It was Christmastime and Target was as busy as ever. I had gotten everything I on my list, wrapping paper, tape, some presents. It was getting late and I was tired. I used to love shopping, but now it just takes it out of me, especially when the stores are busy. My husband said he would go get the car as he usually does and I wrapped up inside, getting a few last things, browsing for a few more minutes. Finally I got in line to check out. Obviously it was longer than normal during this time of year, but that usually doesn’t bother me, being a former Target employee, I know they handle the lines fairly well. I started chatting with the girl at the register when it was my turn. The usual conversation, about the crowds, if your shopping is done, etc.

Then, it happened. I didn’t notice it at first, it can be sneaky like that. But then I felt it, the warmth and urgency that I have felt so many times before.

I panicked.

Bladder Dysfunction in MS

Bladder dysfunction is one of the most commonly reported symptoms from MS patients, with up to 80% being affected. If an individuals system is working properly, urine will collect slowly in the bladder and cause it to expand. When enough fluid has accumulated nerves in the bladder will send signals to the spinal cord which will send signals to the brain that the bladder needs to be emptied. When the person is in the bathroom, the brain sends signals to the spinal cord which triggers the bladder and sphincter to open.

Dysfunction occurs when lesions are present and inhibit nerve signals from reaching their intended destination. With so many signals being sent in between the brain and the spinal cord multiple times, it’s no wonder bladder dysfunction is such a common problem! The specific dysfunction can happen for two reasons, the bladders spastic or the bladder isn’t emptying all the way because the sphincter is spastic.

Because of either cause, there can be many symptoms present including:

• Urgency– The need to urinate may come on (very) quickly and suddenly
• Hesitancy– The urge to urinate is present, but starting to urinate can take a long time or it’s difficult to keep it flowing.
• Frequency– The urge to urinate happens much more often than usual, often times at night which can cause sleep disturbances (otherwise known as nocturia).
• Incontinence– Either having a sudden urge to urinate and the flow starting immediately, or being unaware that there is leaking happening.

If bladder dysfunction continues without treatment, it can lead to severe symptoms and can lead to permanent damage to the urinary tract. This occurs when urine is left in the bladder and can lead to urinary tract infections, bladder infections, kidney infections or stones.  Also. these issues can also lead to emotional distress and avoidance of social situations or isolation.

Thankfully, there are many ways to treat bladder dysfunction with either lifestyle modifications, medications or procedures. Lifestyle modifications include both dietary and behavioral changes. Dietary changes include liming caffeine and alcohol (as these can be irritating to the bladder) as well as limiting fluids several hours before bed time if you struggle with waking up in the middle of the night.

Behavioral interventions include timing fluid intake as well as urinating on a regular schedule to help train the bladder. Other interventions include:

• Pelvic floor physical therapy is also a great option. This targets muscles that are attached to the pelvic bone and sacrum that control bladder and bowel function. This method utilizes biofeedback, neuromuscular stimulation and home exercises to strengthen pelvic floor muscles which improves muscle control.
• Percutaneous tibial nerve stimulation is another alternative option. This is where a very small electrode is inserted into the ankle which transmits a signal to the sacral plexus. This treatment does for 30 minutes per week for 12 weeks has been shown to reduce urinary frequency, nighttime urination and incontinence.
• Intermittent self-catheterization is sometimes recommended for individuals who have difficulty fully emptying the bladder. With this treatment, a small tube (catheter) is inserted into the urethra to empty the bladder, then removed.

There are many medications available to help control spasticity and to promote the flow of urine. Some include baclofen, oxybutynin and terazosin. If symptoms persist after these interventions are tried, there are surgical options available as well.

Dealing with bladder issues during day to day life can be tiring and isolating, but there are ways to plan ahead.

• Plan frequent stops. I am unapologetic about having to stop every half an hour to go to the bathroom and you shouldn’t be either.
• Use protection. Some days are worse than others and I can usually tell what kind of day it will be early in the morning. On the ‘bad’ days, I add a layer (or two) or protection to my undies. It has come in handy more than I’d like to admit. And, I always carry a few pads with me just in case I need to add some in the middle of the day.
• Have a change of clothes handy. For the worst case scenario, have an extra pair of everything on hand. I’ve been stuck without this, and it’s not fun. Worried about what others might say? Just say you’re a klutz and spilled water/tea/kombucha on your pants and you have to change pronto!
• Have support. This is one of the most embarrassing, demoralizing, isolating symptoms we can deal with. Having someone to talk to about it changes everything.
• Stay hydrated! I know it sounds counter-intuitive, but my bladder symptoms really act up when I am dehydrated. Plus, being dehydrated can bring on a whole bunch of other symptoms and issues, not good!

I always tell my husband, if I could make one symptom magically disappear, this would be it. But I’ve found that through lifestyle changes and paying attention to my body,  I am more able to manage my bladder dysfunction. I know that around my cycle, when I am dehydrated and when I drink coffee, my bladder symptoms act up. So being extra prepared on some days, really helps me both mentally and practically.

Bladder dysfunction is no joke, and can cause a boat load of other issues if left untreated. But thankfully there are many ways we can manage the symptoms and not let it run and ruin our lives.

My panic quickly grew to terror. ‘This has never happened in public before, what do I do?’ I thought to myself. I didn’t feel like I could run away from all of my things to the bathroom, I felt trapped. I rushed through the transaction as fast as I could in a socially acceptable way, and then ran to the bathroom. The damage was done and I began to cry. I gave myself a few more moments of pity before running from the bathroom to my awaiting husband and car. He could tell by my speed and tears that something had happened. Immediately he began asking what was wrong, “Just drive” was all I could muster. Eventually I was able to calm down to gesture toward my pants and said

“yeah, that just happened”.