MS and Bladder Spasms

Understanding Bladder Spasms in Multiple Sclerosis (MS)

Bladder problems are very common in multiple sclerosis (MS) – in fact, up to 50–80% of people with MS experience issues with bladder function at some point in their disease. These symptoms can be frustrating, but understanding why they happen and the treatment options available are important in managing your MS.

How the Bladder Normally Works

In a healthy body, bladder function relies on smooth communication between the brain, spinal cord, and the bladder muscles. Urine made by the kidneys flows into the bladder, where it’s stored. During this storage phase, the bladder muscle (called the detrusor muscle) stays relaxed, while a ring of muscles at the bladder outlet (the sphincter) stays tight to prevent leaks.

When the bladder fills, it sends a message to the brain via the spinal cord. The brain holds off the urge to urinate until it’s appropriate. When you’re ready to go, the brain signals the bladder to contract and the sphincter to relax, allowing urine to flow out.

How MS Affects Bladder Function

In MS, the immune system damages myelin, the protective coating around nerves in the brain and spinal cord, interrupting communication between nerves. When this damage happens in areas that control the bladder, it can disrupt the signals that manage when to store and when to release urine. This nerve damage can lead to two common problems:

• Overactive bladder (OAB): The bladder contracts at the wrong time, causing frequent urges to urinate – even if it’s not full – and sometimes leaking.
• Urinary retention: The bladder doesn’t empty fully, either because it’s not getting the signal to contract or the sphincter doesn’t relax properly.

What Are Bladder Spasms?

Bladder spasms are sudden, involuntary contractions of the bladder muscle. They can feel like cramping or pressure in the lower abdomen or pelvis and often lead to a strong, urgent need to urinate. Some people may also experience leakage.

You can think of bladder spasms as similar to muscle spasticity in the legs – a common MS symptom. Just like leg muscles can tighten on their own due to faulty nerve signals, the bladder muscle can also spasm unexpectedly.

Bladder spasms may cause:

• Cramping or a “charley horse” feeling in the lower abdomen
• Sudden, strong urge to pee
• Possible urine leakage

Bladder Spasms vs. Overactive Bladder

While they’re closely related, there is a difference between the two:

• Overactive bladder (OAB) is a group of symptoms – including urgency, frequency, and sometimes incontinence – that result from involuntary bladder muscle contractions.
• Bladder spasms are the physical muscle contractions themselves. These spasms are often a part of OAB, but can also occur separately, such as after a urinary tract infection (UTI), catheter use, or other irritation.

How Can Bladder Spasms Be Treated?

The good news is that many treatment options are available, ranging from simple lifestyle changes to medications and advanced therapies. Treatment plans are personalized, depending on the severity of your symptoms and how they affect your daily life. Getting better control of bladder symptoms can significantly improve quality of life for people living with MS.

1. Lifestyle and Behavior Changes

• Timed voiding: Try to go to the bathroom every 2-3 hours to prevent your bladder from becoming overly full.
• Fluid management: Drink small amounts throughout the day rather than large amounts at once. Avoid fluids in the 2-3 hours before bedtime to minimize overnight waking.
• Avoid bladder irritants: Limit caffeine, alcohol, and spicy foods, which can worsen bladder spasms.

2. Pelvic Floor Physical Therapy

A pelvic floor therapist can teach you exercises to strengthen the muscles that support bladder control and help reduce urgency.

3. Medications

Medicine to relax the bladder muscle can be helpful after trying lifestyle and behavioral changes. However, in instances where the bladder doesn’t empty completely, medicines to relax the bladder can make this worse. Sometimes a consultation with a urologist (bladder doctor) is helpful to find the best treatment for your symptoms. Medicines to relax the bladder include:

• Oxybutynin, tolterodine, solifenacin, trospium: These block contraction of the bladder muscle to reduce spasms and urgency.
• Mirabegron, vibegron: These relax the bladder, allowing it to hold more urine and reduce the feeling of urgency.

4. Botox Injections

If medications don’t provide enough relief, botulinum toxin (which includes Botox) can be injected into the bladder wall. This relaxes the muscle and reduces spasms, often lasting for several months. This is a specialized procedure done by a urologist.

5. Neuromodulation

For some people, nerve stimulation techniques can improve the way nerves communicate with the bladder and help manage symptoms.

• Tibial nerve stimulation involves treatments with a small needle in the leg that sends electric impulses to some of the nerves that help control bladder function.
• Sacral nerve stimulation is achieved by implanting a small device that delivers electric impulses to the bladder, which helps normalize signals between the brain and bladder.

In summary, bladder spasms occur in MS because damaged myelin interferes with the brain’s ability to properly send signals to control the bladder. This causes the bladder muscle to contract at the wrong time, leading to urgency, cramping, and sometimes leakage.  Fortunately, many treatment options are available. Lifestyle changes, medications, physical therapy, Botox injections, and nerve stimulation therapies can all help reduce symptoms and improve your quality of life. If you’re experiencing bladder problems, talk with your neurologist and/or urologist – they can help you find a treatment plan that works for you.