I'm joined today by Sophia Starke, who is a clinical nurse specialist in multiple sclerosis at St George's Hospital in London. And today we're going to be talking about management strategies for people with MS who are experiencing bladder problems. So, Sophia, what sorts of problems do people discuss with you when they come and see you in clinic if they've got MS and they're experiencing bladder problems? Well, some people say that the bladder is ruling their lives.
They're feeling that they're not actually going out because they're worried about not finding a toilet in time. If they really need to go to the toilet, they experience having to go to the toilet all the time and or they're feeling they're up all night having to keep going to the toilet. They're more prone to urine infections or they're actually caught short. For example, when they're coming home from work, they're putting the key in the front door and they suddenly get the urge, but they can't manage to get to the toilet in time.
And sometimes people are stopping drinking, aren't they, because they just don't worry that they're going to have a bladder problem, that they just stop drinking completely. Yes, that can be a real problem. So is there anything that makes the bladder problems worse? Absolutely.
There are certain drinks that can irritate the bladder. Okay. Brown drinks, as we call them. So caffeinated, tea, coffee, hot chocolate, cola can really make things like urgency or frequency more problematic, as can sugary drinks or acidic drinks.
So try and avoid those or limit those as much as possible. Also, not drinking enough can irritate your bladder because your urine becomes very concentrated and therefore your body wants to get rid of it more quickly. And that's a lot of people do that. I think I'm going out, so I'm not going to drink anything at all today.
Exactly. That just makes it worse. Exactly. Smoking can irritate your bladder, so it's best to avoid that.
Being constipated can have an impact on your bladder. And I suppose if you're not drinking, then it's going to make you more constipated, isn't it? Yeah, exactly. So the other problem with not drinking enough and having concentrated urine is that it can make you more prone to urine infections.
Okay. Which can impact your bladder as well. And that makes you want to pass urine more often and have more frequency and urgency. So what can you do if you've tried all these things, you've tried all the conservative management, but you've still got bladder problems.
What else can you do now? So what an MS nurse or a continence adviser can do can take you through a more thorough bladder assessment. Okay. The first thing that they would ask you to do is to fill in what we call a bladder diary.
And that's a diary over three to four days and nights where you write down how much you drink, how much you pass urine and whether you're experiencing urgency. And this really helps us visualize or work out where your problems are and so that we can work out how to help you with your bladder. It gets a really good picture of how the person's bladder is functioning day and night, isn't it? Okay.
And sometimes you might find that one of the things could be that you're just not drinking enough and you might not realize that, and that it could be as simple as that. And some people I know, I have a man who was only drinking on an evening, he was at work all day. He'd come home, drink a lot in the evening, then wondered why he was up all night and hadn't realized until he finished until he completed a bladder diary. And then he realized what other things can be done.
So secondly, what we would do is a bladder scan. Now, this is a noninvasive painless way of us working out whether you're emptying your bladder properly. So a little bit like when pregnant women have an ultrasound with a baby, but it's a lot more simplistic. So we would ask you to come to clinic with a full bladder.
So you might need to come a little bit early and just drink just before seeing one of us, because if you've got bladder problems, you don't want to come with a full bladder, you're going to worry about breaking yourself out. So when you get there, you could perhaps drink before you have the scan slowly. And then we would do the scan straight away and then ask you to go and empty your bladder to go to the toilet. And then we would redo the scan and see whether there's any urine left in your bladder.
So if you are emptying your bladder sufficiently, but you're still experiencing things like frequency or urgency, there are medications that could help you. They're known as antimuscarinic or the other name for them is anticholinergics. And they can help calm down the signals going from your bladder to your brain and back again, which can be too many signals going on, which makes you want to wee more frequently than you should be. They can really help calm down what we call an overactive bladder.
Yeah. If we find during the scan that you're not emptying your bladder properly, one option could be for you to be referred for training for something called clean intermittent self-categorization. And that is a very simple technique that just needs a little bit of practice and people find that it can really transform their lives and put them back in control of their bladder. I suppose that sounds a bit scary, doesn't it?
So is the patient referred straight away or what happens? It's completely up to the patient. We discuss it with them and it's an option that they can go away and have a bit of a read about. I think it can sound really daunting, but from the reports of people who have tried it and practiced it, people have said that it's completely transformed their lives.
They can go out again, they can carry on with their normal daily activities they haven't been able to do before. And yeah, it's really worth having a look into and persevering with. So can you use these catheters when you're out and about socially? Absolutely.
They're very discreet small catheters that you can just take with you in your handbag or in a pocket if you're a male and they're like in and out catheters which you just dispose of after you've used them. Okay, that's great. And what about catheters in general? Because I think sometimes some people have to have catheters that are in on a more permanent basis.
So when would somebody need a catheter like that? If you found an in and out catheter very difficult to use, then there is the option of what we would call an indwelling catheter and this is a catheter that stays in permanently to help you drain your urine. And how do people find those too? Because it sounds so scary, but how do people find those once they're in?
I think people have so much support with them and are very well educated if the time comes when they would need one of those that they find that they just can manage them and they're just part of their everyday life, really and they can carry on with their daily activities as usual. I think some people worry about that bag of wee sort of situation. I know some of our patients can put a plug in the end of the catheter so they don't need to carry the bag of wee with them. Exactly.
Which isn't it not everyone realizes that. Yes. So it's important to talk to your continence nurse or your specialist nurse, isn't it about if you don't want that bag of wee hanging around, it's important to talk to your nurse about what else you can do about other options are, exactly, yes. So the take home messages from this video are it's important to plan when you go out so you know where the toilets are and there's plenty of information online to be able to help you with that.
It's important to drink plenty of fluids because there is a strong urge to not drink if you're going out because you worry that you're going to need the toilet. But the repercussions of having concentrated urine are huge. It's important to do your pelvic floor exercises and do these regularly, not just do them one day and then skip a day. It's important that these are done every day and it's also important that you don't suffer in silence, that there's plenty that can be done about bladder problems and bladder symptoms, but only if you bring up the subject because your health care professional might not it doesn't have to be this way.
You don't have to suffer in silence there's lots that can be done.