| MS PERSPECTIVES
By Ed Lash
As is often pointed out in literature about multiple sclerosis (MS), one of the common complications of the disease is a tricky bladder problem, primarily frequency and urgency. This may cause some people to limit their fluid intake, thereby reducing the flushing action that eliminates waste products through the urinary tract and often resulting in a low-grade bladder infection, which only makes their bladder problem worse.
A number of measures can be taken to improve bladder control, including medications. Talk it over with your doctor to choose the best for you. You could also try some self-help exercises to condition you to regain control over your bladder.
Kegel exercises, named after Dr. A. H. Kegel, the gynecologist who developed them, strengthen the pelvic floor muscles to control your bladder more efficiently. Kegel exercises are performed by alternately squeezing and relaxing the pelvic floor muscles that surround the urethra and support the bladder. To locate the pelvic floor muscles, try slowing or stopping your urine flow mid-stream as you urinate. Strengthening these muscles should improve bladder control.
Kegel exercises involve contracting the pelvic floor muscles for three seconds and then releasing them for another three seconds. “Johns
Hopkins White Papers” recommends that a good starting point is 45
repetitions a day, and dividing the 45 repetitions into 3 sets of 15, each set in a different position—sitting, standing and lying down—but not one immediately after another. I do one in the morning, one in the afternoon, and one in the early evening or when I hop into bed to go to sleep. Then increase each set by one each week after that. Protective undergarments can be used to play it safe.
In one study, 19% of men who performed regular Kegel exercises had regained urinary continence by one month, and 95% of the men were continent by six months. I wasn’t part of the study, but I became continent after one month of doing Kegel exercises, and now still do three sets a day. And often I can wait three to four hours between bathroom visits.
And, according to Johns Hopkins, simple changes in diet and behavior can be helpful. Excess weight increases pressure on the bladder and worsens incontinence. Weight loss through calorie restriction and increased physical activity will help ease the problem, so talk to your doctor.
Many men and women have heard of Kegel exercises and have tried them. Unfortunately, some have not found them helpful for a number of reasons. Some people never locate the right muscles as described above, and may exercise the wrong muscles. Even when the right muscles are identified, some give up too soon before the exercises can take effect.
The book Staying Dry, A Practical Guide to Bladder Control by Katherine Burgio and colleagues, mentions that the worst time to head for the bathroom is when you already have a strong urge to urinate. The best time is before you get a strong urge or after you have successfully reduced or eliminated the urge to go. You may be able to obtain success by doing a few Kegel exercises before you go. For example, many people like me note that a strong urge feeling strikes when we stand up from a sitting position. To prepare for this situation, get into the habit of squeezing your pelvic floor muscles several times before standing up and hold with another squeeze while you stand up. In the morning when you awaken, it also is a good time to use this approach. If other situations affect your bladder negatively, use this procedure at those times, also.
In my own case, my MS bladder was pretty much in control at night and acted up only occasionally during the day. I suddenly began getting up at night to empty my bladder more and more frequently, and within a few days I was getting up hourly. Having read once that allergies could affect the bladder with frequent urination, I eventually found out that I was sensitive to raw tomatoes, which I had been eating frequently. I gave them up with success. Allergy books say that after discovering what the allergic food is for you, your system should be able to tolerate it occasionally, but not more than once in five days.
So, good luck. I hope you find success with Kegel exercise, allergy alleviation, or anything that can help you take back control.
Note: Self-help is not intended to replace medical treatment, but should be used together with the help of all appropriate professionals in a team effort.
Ed Lash is a United Spinal member who lives in Trumbull, Connecticut. For more information, or to order his book (Multiple Sclerosis – A Patient’s View) call 203-445-0118 or by e-mail at elash@unitedspinal.org.
