Key takeaways

  • Myasthenia gravis (MG) or its treatments may lead to urinary symptoms. Studies suggest a link between overactive bladder symptoms and a common MG medication called pyridostigmine.
  • Urinary symptoms in MG may include frequent nighttime urination, urine leakage, and a strong urge to urinate. These symptoms can negatively affect your quality of life.
  • You can manage urinary symptoms through strategies such as changing your diet and urinating at regular intervals. You might also want to talk with your doctor about changing your medication.

Myasthenia gravis (MG) is an autoimmune condition that causes muscle weakness. When you have MG, the neurotransmitter (messenger chemical) acetylcholine cannot properly connect to receptors on your muscles to tell those muscles to contract. You can manage MG with treatments such as medication and surgery.

Bladder problems are more prevalent in people who have MG than in those who do not. But there are steps you can take to reduce your urinary symptoms while living a full life with MG.

The cause of urinary symptoms in MG is not clear. These symptoms may occur either as a result of MG’s effects on your body or as a side effect of MG treatments.

A 2021 study involving 83 people with MG and 50 people without MG found a link between overactive bladder and the medication pyridostigmine. This drug stops the enzyme acetylcholinesterase from breaking down acetylcholine, so there’s more acetylcholine left in your body.

Doctors commonly prescribe pyridostigmine to treat MG. According to a 2020 research review, doses of 180 to 240 milligrams (mg) per day are typical, although some people may take up to 480 mg per day. In the 2021 study mentioned above, people who took 300 mg or more per day had higher scores on a survey of overactive bladder symptoms.

Another 2021 study involving 36 people with MG and 29 without MG found that urinary symptoms were more common in late onset MG. The data showed a correlation between the lack of acetylcholine receptor antibody (a marker of MG) and increased urinary symptoms.

Researchers in another 2021 study involving 21 people with MG suggested that the bladder muscle might become overactive as a result of nerve irritation in MG. They also suggested that bladder underactivity, or difficulty emptying the bladder, in MG be linked to a type of neuropathy (nerve damage) that affects smooth muscles in autoimmune conditions.

MG can also cause weakness in the pelvic floor and the sphincter. These muscles help control bladder and bowel movements. If these muscles are weak, you might have more urinary symptoms.

If you have MG, you might experience urinary symptoms such as:

  • nocturia (getting up at night to pee)
  • incontinence (urine leakage)
  • stress incontinence (peeing as a result of bladder pressure)
  • bladder urgency (a strong need to pee)
  • an increased volume of urine
  • difficulty emptying your bladder

One 2021 study found that people with late onset MG urinated more often during the night and had lower daytime urine volume as compared to those with early onset MG. The same study found that nocturia was the most common urinary symptom among the participants.

Urinary symptoms lead to a worse quality of life for people with MG, according to a 2021 study that compared 21 people with MG and 235 people without MG. Given this impact, the authors noted the importance of managing or relieving bladder symptoms in MG.

You can start taking steps today to reduce urinary symptoms in MG. Here are some strategies that might help:

  • Review your medications: If MG treatments are causing bladder discomfort, you might want to talk with your doctor about taking a lower dose or a different medication.
  • Try to quit smoking if you smoke: Cigarette smoking is linked with greater urgency urinary incontinence among women, according to a 2020 study.
  • Assess your diet: Reducing your consumption of caffeine, alcohol, and acidic foods can help reduce bladder symptoms. Weight loss can help reduce stress incontinence.
  • Try bladder retraining: To overcome urinary urgency, you can try peeing at regular intervals even if you don’t feel like you need to. Over time, you might regain control of your urinary schedule for hours at a time.
  • Strengthen your pelvic floor: Kegels and pelvic floor muscle exercises can help you regain strength in the areas around your bladder. Gentle exercise for your whole body can also often help manage MG symptoms.
  • Use absorbent pads: Using absorbent pads on your bed and under your clothing can help contain urine and make cleanup easier in case of any leaks.
  • Consider medical interventions: Surgery or medication for urinary symptoms might be the right option for you.

You might need to use these strategies for a while before they start to have a positive effect on your urinary symptoms.

You may also want to reach out for support from nonprofit organizations dedicated to bowel and bladder concerns, such as the National Association for Continence and the Urology Care Foundation.

Changes in your urinary patterns can happen frequently when you live with MG. You can help reduce these symptoms through lifestyle changes such as changing your diet, quitting smoking, and trying to urinate at regular intervals.

You can also consider reviewing your MG medication with your doctor. They can help you decide whether you need to update your treatment plan to better support your urinary health.