You. So I'm joined here today by Nikki Abel. Nikki is a lecturer practitioner at Birmingham. And in this video we're going to discuss the urinary tract, how the bladder works and how MS affects the bladder.
I think most of us take it for granted that we can control our bladder. And by that I mean that we may experience the urge to pass urine or the urge to have a wee, but we're able to suppress that. It might be that we're gardening, we're chatting to friends, we're at work and we can suppress that urge until we find the right toilet and then we can pass urine. But that's not the same case for everybody.
Some people find they can't resist that urge and maybe they have quite complicated bladder problems. So Nikki, can you tell me a little bit about the urinary tract? Yes. So the normal urinary tract works that we've got two kidneys.
From each of those kidneys we've got a tube called the ureter that runs from the kidney to the bladder. We've all got one bladder and it's like a balloon. The bladder acts as a reservoir for the urine that the kidneys make from the bladder. There is a tube called the urethra and it is through that tube that we pass urine or we have a wee into the toilet.
So the kidneys are really important as filtering agents. So they filter the blood, they take out the impurities and they make urine which then travels down the ureters, as I've said, and into the bladder. The bladder has a muscle around it called the detrusor muscle. And that's a really important part of the anatomy if we're talking about multiple sclerosis.
And we'll explain a bit more about that in a minute. So the urine travels down the ureters into the bladder and the bladder will fill up. It fills I mean, most of its time it's filling with urine. So 99% of its time it's filling up and 1% of the time it's voiding urine.
Now for us actually to pass urine, what happens is that as the bladder fills, the detrusor muscle starts to stretch and that stretch sends impulses up the spinal cord to the brain. The brain then realizes that it's time for the person to pass urine. So messages are sent down the spinal cord to the detrusor muscle and that's when we receive the urge that we need to have a wee. The amount of urine in the bladder that stimulates the stretch reflex will vary in each of us.
Okay? So we generally say about the bladder can store about 400 to 600 MLS, but that's not the same for everybody. So some people will actually experience the desire to pass urine in when it's about 300 MLs or 200 ML. We're all different.
And that's perfectly normal. That's perfectly normal. So we can store roughly up to about 600 MLs. We tend to pass urine about five to six times a day.
If you find that you're passing urine more often than that, at what point would you contact somebody or speak to somebody about that being a problem for you? Yeah, and I think that's a really good question. Especially if you're passing urine regularly during the night, then you might need to seek help. Yeah, that makes sense.
And I guess the frequency, the amount of time you go into the toilet is if it's getting in the way of your everyday life, I suppose that's when you might want to speak to somebody about it. Absolutely. For some people, it's not a problem and they can manage it, but for other people, it certainly is a problem. So, Nikki, do people with MS often have bladder problems?
So surveys have shown that seven in ten people with multiple sclerosis will experience bladder problems. But that doesn't mean that they'll have bladder problems the entire time, every day. It means at some point when living with the disease, they will experience bladder problems. And also if the person has a disability and is struggling to walk, maybe then they will probably find they have more bladder problems.
But I think we have to remember that bladder problems are common in the general population as well. They do say about three to six million people living in the UK have bladder problems, which aren't anything, obviously, to do with MS. It's nothing to do with MS, but the problem is that because a lot of us think it's embarrassing, we don't always talk about it. That's quite a big statistic, isn't it, that so many people in the UK have bladder problems.
And like you say, initially, people might be a little bit embarrassed to talk about it, but what are the advantages of talking about it to your health care professional? I think because there's so much that can be done about it, it doesn't have to be this way, that people have bladder problems that are uncontrollable. But people do need to bring the subject up because sometimes the healthcare professional might not bring it up themselves. So the person with MS needs to have the confidence and sometimes they can, like, practice in front of the mirror if they feel they're not able to ask the question, just practice saying it out loud and then go along to their GP or their MS nurse and say that there is a problem.
And GPS and MS nurses, continence advisors, obviously they talk about bladders all the time, don't they? So really, for them, it wouldn't be a surprise if anyone brought it up. So it really doesn't need to be embarrassing. Now, I think that's a really good point to nurses.
To doctors, bladder problems are something that they talk about a lot, so a person with MS isn't going to say something to them that the doctor's never heard before. So what happens in MS is that there is an interruption of those signals. Okay, so do you remember we said that the detrusor muscle will start to send signals up the spinal cord to the brain and then the brain will send signals back to the bladder to signify that it's time to pass urine. But in multiple sclerosis there is scar tissue or lesions that develop within the spinal cord and within the brain that interrupts those signals.
And that means that as the signals go up and down that they're not getting through properly. So sometimes the signals get through partially, sometimes they don't get through at all, sometimes they're short circuited. So the bladder isn't receiving the right signals that it needs to pass urine in and sometimes that can lead to all sorts of bladder issues. So what you're saying is there's a lot of signals that are needed from the brain between the bladder and the brain.
It's quite complicated signals in order to coordinate the emptying of your bladder. Absolutely. That's entirely okay. Well, I'm saying yeah.
So Nikki, is there anything else that can actually have an effect on the bladder itself? Any other part of the body? I think we forget about the bowels and again for some another embarrassing symptom to talk about. But again, it's just bread and butter to MS nurses and consultants and GPS.
But if the person is constipated so they have perhaps a full rectum or a full bowel, then that is going to impact on the bladder and it's going to cause problems with bladder emptying. So certainly if I was talking to a patient who was having bladder issues, I would always ask about their bowel function as well. So it could be that the actual problem is actually about the bowel and not about the bladder initially, but it's the bladder that's getting affected. Absolutely.
So things as simple as trying to prevent or resolve a constipation can actually in turn help the bladder. That's interesting. OK, and what kind of problems, bladder problems can people with MS experience as a result of these interruptions in the signals then? Okay, so it may be easier to divide it into two.
So let's talk about storage first. And by storage I mean let's talk about the bladder. So on some occasions the bladder becomes irritable and it becomes what we call hyperactive. So it's far too active and that's the bladder it's got the detrusor muscle is made up of the detrusor muscle.
So that's the bit that's becoming hyperactive? It is. That's the bit that's becoming hyperactive. Absolutely.
And that might be due to perhaps the wrong drinks, which we're going to talk a bit more about in another video. But we call it storage problems, we call it hyperactivity. So the detrusor muscle becomes hyperactive and it thinks that the bladder needs to keep emptying because it's not empty. So what happens is the person starts to experience frequency.
So maybe more than eight times a day they begin to experience what we call urgency. So they get that feeling that they're desperate to go to the toilet, to have a way, they're very desperate. And that is obviously very incapacitating for some people because they fear that they're going to be incontinent or they're going to wet themselves. And on some occasions, yes, that urge might be so much that they do leak a little bit of urine.
So there is frequency, there is urgency, and on occasions there is slight incontinence. But the frequency is so intense that some people say they spend the whole day on the toilet. You'll hear people saying, people come and see me and they say I'm going every ten minutes. It's absolutely extreme for some people and we can manage that really well, especially if they're going at night.
It's stopping them sleeping, they're having all sorts of issues. We've been tired, it's adding to their fatigue. We can do things about that. We'll talk about that a bit later on.
The other problem the person has is incomplete emptying of their bladder. Now, sometimes people can have both, but incomplete emptying means that they will experience the urge to pass urine. It could be quite intense. So they rush to the toilet, they sit there or stand there waiting to go.
And although they're desperate, they can't begin to pass urine. They have what we call hesitancy. So they sit there for a while. Sometimes they just get fed up of sitting there and they think it's not going to happen and they walk away.
And then five minutes later they'll get the urge to go again, or other times that they will pass urine. But the gate of the bladder isn't opening completely and they don't empty their bladder completely. And what's the gate? So you're calling it a gate.
What part of the anatomy is that? The so what you've got is that you've got the bladder. And to stop us being wet all the time, I call it the gate, it's the urethral sphincter, I call it the gate of the bladder. And we voluntarily open that gate, else we would just be wet all the time.
But that gate doesn't completely open, or sometimes it doesn't open at all. So then what happens is that the bladder is almost consistently half full, they're just skimming off the top. And that can lead to bladder infections, which isn't good with multiple sclerosis. It can have a big effect on the disease and obviously on the person as well.
But it also means that the person has a continual desire to pass urine and that can be extremely incapacitating for people. So the take home messages, from what you've told me already, is that you can have bladder problems. The general populations have bladder problems and there can be nothing to do their best. But bladder problems in MS are common.
And the key is not to be embarrassed to talk to your healthcare professional, because there's lots out there that we can do to help. But you're also saying, it doesn't have to be this way now. It certainly doesn't have to be this way. There's lots that can be done, and we can make life so much better for people with MS and bladder problems.