Yes, multiple sclerosis causes incontinence, and it’s one of the most common symptoms of the disease. Bladder dysfunction affects at least 8 out of 10 people living with MS, according to the National MS Society. Both urinary and bowel incontinence can develop, though urinary problems are far more frequent. The good news is that several effective treatments exist, from targeted exercises to medications.
Why MS Disrupts Bladder and Bowel Control
Normal bladder function depends on a chain of nerve signals running between your brain, spinal cord, and the muscles that hold and release urine. MS damages the protective coating around nerve fibers in the brain and spinal cord, which slows or scrambles those signals. The result is a communication breakdown: your bladder may contract when it shouldn’t, or the muscles that hold urine in may not respond when they need to.
Where the nerve damage occurs matters. Lesions above the lower spinal cord (roughly the sacral region) tend to create an overactive bladder that contracts too easily, leading to urgency and leakage. Lesions in the lowest part of the spinal cord or the nerves branching out from it can cause the opposite problem: a bladder that becomes sluggish and doesn’t empty properly, leading to overflow. Some people develop both patterns simultaneously, which makes management more complex.
Urinary Incontinence: The Most Common Type
Urge incontinence is the form most people with MS experience. The bladder muscle becomes hyperactive, contracting in response to minimal filling. You feel a sudden, intense need to urinate, and leakage can happen before you reach a bathroom. Alongside urgency, many people notice increased frequency, needing to go far more often than usual, and nocturia, waking multiple times at night.
Urinary retention is less common but still significant. In this case the bladder doesn’t fully empty, leaving residual urine that can eventually overflow. Retention also raises the risk of urinary tract infections, which create their own set of problems for people with MS. Urgency, frequency, and incontinence from the MS itself can look identical to UTI symptoms, making it difficult to tell whether a new infection has developed or whether existing nerve damage is simply causing a flare. A urine culture remains the most reliable way to distinguish between the two.
Bowel Incontinence in MS
Bowel problems are also common, though they receive less attention. Neurogenic bowel dysfunction is one of the earliest symptoms to appear and persists throughout the course of the disease. Estimates of fecal incontinence range from 12% to about 32% of people with MS, depending on how long they’ve had the disease. Constipation is even more widespread, affecting roughly 26% to 49% of patients.
The causes mirror what happens with the bladder. Nerve damage reduces sensation of rectal filling, weakens the anal sphincter muscles, and can impair the ability to voluntarily delay a bowel movement. MS lesions in certain brain regions may also shift the balance of the autonomic nervous system in ways that relax the internal anal sphincter, contributing to leakage. For women with MS who have had difficult vaginal deliveries, pelvic nerve damage from childbirth can compound the effects of central nerve damage.
The emotional toll is substantial. In one study of 218 people with MS and bowel symptoms, 36% reported depression and 28% reported anxiety.
Pelvic Floor Training: A First-Line Treatment
Pelvic floor muscle training is one of the most effective and accessible treatments for MS-related incontinence. A 2023 systematic review confirmed that these exercises significantly reduce both leakage episodes and the severity of overactive bladder symptoms in people with MS. Multiple studies found measurable decreases in pad usage and pad weight after training programs.
The exercises involve contracting and relaxing the muscles you’d use to stop the flow of urine. A typical supervised program might include 30 slow contractions plus several minutes of rapid contractions, performed two to three times daily over 12 weeks. Results improve significantly when training is supervised by a physiotherapist rather than done independently at home. Adding biofeedback, where a device shows you how strongly your muscles are contracting, produces even better outcomes. Some programs also incorporate neuromuscular electrical stimulation, using mild electrical pulses to help activate the pelvic floor muscles, which further boosts results beyond exercise alone.
Medications for Overactive Bladder
When pelvic floor training alone isn’t enough, medications can help calm an overactive bladder. The two main categories work in different ways.
Anticholinergic medications block the chemical signals that trigger involuntary bladder contractions. They’re typically started at a low dose and adjusted based on how you respond. The main drawback is side effects: dry mouth, constipation, and sometimes cognitive fogginess, which can be particularly unwelcome for people already dealing with MS-related fatigue or brain fog.
A newer class of medication works by activating receptors on the bladder muscle that promote relaxation during filling. This approach tends to cause fewer of the drying and cognitive side effects that anticholinergics are known for. For people who get partial relief from one type alone, combining both classes has shown significant improvements in urgency and incontinence episodes compared to either medication on its own.
Bladder Management Strategies
Beyond exercises and medications, practical management techniques make a real difference. Timed voiding, where you urinate on a set schedule rather than waiting for the urge, helps prevent the bladder from overfilling. Double voiding, waiting a moment after urinating and then trying again, helps ensure the bladder empties more completely.
For people with significant retention, clean intermittent self-catheterization is a common and safe approach. It involves passing a thin, sterile tube into the bladder several times a day to drain residual urine. While the idea can feel daunting at first, most people find it becomes routine quickly, and it dramatically reduces UTI risk and overflow leakage.
A consensus pathway for bladder and bowel management in MS, published by the British Journal of Neuroscience Nursing, emphasizes that the entire MS care team should be “bladder aware,” meaning bladder symptoms should be actively asked about and addressed at every stage of the disease rather than waiting for patients to bring them up. If your care team hasn’t asked about bladder or bowel function, raising it yourself is worthwhile.
How Symptoms Change Over Time
Bladder and bowel problems in MS are not static. They can worsen during relapses and partially improve during remissions. Research in animal models of demyelination has shown that when nerve fiber coatings repair themselves, bladder function improves, including better volume sensitivity and more efficient emptying. This suggests that treatments targeting remyelination could eventually help with incontinence, and that current relapse-recovery cycles genuinely affect bladder function, not just other MS symptoms.
Disease duration matters too. In one cohort studied 2 to 5 years after diagnosis, 12% reported fecal incontinence. In a group with an average disease duration of 18 years, that number had risen to nearly 32%. Urinary symptoms follow a similar trajectory. Starting pelvic floor training and management strategies early, before symptoms become severe, gives you the best foundation for maintaining control as the disease progresses.