Nurse Practitioner Response:

Kathy Costello, ARNP
Associate Vice President of Programs, Can Do MS

PTNS, or percutaneous tibial nerve stimulation is a procedure used once weekly for 12 weeks to help control bladder urgency and loss of control. In this procedure, a small needle (like an acupuncture needle) is placed over the tibial nerve – just above the inner side of the ankle. A small amount of electrical current is delivered through the needle and the tibial nerve is stimulated, which causes stimulation of the nerves around the bladder leading to the brain. The nerve stimulation leads to decreased urgency and urination. The electrical pulses help block the nerve signals causing the bladder to be overactive.

InterStim Therapy is an FDA-approved treatment for overactive bladder and urinary retention. With InterStim Therapy, an implantable device sends mild electrical pulses to the sacral nerves to reduce symptoms of bladder control problems. InterStim requires a surgical procedure and has been used for a number of different symptoms, including:

• Urinary incontinence
• Overactive bladder (OAB)
• Urinary retention: the inability to empty the bladder
• Fecal incontinence: the inability to control bowel movements causing stool to leak unexpectedly from the rectum.

While both PTNS and the InterStim can be very effective for bladder and bowel issues, they are not for everyone. For either of these interventions, a careful and thorough assessment by a urologist familiar with MS is needed before any treatment plan is decided upon.

Psychologist Response:

Roz Kalb, PhD
Senior Programs Consultant, Can Do MS

Sling surgery is often used to treat stress incontinence, which can occur when someone (with or without MS) loses urine when laughing hard, stepping off a curb, or engaging in various kinds of physical activity. It may be used in a person with MS for this purpose, but it does not address the most common MS symptoms (difficulty emptying or difficulty storing urine).

I would suggest that you discuss your urinary symptoms with your MS provider and have a thorough evaluation by a urologist to determine exactly what types of urinary problems you are having – and which treatments would be most effective for you.

Psychologist Response:

Roz Kalb, PhD
Senior Programs Consultant, Can Do MS

So sorry that you are having bowel symptoms.  Fortunately, the bowels often respond to interventions.  First, if you have not already, talk to your MS provider about this, to ensure that the symptoms are MS related and not another bowel issue.  Treatments for bowel symptoms are individualized to the specific issue, and interventions may include: increasing fiber (sometimes with a soluble fiber supplement) to create more bulk, dietary modifications to reduce any irritation to the system, sufficient fluid intake to ensure this is not liquid leaking around hard stool, regular physical activity which helps overall bowel function, pelvic floor physical therapy that can help to strengthen the pelvic floor for better muscle control, and medications that can sometimes be used depending on the specific issue.  Here is a Can Do MS library article that you may find helpful: https://www.cando-ms.org/online-resources/can-do-library/bowel-and-bladder-symptoms-tips-for-success  And here is an archived webinar with helpful information about bowel function (also bladder) – the bowel information starts at minute 34:21: https://www.youtube.com/watch?v=Q2Zlwvh3VpM Please talk to your MS provider about the symptoms so that the best treatment plan is developed for the issues you are experiencing.

Psychologist Response:

Roz Kalb, PhD
Senior Programs Consultant, Can Do MS

For men, bladder issues may be caused by MS as well as by prostate issues. As men age, the prostate often becomes enlarged, making urination difficult. Since MS can also cause urinary urgency and urinary hesitation (or difficulty starting the urinary stream), it’s important for older men to be carefully evaluated to determine the cause(s) of any urinary problems they are having. The correct diagnosis will inform the best treatment strategy. In younger men with MS, prostate enlargement is unlikely to be playing a role in any urinary symptoms they experience. For them, the treatment strategies discussed in the program are the same as for women.