MSA Trust

05. Bladder

Point to note – It is important to put bladder problems into context. Over 50% of over 60 year olds and around 5 million people in the UK have bladder continence issues – it is not often talked about but you are certainly not alone.

Most people by the time they have a diagnosis of MSA may already have significant bladder problems. The social indignity of having accidents and coping with them outside of the safety and privacy of your own home, is a challenge and impacts hugely on quality of life. Keep a small bag with a change of clothes, wipes, soap, towel and any devices e.g. spare catheter or a pad, so you can easily take it out with you.

There is a multitude of intercommunicating nerve pathways within the brain and spine that allow us to develop and maintain comfortable and good control of the bladder. In MSA they can all go awry and produce a complicated picture of bladder problems – the need to go suddenly, feeling you need to go then can’t, needing to go frequently, passing tiny amounts sometimes and large amounts other times, needing to get up frequently in the night etc.

Whatever your bladder problem you won’t be the only person to experience this and the professionals involved in your care will be used to discussing the issues about someone’s bladder problems. So, the first step is to be honest about the problem you are having and how it impacts on you. Any health professional you see who knows about MSA will almost certainly ask you about bladder problems even if you don’t volunteer this information as we know it goes with the MSA territory.

The simplest way to maintain bladder health is to drink plenty – particularly water. Developing a good drinking habit through the day; drinking two litres a day, avoiding too much caffeine-based drinks and limiting intake after 6pm, will all help. The more dilute your urine the less irritating it is to the bladder lining so the feeling of needing to go when you don’t really is reduced. When you do go you are likely to pass more urine and the delicate lining of the bladder stays healthy and more resistant to infection.

Impairment of the nerve co-ordination of the bladder, preventing proper emptying of the bladder, is common in MSA. This can be one of the main reasons why people with MSA are so susceptible to getting urinary tract infections (UTI’s). Insertion of a catheter to drain the bladder often becomes necessary; this may be via intermittent catheterisation, an indwelling catheter via the urethra or a supra-pubic catheter directly through the abdominal wall into the bladder

The thought of needing to use a catheter may seem daunting but actually whichever form of catheterisation is appropriate for you, it is likely to improve your quality of life significantly. You will have some control over when and where you empty your bladder. This will virtually eliminate the risk of accidents for most people. For those minority where the bladder leaks constantly then a catheter is not an option and use of pads is a necessity. Your local continence service, Urologist and Continence Nurse Specialist can support and advise you on the most appropriate bladder management options.

UTI’s are common for people with bladder issues. When people with MSA get an infection, they do not always develop the expected bodily response to deal with an infection. Usually, we would have a higher than normal temperature, experience discomfort passing urine, have lower back pain, the urine may have an unpleasant smell and look darker in colour. However, many people with MSA when they have a UTI do not show all these symptoms – instead they may become confused and all their MSA problems get worse quite quickly with changes in mobility, speech, swallow etc. If this happens you should assume you have a UTI and ask for a sample tested as soon as possible to start antibiotics before you become increasingly unwell. If treated promptly you should be able to avoid the need to go into hospital.

A factsheet about Continence in MSA can be found here –

Key messages

  • Drink plenty – at least 1.5 to 2 litres a day
  • Seek help for any bladder problems
  • Keep an open mind about management options – they may not sound appealing but can be life transforming
  • If you suspect you have a UTI (a sudden change in your MSA symptoms, confusion, sleepy) get a sample tested and get treated quickly
  • People with MSA do not always get a high temperature when they have an infection – your GP may not be aware of this
  • Keep a small bag with a change of clothes, wipes, soap, towel and any devices e.g. spare catheters or pads, that you can easily take out with you.

The MSA Trust is here to support anyone affected by MSA. If you have any questions about the information on this page, please contact us and we will do our best to help you.