Elizabeth Timbook Brown, MD: Bladder issues in MS is actually very common. Up to 90% of patients can have bladder control issues at some point. We find symptoms of overactive bladder such as urgency, frequency, and sometimes associated incontinence. But other patients can have difficulty emptying their bladder and sometimes not be able to urinate at all. Unfortunately, patients often minimize or don't bring up such sensitive topics. And it's really important to bring these issues forward, because there's absolutely help for patients with MS that have bladder control issues.

I typically recommend behavioral modifications as a start. If you're having nighttime problems, you could limit fluid after dinnertime. Certain foods and beverages can affect the bladder and make your symptoms of urgency and frequency worse. I recommend avoiding alcohol, caffeine, diet drinks or artificial sugars, spicy foods, and chocolate. Often patients carry extra pads with them. And many of my patients know where all the bathrooms are when they walk into a certain store because they know they might have to rush to get there in time.

If behavioral modifications don't work, then we will move on to medication. And if that doesn't work, there's other outpatient-based procedures that can provide a lot of relief. Often I recommend pelvic floor physical therapy. Learning to contract certain muscles or relax other muscles can help with their urinary symptoms.

Exercise is really important because weight loss is a huge step in preventing incontinence or improving the incontinence. If patients can lose 5% to 10% of their body weight, it can actually improve their incontinence by 50%. I tell patients, there's certainly hope and that we can treat a lot of their problems to really improve their quality of life.