Bladder dysfunctions (BL-D) are common in people with multiple sclerosis (pwMS), significantly affecting daily life, infection risk, and survival. Nonetheless, BL-D are frequently stigmatized and inadequately addressed in clinical practice. To date, no comprehensive analysis of BL-D has been conducted in Germany.
To assess the prevalence of BL-D and its subtypes in a German cohort and identify associated factors and treatment patterns.
Data were analyzed from individuals enrolled in the German MS Register, aged ⩾18 with definite MS. Inclusion required ⩾3 visits and complete data on MS onset, diagnosis date, and BL-D status. BL-D were subclassified into urinary urgency, voiding dysfunction, bladder incontinence, and other BL-D. PwMS with different subtypes were compared regarding clinical, sociodemographic, and therapeutic characteristics and associated factors were identified using logistic regression.
The study cohort included 10,572 pwMS (71.7% female) with a mean age of 48.2 years, disease duration of 16.0 years, and median Expanded Disability Status Scale score of 2.0. BL-D was present in 38.0% of pwMS, with urinary urgency being the leading subtype (41.0%). Associations included older age, longer disease duration, progressive disease course, polysymptomatic onset, and receiving disease-modifying therapy. Interestingly, 37.1% of pwMS with BL-D received no bladder treatment, while 36.9% received pharmaceutical and 36.4% non-pharmaceutical bladder treatment.
The results highlight the clinical relevance and burden of BL-D in MS and provide first insights into subtype-specific differences in the German MS population. Providing appropriate BL-D care requires investigation into causal factors and a deeper understanding of the underlying reasons of the treatment gap.
Retrospective, cross-sectional study.
Understanding bladder problems in multiple sclerosis: how common they are, who is affected and how they are treated Bladder problems are common in people with multiple sclerosis (MS) and can strongly affect daily life, independence and overall health. Despite this, these symptoms are often overlooked, stigmatized or not treated accordingly in clinical practice. To better understand how common bladder dysfunctions are, which subtypes occur and which factors are associated with them, data from more than 10,000 people with MS enrolled in the German MS Register were analyzed. Overall, 38% of people with MS had bladder dysfunctions. The most common problem was a sudden and urgent need to urinate. Bladder problems were more likely in people who were older, had lived with MS for a longer time or had a progressive form of the disease. Importantly, we also observed clear differences between the various subtypes of bladder dysfunctions. A key finding was that over one-third of people with bladder problems were not receiving any symptom-related treatment. Pharmaceutical and non‑pharmaceutical treatments were used at similar rates among those who did receive treatment. These results show that bladder problems are a major but often unmet need in MS care. Understanding how common these symptoms are, how they differ between subtypes and how they are currently treated can help improve care pathways and ensure that people with MS receive the support and therapies they need.
Therapeutic advances in neurological disorders. 2026 Jul 25*** epublish ***
Mathia Kirstein, Niklas Frahm, David Ellenberger, Alexander Stahmann, Firas Fneish, Melanie Peters, Friedemann Paul, Clemens Warnke, Kerstin Hellwig, Peter Flachenecker, Klaus Berger, Michaela Mai, Michael Hecker, Uwe K Zettl
German MS Register, MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH), Krausenstr. 50, 30171 Hannover, Germany., German MS Register, MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Project Development gGmbH), Hannover, Germany., Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany., Department of Neurology, University Hospital of Gießen and Marburg, Marburg, Germany., Department of Neurology, St. Josef Hospital, Ruhr University, Bochum, Germany., Neurological Rehabilitation Center Quellenhof, Bad Wildbad, Germany., Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany., Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German Multiple Sclerosis Society), Hannover, Germany., Division of Neuroimmunology, Department of Neurology, Rostock University Medical Center, Rostock, Germany.