Bowel and Bladder Problems

Neuromyelitis optica spectrum disorder (NMOSD) can affect the nerves of the spinal cord. This can lead to issues with bladder and bowel function. If you experience this, you are not alone.¹

Bowel and bladder problems that occur as a result of NMOSD can be challenging. Bowel and bladder accidents can be embarrassing and impact your social and emotional life. But with planning and some modifications, you can live an active, productive, and social life.¹

What causes bladder and bowel problems with NMO?

Nerve fibers in your brain, spinal cord, and eye have a protective coating called myelin. When this coating is damaged, it is called demyelination. NMO, among other diseases, causes demyelination. It attacks the myelin coating on nerve fibers.^2,3

When myelin is damaged, nerve signals can slow or stop. In the spinal cord, damaged myelin leads to a condition called transverse myelitis.^2,3

What is transverse myelitis?

Transverse myelitis occurs when inflammation damages the spinal cord. Transverse myelitis can also be called spinal cord lesions. The condition can cause muscle weakness, paralysis, or pain. It may also lead to bladder and bowel problems.^4,5

Bladder and bowel symptoms from NMOSD are officially called neurogenic bladder and bowel. Bladder and bowel symptoms of transverse myelitis may include:^1,4,5

• Constipation
• Unintentional passage of stool (bowel incontinence) – this is rarer than constipation.
• Frequent need to pee (urinary frequency)
• Needing to pee suddenly (urinary urgency)
• Leaking or being unable to hold pee in the bladder (urinary incontinence)

Neurogenic bladder

Your urinary system is a network of nerves and muscles that work with your brain and spinal cord. Under normal conditions, the brain, bladder, and spinal cord coordinate the holding and release of urine.^1,4

In people with NMOSD, demyelination may damage the nerves that send signals from the brain and spine to the bladder. This can cause neurogenic bladder, which can lead to dysfunction in a couple of ways:^1,4

• Overactive bladder happens when the bladder squeezes before it is really full. This leads to urinary frequency. Over time, it can lead to urinary incontinence.
• Underactive bladder happens when the bladder will not release urine when it is full. Over time, this can lead to infection or kidney damage.

Neurogenic bowel

Similar to your bladder, your bowels work together with the muscles and nerves around your rectum and anus. Damage to these nerves can cause loss of bowel control.^1,5

Normally, your brain sends signals to your digestive tract to keep your bowels moving properly. This process is part of digestion and is not voluntary. That means your body does it without you thinking about it.^1,5

When nerves are damaged in diseases like NMOSD, these signals can become blocked. This leads to less movement of your gut, causing constipation.^1,5

Nerve damage can also change the normal feeling you have when it is time to have a bowel movement. This damage can make it hard to control the muscles in the digestive tract (sphincters) that allow you to control your bowel movements. This may lead to bowel incontinence.^1,5

Treatment

There are actions you can take to help better control your bladder and bowel. A good first step is to develop a bladder and bowel plan. This plan can address diet, urinary incontinence, and bowel problems.¹

For example, adjusting your fluid intake can help manage urination and bowel movements. Spread fluids out throughout an entire day. Try not to drink large amounts at once.¹

There are many treatments that can prevent bladder accidents. For example, medicines that relax the bladder can help decrease urinary frequency. Medicines that can help treat urinary incontinence include:^1,6-8

• Anticholinergics – These drugs help reduce involuntary bladder contractions.
• Alpha-blockers – These drugs relax muscles around the bladder to make it easier to pee.
• Bethanechol – This drug helps the bladder muscles contract so the bladder empties completely.

Other ways to treat urinary incontinence include:^1,6,7

• Intermittent self-catheterization – In this procedure, you insert a small tube called a catheter into your bladder. It empties your urine, and you remove it when you are finished. You do this at regular times during the day.
• Neuromodulation – This procedure uses electrical stimulation to regulate your nerve activity.
• Rehabilitation – This often includes physical therapy focused on the pelvic floor.
• Botulinum toxin (BOTOX®) injections – These injections can calm an overactive bladder.

To treat constipation and bowel incontinence on your own:^1,5

• Eating more fiber or taking a fiber supplement can help achieve proper stool consistency.
• Exercise and an active lifestyle can help improve digestion.
• Abdominal massage may help to move the bowels.

Other treatment for constipation may include:^1,5

• Laxatives
• Suppositories or enemas
• Manual removal of stool

Bowel and bladder problems can be very challenging. But working with your doctor and listening to your body can help you manage their impact.¹