Overactive bladder, characterized by frequent and sudden urges to urinate that may be difficult to control, is one of the most common symptoms of MS1. The following are some researched and/or tried-and-true tips for management:

• In a small group of MS patients with bladder dysfunction, electroacupuncture once a week for 10 weeks was associated with improvement: the average urge frequency decreased by more than 50%, from nearly four to less than two times per day, and the average number of daytime leaking episodes declined from more than once to nearly none per day 2.
• Pumpkin (Cucurbita pepo or Cucurbita maxima) is an edible fruit found in the American and European continents and grown in Asia and Africa. The oil from the seed is a rich source of vitamins, linoleic acid, oleic acid, and micronutrients, and has been used for the treatment of urinary disorders 3 including overactive bladder and related symptoms from prostate issues 4. In an uncontrolled clinical study, 45 adults with overactive bladder were given 10 g/day of pumpkin seed oil. Six and 12 weeks after the first treatment, the total Overactive Bladder Symptom Score (OABSS) was significantly improved compared to pre-treatment, as were the scores on all parts of the scoring questionnaire (daytime frequency, nighttime frequency, urgency, and urgency incontinence) 5.
• Dandelion (Taraxacum spp.) is considered in traditional medicine to have a beneficial effect on the bladder 6,7. The root is believed to have a strengthening effect, with potential benefit against both overactive bladder and/or incontinence 8. It is recommended to be consumed as a tea twice a day.
• The traditional Chinese medicine gosha-jinki-gan has been successfully used for urinary disturbances such as overactive bladder 9,10. An animal model of MS showed it to alleviate inflammation of the nervous system 11. It composed of Rehmanniae radix, Achyranthis radix, Corni fructus , Moutan cortex , Alismatis rhizome , Dioscorea rhizome , Plantaginis semen , Hoelen , processed Aconiti tuber, and Cinnamomi cortex 9.
• The traditional Chinese medicine hachi mi jio gan has been shown to have a relaxant effect on bladder muscle contraction 12. It is composed of Rehamanniae radix, Cori frunctus, Dioscorea rhizome, Alismalis rhizome, Hoelen, Moutan cortex, Aconitii tuber, and Cinnamomi corte.
• Additional herbs suggested in traditional medicinal practices around the world to be helpful include the following 9:
  • Buchu (Barosma betuline)
  • Chili pepper (Capsicum spp.)
  • Cleavers (Galium aparine)
  • Cornsilk (Zea mays)
  • Ganoderma lucidum
  • Horsetail (Equisetum spp.)
• In addition, in cases over overactive bladder and/or incontinence, it is recommended to avoid caffeine-containing beverages, such as coffees, teas, colas, and energy drinks. These are “diuretic,” meaning they pull fluids out of the body and increase urination frequency.

MS patients may also experience urinary retention (incomplete or lack of urination), which is a major risk factor for urinary tract infections. Many affected individuals may retain urine as a result of “neurogenic” (underactive) bladder from weak muscles or poor neural signaling from the brain, and/or bladder outlet obstruction from disordered local muscle contraction, the latter occurring in approximately half of studied MS patients13. When experiencing urinary retention symptoms, it is important to talk with a healthcare professional, they can cause serious health problems if left untreated. Urinary retention is not always preventable, but steps can be taken to help lower the chances of developing it, as well as manage symptoms if they do occur.

• Manage medications: Certain drugs interfere with nerve signals to the bladder or other key parts of the urinary tract, which can cause urinary retention. Medications with these side effects include decongestants, antihistamines, antidepressants, anti-inflammatory drugs, and opioids. Discuss with your healthcare provider if there is a way to avoid using them if relevant.
• Physical therapy: Physical therapy is one of the most non-invasive urinary retention remedies that both men and women can benefit from. Pelvic floor exercises, also known as Kegel exercises, are an effective way to strengthen pelvic floor muscles, which can improve the bladder function.
• Bladder training: Urinating at specific times can help prevent the bladder from becoming too full. To make sure the bladder is completely empty, wait a short amount of time after urinating before trying to go again. When using the bathroom, it is also helpful to take extra time to relax the local muscles and empty the bladder.
• Dietary modification: Constipation is another cause of urinary retention that can be prevented by making simple diet and lifestyle modifications, particularly consuming enough fiber and water and getting regular physical activity14.
• Warm bath: A warm bath can help relax the lower urinary tract muscles or pelvic floor muscles, which may help strengthen a weak urine stream.
• Dandelion: Dandelion is a wild herb known for its anti-inflammatory properties, used to treat bladder inflammation as well as retention. It has been found to be a diuretic, with potential benefits against urinary retention6. It is recommended to be consumed as a tea twice a day.
• Peppermint oil: The vapors from peppermint oil may help to treat bladder issues. In a clinical study, relief was observed with placement of an adhesive patch infused with peppermint essential oil on the patient’s gown 15. Another suggested method is to place a few drops of peppermint oil into the toilet water and allow the vapor from the oil to contact the perineum. Do not apply essential oils directly to the skin without first diluting.
• Stinging nettle (Urtica dioica): The root of the stinging nettle plant has been observed to help provide relief from the symptoms of urinary retention16,17. It is recommended to be consumed as a tea three times a day, or as pills or extracts per recommendations of an alternative healthcare professional. Side effects to be aware of include allergy and stomachache 18.
• Avoid irritants: Caffeine and alcohol are irritants of the bladder that can severely alter the flow and quantity of urine. If related problems exist, those beverages should be abandoned.
• Remember to drink plenty of water. Despite it sounding counterintuitive, dilution of bladder content is key to preventing urinary tract infections.
• Seek emergency care immediately if urination stops completely or there is lower abdominal pain – these are very serious symptoms and can be life-threatening if not treated as soon as possible.

Bladder symptoms (including involuntary urination and urinary retention) have also been helped by the homeopathic therapy causticum in a 6C or 30C potency. For those who perform self-catheterization to pass urine, a dose of Staphysagria 6C daily or with each catheterization can aid expulsion of urine and make it a more comfortable experience. The remedy Secale (a dilution of the organism Secale cornutum) may also provide a regulating benefit to those who never feel they are quite emptying the bladder 19. References 1. Fingerman JS, Finkelstein LH. The overactive bladder in multiple sclerosis. J Am Osteopath Assoc. Mar 2000;100(3 Suppl):S9-12. 2. Tjon Eng Soe SH, Kopsky DJ, Jongen PJ, de Vet HC, Oei-Tan CL. Multiple sclerosis patients with bladder dysfunction have decreased symptoms after electro-acupuncture. Mult Scler. Nov 2009;15(11):1376-7. doi:10.1177/1352458509107020 3. Friederich M, Theurer C, Schiebel-Schlosser G. [Prosta Fink Forte capsules in the treatment of benign prostatic hyperplasia. Multicentric surveillance study in 2245 patients]. Forsch Komplementarmed Klass Naturheilkd. Aug 2000;7(4):200-4. Prosta Fink Forte -kapseln in der behandlung der benignen prostatahyperplasie. Eine multizentrische Anwendungsbeobachtung an 2245 patienten]. doi:10.1159/000021344 4. Vahlensieck W, Jr., Fabricius PG, Hell U. [Drug therapy of benign prostatic hyperplasia]. Fortschr Med. Nov 10 1996;114(31):407-11. Medikamentose Therapie der benignen Prostatahyperplasie. 5. Nishimura M, Ohkawara T, Sato H, Takeda H, Nishihira J. Pumpkin Seed Oil Extracted From Cucurbita maxima Improves Urinary Disorder in Human Overactive Bladder. J Tradit Complement Med. Jan 2014;4(1):72-4. doi:10.4103/2225-4110.124355 6. Clare BA, Conroy RS, Spelman K. The diuretic effect in human subjects of an extract of Taraxacum officinale folium over a single day. J Altern Complement Med. Aug 2009;15(8):929-34. doi:10.1089/acm.2008.0152 7. Lis B, Jedrejek D, Stochmal A, Olas B. Assessment of effects of phenolic fractions from leaves and petals of dandelion in selected components of hemostasis. Food Res Int. May 2018;107:605-612. doi:10.1016/j.foodres.2018.03.012 8. Baksu A. Natural and Alternative Treatment Methods for Incontinence. Accessed August 23, 2024, https://alparslanbaksu.com.tr/en/inkontinans-icin-dogal-ve-alternatif-tedavi-yontemleri 9. Chughtai B, Kavaler E, Lee R, Te A, Kaplan SA, Lowe F. Use of herbal supplements for overactive bladder. Rev Urol. 2013;15(3):93-6. 10. Ogushi T, Takahashi S. Effect of Chinese herbal medicine on overactive bladder. Hinyokika Kiyo. Dec 2007;53(12):857-62. 11. Jiang S, Baba K, Okuno T, et al. Go-sha-jinki-Gan Alleviates Inflammation in Neurological Disorders via p38-TNF Signaling in the Central Nervous System. Neurotherapeutics. Jan 2021;18(1):460-473. doi:10.1007/s13311-020-00948-w 12. Ito Y, Seki M, Nishioka Y, et al. Pharmacological effects of Hachi-mi-jio-gan extract (Harncare) on the contractile response and on pharmacologically relevant receptors in the rat bladder. Yakugaku Zasshi. Aug 2009;129(8):957-64. doi:10.1248/yakushi.129.957 13. Stoffel JT. Chronic Urinary Retention in Multiple Sclerosis Patients: Physiology, Systematic Review of Urodynamic Data, and Recommendations for Care. Urol Clin North Am. Aug 2017;44(3):429-439. doi:10.1016/j.ucl.2017.04.009 14. Coggrave M, Norton C, Cody JD. Management of faecal incontinence and constipation in adults with central neurological diseases. Cochrane Database Syst Rev. Jan 13 2014;2014(1):CD002115. doi:10.1002/14651858.CD002115.pub5 15. Fryatt J, Bell P. Effect of Peppermint Oil On Postoperative Urinary Retention. J Pediatr Nurs. Mar – Apr 2020;51:116-118. doi:10.1016/j.pedn.2020.01.001 16. Ghorbanibirgani A, Khalili A, Zamani L. The efficacy of stinging nettle (urtica dioica) in patients with benign prostatic hyperplasia: a randomized double-blind study in 100 patients. Iran Red Crescent Med J. Jan 2013;15(1):9-10. doi:10.5812/ircmj.2386 17. Khalafi-Kheydani A, Mahmoodi, H., Sadat, Z., Azizi-Fini, I. The effect of nettle root extract on urinary problems in older men with benign prostatic hyperplasia: A randomized clinical trial. J Herb Med. 2022;34 18. Kharchoufa L, Bouhrim M, Bencheikh N, et al. Potential Toxicity of Medicinal Plants Inventoried in Northeastern Morocco: An Ethnobotanical Approach. Plants (Basel). May 31 2021;10(6)doi:10.3390/plants10061108 19. Whitmarsh TE. Homeopathy in multiple sclerosis. Complement Ther Nurs Midwifery. Feb 2003;9(1):5-9. doi:10.1016/S1353-6117(02)00105-1