Multiple sclerosis is a demyelinating disease, which puts it in the category or neurological conditions. Due to its demyelinating nature, a number of conditions occur, including a number of urinary dysfunctions. Neurogenic bladder falls under this category, and its primary symptoms is overflow incontinence.  There are several risks involved with this condition, including serious complications like vesicoureteral reflux, autonomic dysreflexia, recurrent infection and such.

There are two types of neurogenic bladder: flaccid and spastic.  When someone has a flaccid neurogenic bladder, the pressure is low, volume is large and the contractions are absent. This condition can result from peripheral nerve damage or spinal cord damage.  Spastic bladder is defined by normal or small volume and involuntary contractions. This condition results from spinal cord damage or brain damage.
There are persons who have mixed patterns ( spastic and flaccid bladder) and this happens quite often in multiple sclerosis patients.

There are many symptoms, but the primary one is urine retention and constant overflow dribbling. For men, erectile dysfunctions are typical. When someone has a spastic bladder, nocturia, frequency and urgency or spastic paralysis with sensory deficits is to be expected.

The diagnosis is made clinically, by measuring postvoid residual volume, serum creatinine and renal ultrasonography.
There are several treatments for neurogenic bladder: increased fluid intake, cauterization and surgery. The recovery rate from this condition is good as long as it is diagnosed and treated before any kidney damage occurs.
When it comes to general treatments, these include control of the UTIs, high fluid intake to decrease the risk of urinary calculi and UTIs, renal function monitoring and dietary calcium restrictions to inhibit calculus formation.
In the case of a flaccid bladder, catheterization is needed. In the case of spastic bladder, the treatment greatly depends on the person’s ability to retain urine. For patients who can retain normal volumes of urine, techniques to trigger voiding are recommended.  If patients can’t retain normal volumes, then the treatment includes drugs and sacral nerve stimulation.

It’s needless to say that surgery is the last resort, and it is usually indicated if patients had or at are risk of severe chronic or acute sequelae, and also, if social circumstances prevent the use of continuous or intermittent bladder drainage.  For men, sphincterotomy converts the bladder into an open draining conduct. Sacral rhizotomy converts a spastic bladder into a flaccid bladder.

For patients who have adequate bladder capacity, upper extremity motor skills and good bladder emptying, an artificial, mechanically controlled sphincter is surgically inserted.

It is needless to say that not all multiple sclerosis patients have a neurogenic bladder, and the risk of developing this condition depends on a number of factors. As it is known, MS doesn’t have the same symptoms in two patients, so while some many develop this condition, some might not. What is recommended is for all MS patients to check with their doctor and report any bladder dysfunctions, to prevent further damage caused by an untreated condition like neurogenic bladder.