Bladder Problems and Ataxia: What You Might Experience

If you have ataxia, have you ever noticed that you need to go to the bathroom a lot or really have to go all of a sudden? If so, you are not alone. These are pretty common symptoms for people with Friedreich ataxia. Let’s talk about how ataxia affects the body, why the bladder gets involved, and what medical options there are.

What Is Ataxia?

Ataxia is a general symptom that means poor muscle control. This leads to trouble with movement, such as walking and balance. There are many causes for ataxia. It can be a symptom of a brain-related injury or part of a hereditary condition.

Ataxia

Ataxia typically comes from something that affects a part of the brain called the cerebellum. The cerebellum is an important part of the brain that is responsible for controlling movements such as balance and swallowing. Ataxia can be associated with different conditions and additional symptoms. General ataxia can come from anything that causes damage to the brain. This can include a direct injury, toxins, a stroke, autoimmune diseases, multiple sclerosis, cerebral palsy, or infections. Ataxia can also be part of an inherited condition.

Friedreich Ataxia

Friedreich ataxia is the most common hereditary ataxia. It’s a rare genetic condition that affects the cerebellum, as well as the spinal cord and the nerves that run into the rest of the body. Just like general ataxia, it causes symptoms like uncontrolled movements. Friedreich ataxia can also lead to other health problems, such as heart problems, skeletal abnormalities, diabetes, and changes in the feeling of the arms and legs.

How Does Ataxia Affect the Bladder?

Ataxia affects the body’s nervous system. The nervous system is the signaling system of the body that controls how muscles move and helps to interpret signals to let us know what sensations we feel. Muscle movement and sensation are both important for how the bladder works.

How the Bladder Works

The bladder stores urine until it’s released when someone goes to the bathroom. When the bladder starts to get full, the nerves in your bladder send a signal up to the brain that it’s almost time to go to the bathroom. When you get to the bathroom, the brain then has to send nerve signals to the bladder that it’s time to squeeze and let urine out.

What Happens to the Bladder With Ataxia?

Since ataxia affects the nerves that control our muscles and sensation, changes to how these nerves work can change how well the bladder works. Ataxia slows down the nerve signaling between the bladder and the brain. When the sensory nerves that tell the brain it’s time to go to the bathroom aren’t working well, the bladder can get overfull. Once the brain realizes how full it is, it can trigger urinary urgency, which is a sudden urge to pee.

When the motor nerves from the brain to the bladder aren’t working well, it can make it hard to contract the bladder to go to the bathroom, which leads to trouble starting a urine stream and not being able to fully empty the bladder. Ataxia can also lead to other lower urinary tract symptoms such as urinary frequency (needing to go to the bathroom often), accidents or leaking, and having to go to the bathroom during the night. Around 80 percent of people with Friedreich ataxia report having some or all of these lower urinary tract symptoms.

How Do These Bladder Changes Affect Daily Life?

If your brain and bladder are not communicating well, it can affect your daily life. As mentioned above, you might experience lower urinary tract symptoms. This can make you go to the bathroom more often throughout the day, require you to get up throughout the night to pee, and may require you to change clothes if you have an accident.

The other symptoms of ataxia can also affect your bathroom habits. Since ataxia can affect walking and balance, it can make it physically more difficult to get to the bathroom. It might take you longer to get to the bathroom safely, and you might need to plan ahead for when you need to use it. Other movement patterns, like wiping and getting back up from the toilet, can also become increasingly difficult as the ataxia gets worse. There are some changes you can make to help manage these changes to your bladder function.

Do You Need Treatment?

Friedreich ataxia requires a holistic approach to treatment. It usually requires many members of a medical team to figure out the best treatment options. The bladder changes that happen with all types of ataxia have treatment and management options.

Day-to-Day Changes

Usually, the first step when working on bladder health is to make changes to your lifestyle around your bladder’s function. Since your brain doesn’t always know how full your bladder is, it’s helpful to go to the bathroom at regular intervals or “on a schedule.” This way, you don’t have to rush to the bathroom when you get the urge, which can lead to accidents and potential falls. This may mean that you are taking a trip to the bathroom before you even feel like you have to go.

Once you get to the bathroom, it can be helpful to try to go multiple times. Since the brain-to-bladder connection isn’t working as well, the brain can’t properly signal the bladder how hard to squeeze, and the bladder can’t tell the brain if it still has urine in it. By emptying multiple times, it can help to get as much urine out as you can.

Other tips to help with bladder function are limiting or avoiding certain foods and drinks. Caffeine, alcohol, and spicy foods can all irritate the bladder and cause an increase in lower urinary tract symptoms. It’s helpful to pay attention to which foods and drinks affect your system.

When To Go to a Doctor

Sometimes, even with these daily changes, there are other symptoms that need to be quickly assessed by a doctor. When the lower urinary tract is affected, it can lead to a urinary tract infection. If you notice any pain with urination, worsening of your normal bladder symptoms, blood in your urine, not being able to go to the bathroom, or any other signs of inflammation like a fever or burning sensation, it’s important to go to your doctor to get checked out. Or if you start experiencing new bladder symptoms or symptoms for the first time, it’s also a good idea to head to the doctor for an appointment.

When you go to the doctor, they’ll talk to you about what’s been going on and run some tests. These tests may include:

• Urinalysis, where they’ll take a urine sample and test it for signs of infection
• Bladder scan using an ultrasound to show if you have urine left in your bladder after going to the bathroom
• Cystoscopy, where the doctor will insert a tube with a tiny camera up into the bladder to look at it
• Urodynamic testing that looks at how well your bladder holds onto and lets go of urine
• Imaging, like X-rays or CT scans, to inspect your organs and look for anything that might be wrong

After some or all of these tests, your medical team will chat with you about what they find and which treatments are available to help.

Bladder Treatments

The bladder is a muscle, and the pelvic floor around the bladder is also made of muscles. Treatments that focus on these muscles can help improve how well they work. A type of physical therapy (PT) called pelvic floor therapy can help to improve some of the function of these muscles. PT can also help you refine some of the day-to-day strategies mentioned above to best fit your current level.

If you’re still having bladder troubles, there are some medications that can help to improve bladder function. Catheters are another treatment option. If your bladder isn’t able to work well enough to empty urine, catheters can help to empty your bladder for you. If you have any specific questions about your symptoms or what treatments might be right for you, it’s always best to talk to your doctor.

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