This is Part Three of a three-part series on managing the symptoms of multiple sclerosis. The text has been excerpted from Dr. Schapiro's book, Managing the Symptoms of MS, 6th Edition, which came out this month.

Many people with MS experience difficulties with bladder control and urination at some point during the course of the disease. Bladder symptoms usually can be controlled with medication or other approaches that minimize any changes in daily activities and lifestyle.

Probably the most common type of bladder problem in MS results from a small spastic bladder, sometimes referred to as a “ failure-to-store” bladder, which results from demyelination of the spinal cord pathways between the voiding reflex center and the brain. Because the pathways to the brain are blocked, bladder emptying no longer is under voluntary control. Voiding then becomes a reflex activity, with messages to “empty” coming only from the spinal center. A small spastic bladder may produce symptoms of increased frequency, urgency, dribbling, and/or incontinence.

The small spastic bladder is best treated with medications that “slow” the bladder by decreasing transmission in the nerves to the bladder that cause it to empty. These include oxybutynin (Ditropan ®, Ditropan XL®, Oxytrol patch®), tolterodine tartrate (Detrol®, Detrol LA®), hyoscyamine (Levsinex®, Levbid®, Cystospaz®), flavoxate hydrochloride (Urispas®), imipramine (Tofranil®), solfenacin (Vesicare®), tolterodine tartrate LA (Detrol LA®), trospium CL (Sanctura®), darifenacin (Enablex®), mirabegron (Myrbetriq®), and several medications that are used for the “runny” nose of a cold. These medications lengthen the intervals between urination and decrease urgency, thus allowing for more time to reach the bathroom and avoiding dribbling and incontinence.

Onabotulinumtoxin A (Botox®) can be injected into the bladder wall and the sphincter. This decreases the muscle tone (strength) and may allow for increased urine retention. This treatment is becoming more popular and is now approved by the FDA. It needs to be repeated about every three months as it wears off. An experienced urologist or gynecologist performs this procedure.

Physical therapists have developed not only exercises but also biofeedback techniques that enable people with overactive bladders as a result of MS to learn how to decrease the stimulation of the bladder by using learned sensing in the body. These techniques, when mastered, may result in decreased medication use.

If you're experiencing incontinence, whether due to MS or not, you may also find our book The Bathroom Key helpful. Authors Kim Perelli and Kathryn Kassai address physical therapy as a successful solution to incontinence.