UTIs and MS: How to Prevent This All-Too-Common Problem
Why are people with MS prone to UTIs? And how can you prevent more of them? Find the answers here.
By David Spero, RN
Medically Reviewed by Samuel Mackenzie, MD, PhD
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People with multiple sclerosis (MS) have far more frequent urinary tract infections (UTIs) than the general population. And when they occur, they can be more serious, harder to treat, and even life-threatening.
A UTI is caused by bacteria growing anywhere along the urinary tract — the path that urine takes through the body.
The urinary tract is made up of several structures:
- The kidneys, where urine is made
- The ureters, tubes that take urine from the kidneys to the bladder
- The bladder, where urine is stored
- The urethra, the tube that takes urine from the bladder out of the body
Symptoms of UTIs
Most UTIs are bladder infections. Typical symptoms of a bladder infection include a burning feeling when you urinate, the need to urinate frequently, and urinating only small amounts when you go. The urine itself may become cloudy or dark.
Some people develop urinary incontinence — or the inability to hold their urine — during a bladder infection.
In people with multiple sclerosis, UTIs may go unnoticed or unrecognized because the common symptoms — discomfort, urinary frequency, and releasing only small amounts of urine — can exist even without an infection.
What a person with MS may notice instead is a worsening of MS symptoms (called a pseudoexacerbation), severe fatigue, fever, a general feeling of illness, or mental changes.
Because these are atypical symptoms for a UTI, says Antonio Otero, MD, a urologist at Kaiser Permanente in San Francisco, a first UTI in a person with MS may be hard to diagnose.
“After that,” Dr. Otero says, “when they have symptoms they’ve had before and that turned out to be a UTI, we can do urine tests to see what is happening.”
Why Do People With MS Get Frequent UTIs?
According to the National Multiple Sclerosis Society (NMSS), at least 80 percent of people with MS have some bladder dysfunction. The problem may be difficulty emptying the bladder completely, or it may be difficulty holding a normal amount of urine in the bladder.
Several muscles have to work together for the bladder to function properly. A sphincter muscle at the top of the urethra contracts to keep urine in the bladder, or releases to allow it out. Another sphincter at the external end of the urethra also either contracts to keep urine inside the body or releases to allow it out. When it’s time to urinate, the bladder muscles push urine out of the bladder.
MS lesions that block or delay transmission of the nerve signals that control the bladder and the urinary sphincters can interfere with that coordination.
If urine pools in the bladder instead of being eliminated, it creates a “stagnant pond” effect. Infections can easily grow where urine is just sitting instead of flowing.
Complicating matters further, “Some MS treatments, such as steroid drugs, weaken the immune system and make it harder to fight infections,” says Otero. And “sometimes nerve damage leads to urine being pushed the wrong way, back toward the kidney. This ‘reflux’ can damage the kidney or spread infection from the bladder to the kidney.”
It’s important to get a UTI treated while it’s still in the bladder, because if it gets into the kidneys, it can lead to serious complications, including a blood infection.
The symptoms of kidney infection include fever, chills, and flank pain — pain in the upper back, sides, or abdomen.
A blood infection is particularly dangerous because it can lead to sepsis, a life-threatening, body-wide response to infection. Signs of sepsis include a high fever, fast heart rate, and fast breathing rate.
UTIs are treated with antibiotics, but over time bacteria become resistant and infections become harder to treat. So it’s important to prevent UTIs when possible.
Tips for Preventing UTIs
Elizabeth Crabtree-Hartman, MD, neurologist and MS specialist at the University of California in San Francisco, has several recommendations for reducing urinary tract infections.
- To keep urine flowing, Dr. Crabtree-Hartman says, keep drinking liquids. There is mixed evidence about whether some types of drinks are better than others for preventing UTIs, though most experts agree that carbonated sodas and sweetened juices should be avoided.
- “Clean up after sex,” says Crabtree-Hartman. “Ideally, women should urinate after sex, followed by washing with a warm washcloth. Keep wipes by the bed if you don’t want to get up.”
- Always wipe yourself from front to back after using the toilet or when bathing, to avoid bringing germs from the anal area toward your urethra.
- Bowel health and bladder health go together. A full bowel presses on your bladder, so it can hold less urine and has more trouble emptying. “Eat lots of vegetables to promote good bowel function,” says Crabtree-Hartman. “Consider taking magnesium citrate at bedtime to promote a bowel movement in the morning.”
A few more tips from the NMSS and others include:
- Make frequent bathroom stops when you’re away from home.
- Don’t let fear of incontinence stop you from hydrating. Instead, have a plan for accidents: Carry wipes, pads, and a change of underwear.
- Avoid tight underwear and jeans, which encourage germ growth. Wearing cotton underwear rather than synthetics may help.
- If you've had recurrent UTIs, ask your doctor whether you might benefit from taking a medication such as methenamine (Hiprex, Urex) to prevent further infections.
Improving Your Bladder Function
The more completely your bladder empties, the less stagnant urine will be left to become infected. These tips can help you empty your bladder:
Relax.Anxiety can make it harder to start urinating and to fully empty your bladder. If this is a problem for you, look for ways to relax, perhaps by doing some breathing exercises or by reading on the toilet.
Go more than once.After emptying your bladder, get up and move around for a minute or so, then try to urinate again.
Squeeze your abdominal muscles. Pull in your stomach to press the bladder and help push urine out. Or use both hands, lean forward, and press firmly on the lower abdomen between the belly button and the pubic bone.
Taking in a deep breath may also help to compress the bladder, as may crossing one foot over the other thigh and pulling it toward you.
Do pelvic floor exercises.Also known as Kegels, these exercises are commonly done to control urinary incontinence but may be helpful for other bladder problems, too.
Using a Catheter to Empty Your Bladder
A catheter is a narrow tube inserted into the bladder through the urethra to drain urine. Self-catheterization is often the best way to get urine moving when the bladder is disabled.
But some people don’t like to self-cath, and some are physically unable. Catheterizing can also pull germs from the urethra or hands up into the bladder and cause infection.
You will have to talk with your doctor about this option and decide if it’s right for you.
Video: How can MSers avoid UTIs?
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