This Is MS Multiple Sclerosis Community: Knowledge & Support

I am at the end of my tether with a bladder issue and I would really appreciate input from any of you that have struggled with bladder issues.

Basically when I go to the loo before bed, within 30 minutes I feel I need to go again. This is going on until 3am every night. I know there isisn't much there to 'go' with, it's just small volumes, but it bothers me enough to want to go and empty my bladder.

I have taken solifenacin for a week, 5mg in the evening, but it seemed to actually make it worse! - I had to 'go' for longer into the night.

I tried self-catheterisation again last night - a tiny bit came out but within 30 minutes I needed to 'go' again. And again and again.

I am exhausted and I just don't know what to do. I am not sure if it's retention or frequency or just phantom urgency or what?

I try not to drink anything after 7pm in the evening, do not drink caffeine after lunch, don't take green-tea at all, and this problem is something that often occurs at this time of year, for some reason.

Any advice or insights?

_________________
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Concussus Resurgo
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RR-MS dx 1998 and Coeliac dx 2003
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Copaxone, Cymbalta. EPO, Fish Oils, Vitamin D3 2000 IU daily, Cal/Mag/Zinc, Multivitamin/mineral, Co-Enzyme Q10, Probiotics, Milk Thistle.

Things that have worked for me are:
When I go the last time before bed, I lean forward (sitting) and press down / in on my stomach just above my public bone. This allows me to empty a little more. Then, when this is done, I stand up, and press again in on my stomach just above my pubic bone. After all this, I find that if I stand in a doorway, and jump up and down (abt 10-50 times) I manage to get a final empty.

Also, I find that if I am slightly chilled, I have more need to go, so I make sure I am covered enough at night that I don't chill and find I need to go. Just like you, I also limit my intake of fluids before I go to bed.

Since I was once worse, learning what worked for me when I was at my worst means that now that things have improved, I can sleep through the whole night.

Good luck, and I hope some of this helps you, as I know how annoying this can be.

Put a diaper; take sleeping pills and rest few nights.

that sounds so annoying ww. i used to get UTI after UTI when i was younger, any chance of a mild infection ww? do you take any probiotics at all? (that's what fixed my recurrent infections)
other than that, what is your caffeine intake like? coffee? pop? any other diuretics?

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my approach: no meds so far - just balanced whole foods (partial 'paleo', much less outright elimination), science, supplements, & bloodwork
my regimen - www.thisisms.com/ftopict-2489.html
www.whfoods.com, www.nutritiondata.com

http://www.suite101.com/content/urinary ... ncy-a68206
Urinary Frequency
Diabetes, UTIs Not the Only Causes of Frequent Urination


you're already taking magnesium aren't you ww? the spasm thing always red flags magnesium with me..

_________________
my approach: no meds so far - just balanced whole foods (partial 'paleo', much less outright elimination), science, supplements, & bloodwork
my regimen - www.thisisms.com/ftopict-2489.html
www.whfoods.com, www.nutritiondata.com

Thanks Cure, Algis and JL - really glad to hear from you all.

Cure I am definitely going to try your routine this evening, warned my husband about the jumping up and down in the loo so he won't think I've completely lost it it's worth a try and hopefully it will help a bit. Thanks.

Algis - I tell u I am not far from racing back to the GP and roaring 'give me some sleepers now!' - I may yet do that if Cure's routine doesn't work tonight. It's a vicious circle - the less sleep I get the worse my symptoms are....arrghh!

Jimmy my GP checked me for an infection the time before this bout, but I think you're right, it's worth checking again. When I go to see him later this week I'll get him to check infection for definite. This is an annual or twice annual symptom though - I'd nearly like it to be a UTI because it would be fixable but in the past it has never been GP has also checked me for diabetes - no sign of it. I'll ask GP about the others - interstitial cystitis etc. Thanks for the article.
Ha, well my x2 mugs of coffee for breakfast are non-negotiable!! They make no difference to the night time thing tbh, because most of the time this problem does not happen. I just drink water or decaffeinated tea at lunch. No green tea anymore, no fizzy drinks or cola etc. Just juice, milk, or water after lunch. Magnesium I take every day so it's not that. Thanks for the info. x

_________________
~~~~~~~~~~~~~~~
Concussus Resurgo
~~~~~~~~~~~~~~~
RR-MS dx 1998 and Coeliac dx 2003
~~~~~~~~~~~~~~~
Copaxone, Cymbalta. EPO, Fish Oils, Vitamin D3 2000 IU daily, Cal/Mag/Zinc, Multivitamin/mineral, Co-Enzyme Q10, Probiotics, Milk Thistle.

Hi WW,
FWIW:
I was told NOT to press on the stomach or above the pelvic bone or even bending forward, as this first sends the urine back up the tubes to the kidneys, before it comes back down to give a little pressure to help with retention or hesitation.

If you have any germs in your bladder you are forcing them up to the kidneys and you can get a kidney infection which is worse than just a bladder infection.

Kidney and bladder stones, even tiny sand size ones, can make you have the constant urge to urinate too. Small retention under 20 to 30 ccs shouldn't keep giving you the urge to empty. Not much pressure in that amount.

I used to get that problem frequency, hesitation, and retention so I had many renal scans, ultrasound of bladder and kidneys, full and empty and Urodynamics too.

I drink plenty of fluids even up to bedtime. The more fluids the more germs get washed out. I also gave myself a sit every two hours. I am female, but men should sit too when they can, as it takes the pressure off the Prostrate gland when they sit once in a while, unless they can't stand at all then sitting is the only option.

Salt retains fluid, lack of potassium retains fluid, some medication retain fluid, even Blood pressure meds like calcium channels blockers make you retain.

So drinking plenty of fluids during the day and evening is beneficial to good bladder health. If your brain does not get the message you have to go, or if you can't make it fast enough to the bathroom, then think spasticity. The bladder spasms, and Magnesium is good for some muscles (like legs, feet, etc. ) and perhaps the bowel to go (like Milk of Magnesia [same stuff] ), but Magnesium may not help the bladder.

Have you been to a Urologist or a Nephrologists' office? Have you had Urodynamics testing? That Neurogenic bladder is so common in MS and other Neurological diseases. Besides meds, they have techniques and charting you can do, also a way of you measuring your in-take and out-put of fluids, with a toilet, plastic hat. You put it on the bowl and it measures. They give it to you with a chart to see if you are correct, with electrolytes too.

Just some thoughts on this. I've had MS about 30 years, I also have my antiquated nursing career that I still remember, before I switched (thank you MS, NOT) to a financial career. I don't know you or much about what testing or problems you have or the others on here, so I thought I'd just throw in some ideas if you don't mind.
CD

ah i see that you ARE on probiotics so that's good.. your regimen looks fantastic.. i'm looking at the cal/mag/zn thing though, and pondering whether you're getting enough magnesium absorption out of that combo pill.. how many mgs of cal mag and zn are there in each of those pills? and what form is the magnesium? AND, do you eat lots of high magnesium foods? ok i'm done now

_________________
my approach: no meds so far - just balanced whole foods (partial 'paleo', much less outright elimination), science, supplements, & bloodwork
my regimen - www.thisisms.com/ftopict-2489.html
www.whfoods.com, www.nutritiondata.com

I agree with jimmylegs. It sounds like bladder spasms (allowing there's no infection). Increase magnesium. If you take magnesium in the a.m., take more before bedtime. Magnesium glycinate at bedtime would be the best.

~^..^~

Do you know how much WW takes of Magnesium? An increase could cause diarrhea. It's a laxative at high dosages. "Milk of Magnesia" or too many tablets, same thing.
CD

we haven't heard back yet, cd!

also, as for the laxative side effect, it depends what form. REALLY laxative forms like mag oxide.. slightly better ones like mag citrate, ya they'll give you the runs. mag glycinate is a little easier on the system!

timing of mag supps wrt vit d3 intake is another factor affecting absorption.

need more info!

_________________
my approach: no meds so far - just balanced whole foods (partial 'paleo', much less outright elimination), science, supplements, & bloodwork
my regimen - www.thisisms.com/ftopict-2489.html
www.whfoods.com, www.nutritiondata.com

The bladder is the bane of my existence! I struggle mightily with it. I would say if you are getting very little out with a cath, then you may not be inserting it far enough? If you empty your bladder with a cath, you should absolutely not have to go in a 1/2 hour. Have you had your kidneys checked?

One thing that someone told me long ago works well too. When you drink a glass of water, don't sip it over an hour or so. Slam it. I don't mean chug, chug, just drink it faster. It seems to make my 'voids' bigger. I drink more than the full amount during the day, but then I cut off fluids at 8:00 for a 10:30 bedtime. Then I cath before bed and don't have to pee until about 4:00 or so. If you truly are emptying your bladder with the cath, something is wrong that you have enough to go in a 1/2 hour.

On the other hand, you could also possibly have the most overactive bladder muscle there is. If that's the case, check with a urologist for an anticholinergic. I would also get a bladder ultrasound pre and post cath session to make sure you are emptying with your cath.

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http://myhopefuljourneyintoactualmsreco ... ogspot.com

Hey just checking back in today. Well, I slept mostly last night at long last apart from one wake-up - I feel slightly more sane today. But I have to hold up my hands and say that in complete desperation I drank a half a bottle of wine (it's been a while!) before bed because I started getting cramps in my shoulders and back and I was just completely sick of this night-time bladder nonsense and pain. It worked - but before you all think I've a problem it's not a solution I'll be trying every night!

CD - I will ask the GP about kidney stones alright, just to see. That's the volume that is coming out though, that's why I am so frustrated it's because I'm having to void such small amounts.
Yes I have had a full exam and urodynamics testing - all normal - - they tested me when I was fine, so that was a wasted exercise. My neuro did get a ultrasound done of my bladder and it showed retention at that time. The neuro clinic is currently under extreme pressure and I don't think I'll get assessed before this bout passes as it's a public, not private clinic.

Cure I tried the pushing and jumping - it did work! Yay! CD I know you said it could push urine up to the kidneys but I'm in desperation here......Cure I will try it again tonight.


JL in my multi I'm not sure of the form of the mag but it only contains 100mg mag & 162mg Cal. Then later I take 3000IU Vit D3 along with a 250mg Magnesium oxide tablet (it also contains mag stearate as an anti-caking agent), then at bedtime I take a Cal/Mag tablet with 500mg Cal/250mg Mag Oxide & Gluconate. In the past I've added another Mag tablet (250mg) but then I do get the runs so what I'm on seems to be the upper limit of what I can get away with. I take 4 high-dose probiotic tablets too at bedtime.
Whaddya think?

Loobie sorry to hear your bladder is also the bane of your existance. I was wondering about the cath - I've tried putting it in as far as it goes - no good- now I'm wondering if it's the angle - maybe I'm missing a 'pocket' of urine. No - haven't had kidneys checked, it's worth asking my GP as I'm going at the end of the week. I agree - and I'm talking about 'going' with only a very tiny amount too - it's as if my bladder cannot tolerate the feeling of storing ANY urine at nighttime. During the day I ignore the feeling and it's much less of a problem. Yes I suspect that I do own the most overactive bladder in the universe. One night about 7 years ago I counted 28 visits to the loo after 9pm. I think the pre/post-cath session is what's needed - I need to visit the neurology clinic for that I don't think my GP has this equipment.
The thing is Loobie I'm on 25mg amitriptyline for nerve pain already, it's got anticholingeric properties that normallykeep the evil bladder under partial control. It's when a relapse hits me then it just goes crazy adn then by the time I get an appt to see someone, the problem has always gone away! I took a week of solifenacin too and it didn't help.

Thank you all for your replies. Hopefully I will sleep a bit better tonight again. x

_________________
~~~~~~~~~~~~~~~
Concussus Resurgo
~~~~~~~~~~~~~~~
RR-MS dx 1998 and Coeliac dx 2003
~~~~~~~~~~~~~~~
Copaxone, Cymbalta. EPO, Fish Oils, Vitamin D3 2000 IU daily, Cal/Mag/Zinc, Multivitamin/mineral, Co-Enzyme Q10, Probiotics, Milk Thistle.

hi WW glad you had a better sleep last night!

ok so total daily magnesium..
100 mg mag - in multi, likely oxide
250mg mag oxide - with vit d3
cal 500/mag (oxide and gluconate) 250 mg - at bedtime

so my first thought is on combinations, timing and competition. i'm looking at when cal and mag go in relative to D3, to each other, and relative to bed time.

with what you have in the cupboard now, you could try switching it up and taking the cal/mag blend with the vit D3, and the 250mg mag oxide at bedtime. (with calcium to magnesium 2:1 going into you at bedtime, you are just asking your muscles to contract.. bladder, shoulders, back..)

AND, by taking your only isolated magnesium at the same time as D3, your body isn't getting any chance at magnesium absorption, without serious competition from other stuff.

now to forms: magnesium oxide is one of the least soluble forms and therefore most likely to give folks the runs, and the hardest to absorb.

you *could* think about trying magnesium glycinate (glycine is also useful to ms patients per klenner protocol, see below) or transdermal magnesium chloride oil. or a plain old epsoim salts bath, carefully following package directions, before bed.

overall, just make sure you get some mag into you when it's not going up against d3 OR calcium. and no calcium at bedtime!

studies:
http://www.ncbi.nlm.nih.gov/pubmed/11794633.
Bioavailability of US commercial magnesium preparations.
Abstract


http://www.jacn.org/cgi/content/abstract/9/1/48
Magnesium bioavailability from magnesium citrate and magnesium oxide


http://www.medlit.ru/medeng/ver/ver10e0229.htm
Comparative study of magnesium salts bioavailability in rats fed a magnesium-deficient diet


http://www.townsendletter.com/Klenner/klenner4.htm

(aside: and of course your body requires adequate zinc in order for your liver to convert ammonia to urea)

hope that helps WW!

_________________
my approach: no meds so far - just balanced whole foods (partial 'paleo', much less outright elimination), science, supplements, & bloodwork
my regimen - www.thisisms.com/ftopict-2489.html
www.whfoods.com, www.nutritiondata.com

Hi WW

Indeed, hopefully you did sleep better last night.

I can't comment directly on bladder issues as thus far I've managed not to have any (knock on wood). However, I did see this on Pub Med today, and since its research in the UK I thought I'd throw it out here.

Long-Term Effect on Quality of Life of Repeat Detrusor Injections of Botulinum Neurotoxin-A for Detrusor Overactivity in Patients With Multiple Sclerosis

Definitely hope you find something that works.

Take care

Sharon