tripping on Air - My trip through life with MS.  

Watch This Video Of How Botox Helped A Woman With MS Battle Neurogenic Bladder

If you're reading this article, you, or someone you know, have likely dealt with some form of incontinence before. It's a common occurrence (more common than most think!), and can be a source of daily annoyance, shame and fear in our lives. 

For those living with Multiple Sclerosis (MS), bladder dysfunction is often present and can greatly affect the quality of one's life. Symptoms such as hesitation, interrupted or weak flow, incomplete emptying, incontinence, frequency, and pain are reported by many who suffer from MS.  However, there is hope.  Many treatments are available to those living with this condition.  Watch the videos below to see how Amy, an MS sufferer, bravely describes her struggles with neurogenic bladder, and her amazing transformation after she started treating it with Botox. 

Amy's Before Video

Amy's After Video

Video Roundup – Four Inspiring Stories Of People Who Have Overcome Neurogenic Bladders

4 Inspiring Stories of People Who Have Overcome Neurogenic Bladder

Becoming paralyzed or learning that you have MS or another neurological condition is anyone’s worst nightmare. The everyday freedoms that most of us take for granted suddenly become the main focus of life and things that were easy before become monumentally more difficult. We’ve rounded up stories from 4 inspiring people who have overcome tremendous obstacles and are determined to live life on their own terms. Watch their amazing stories in the links below.

Botox Injections For Neurogenic Bladder

Watch this self-taped video from Paralyzed Living about how he uses Botox injections to treat his neurogenic bladder.

Daniela’s Story

Watch Daniela’s inspiring story of how a freak accident left her a quadriplegic, unable to use her legs, and limited use of her arms and hands. Daniela struggled with bladder management, and finally took matters into her own hands by conducting extensive research into her options and finding a solution that has helped her regain her independence.

Audrey’s story

Audrey became paralyzed after an accident and suffered from bowel issues, but found the freedom to do what she wants from using Peristeen, a product for bowel management.

Amy’s Story

MS can wreak havoc on your bladder, resulting in urgent and frequent trips to the restroom, and in some cases, leakage. Watch this story from Amy, on how she used Botox to help her regain control.

Amy’s Video Diary – Before:  

Amy’s Video Diary – After:

Do you have your own story you’d like to share? Contact us!

Watch NAFC's Videos For Tips On Self-Catheterization

Being told that you have to use a catheter can be scary, but many people use a catheter to empty their bladders on both a temporary and a long-term basis. And while you might recoil from the idea at first, once you get the hang of using one and see the benefits it can bring, it you may wonder how you were ever able to get by without it.

With a little practice, using a catheter can become second nature to you.

Here are our best tips for using a urinary catheter.

  • Don’t be afraid to ask your doctor lots of questions. Catheters should be prescribed by your doctor and proper instruction should be given to you by your healthcare provider. If you are unsure of the process, speak up.
  • Be sure to keep the catheter and catheter site clean to avoid infections (UTIs are common with those using a catheter). Wash at least twice per day.
  • Use lubrication when inserting the catheter to reduce pain, discomfort, and friction – all of which may also help reduce infection.
  • Always wash your hands thoroughly prior to and after emptying the urine bag.
  • Be careful of tugging on the tubing, twisting, it, or stepping on the tubing when you are walking. It may be helpful for you to clip the tubing to your clothing to avoid this.
  • Always keep the urine bag below your bladder (below your waste) to prevent urine from flowing back into your bladder and causing an infection.
  • Drink plenty of fluid to help keep your urine flowing well.
  • Stock up on spare catheter equipment for emergencies.
  • Call your doctor if you experience any of the following
    • Trouble inserting or cleaning your catheter
    • Urine leakage between catheterizations
    • You notice any type of smell
    • Blood in the urine
    • Skin rash
    • Pain or burning in the urethra, bladder, or lower back
    • Swelling, draining, or redness in your urethra.
    • Any sign of a urinary tract infection, such as a burning sensation, a need to urinate often, a fever, or chills.

Learning how to use a catheter doesn’t have to be daunting.

Watch NAFC’s videos on how to self-catheterize for both men and women here.

Self-Catheterization for Women:

Self Catheterization for Men:

Pelvic Floor Disorders Are Common Among Patients With Multiple Sclerosis

Pelvic Floor Disorders And Multiple Sclerosis

Multiple Sclerosis (MS) is the most common autoimmune disease presently affecting approximately 2 million people worldwide. 

MS is a disease of the central nervous system. The central nervous system is the hub for the autonomic nervous system and the somatic nervous system. These systems regulate many parts of your body’s mechanics. Most notably: blood pressure, heart rate, bowel activity, sexual arousal, skin sensation, and muscle control.  

In patients with MS the immune system attacks the material that insulates nerve fibers. Without insulation the nerves of the central nervous system cannot communicate with the rest of the body.  This faulty communication between the brain and spinal cord often results in muscle weakness, abnormal sensation, psychiatric problems, and difficulty regulating breathing, blood pressure, and temperature.  Loss of bladder or bowel control can be a result of muscle weakness; almost half of MS patients report bladder and or bowel complaints as the first symptoms of multiple sclerosis.

Sixty-eight percent of individuals with MS experience symptoms of one or more Pelvic Floor Disorders (PFD). PDFs are a loss or lack of bladder or bowel control and can include urinary incontinence, urinary frequency and urgency, bowel incontinence, sexual dysfunction, pelvic organ prolapse, and pelvic pain related to a “spastic” pelvic floor.

Among MS patients with PFDs the most common diagnosis are overactive bladder (69%), voiding problems (41%), Sexual dysfunction (42%), and fecal incontinence (30%)[i].  These symptoms represent major detriments to quality of life. 

The good news is that patients with MS can benefit from the same behavior modifications as anyone else with a pelvic floor disorder. Pelvic floor neuromuscular rehabilitation, often referred to as “pelvic floor therapy”, is a behavior modification practice of retraining the pelvic floor muscles using techniques like pelvic floor muscle training, biofeedback therapy and electrical stimulation. 

Modern methods of pelvic floor rehabilitation such as The Pfilates Method™ and The VESy Lab™ utilize movement taken from Pilates and Yoga to provide greater pelvic floor response.  The key to success with pelvic floor rehabilitation is establishing a practice that continues for a lifetime.  Working with a specially trained Physical Therapist provides excellent results and should be considered an element of any care plan for MS patients with bothersome pelvic floor symptoms.

[i] Int J MS Care. 2014 Spring;16(1):20-5. doi: 10.7224/1537-2073.2012-052.

Dr. Bruce Crawford is Dr. Bruce Crawford is a Board Certified Urogynecologist and the creator of the PfilatesTM program of pelvic floor rehabilitation. He has personally trained over 1,500 physical therapists and fitness professionals in North America, Asia, and the UK. Dr. Crawford also originated the VESy LabTM Method of optimizing pelvic floor fitness training.
Dr. Bruce Crawford is Dr. Bruce Crawford is a Board Certified Urogynecologist and the creator of the PfilatesTM program of pelvic floor rehabilitation. He has personally trained over 1,500 physical therapists and fitness professionals in North America, Asia, and the UK. Dr. Crawford also originated the VESy LabTM Method of optimizing pelvic floor fitness training.