Urinary tract infections (UTIs) are common both in MS and the general population. They are also known as water infections or are covered by the general term cystitis. Treatment is with a course of appropriate antibiotics.
UTIs can be uncomfortable or painful but a simple test of a urine sample will identify any infection present.
It is important to find out if you have a urinary tract infection as it can make MS symptoms such as spasticity or thinking problems worse and may trigger an MS relapse if left untreated.
What is a urinary tract infection?
The urinary tract is the body’s system for removing waste and getting rid of extra water. The kidneys filter the blood to collect waste products and create urine, ureters (tubes) take urine from the kidneys to the bladder where it is stored until the time is right to empty via the urethra (the tube through which urine leaves the body).
A urinary tract infection develops when part of the urinary tract becomes infected, usually by bacteria. The bacteria can enter the urinary tract through the urethra or, more rarely, through the bloodstream.
Symptoms of a urinary tract infection include:
- frequent urge to urinate
- painful or burning sensation when urinating
- feeling generally tired or washed out
- painful bladder or abdomen even when not urinating
- passing a small amount of urine, even though there is an urge to pass more
- milky or cloudy urine that may smell more strongly than usual.
Most people experience some or all of these symptoms if they have a urinary tract infection.
Symptoms of a UTI can be confused with other MS symptoms such as fatigue or existing bladder problems. It is important to have your urine checked for infection if you are feeling generally unwell or experience a worsening of existing symptoms. If there is a flare up of your MS symptoms and you suspect a relapse, your urine is likely to be checked to rule out infection as the cause.
Urine infections are straightforward to treat but if left untreated they can be a trigger for spasticity or cause a relapse. Where MS is very advanced, urinary tract infections may lead to sepsis, where the infection spreads from the urinary tract to other parts of the body causing the immune system to go into overdrive, and this may be life threatening.
What causes urinary tract infections?
A common cause of urinary infections in MS is stagnant urine due to the bladder not emptying fully when going to the toilet. Known as urinary retention, this left over urine provides a good environment for bacteria to grow and a UTI to develop.
It’s thought that a number of other factors may increase the risk of UTIs in people with MS. For instance, infection can happen particularly if you use a catheter to empty your bladder. Similarly, if your MS makes personal hygiene after using the toilet more difficult, this may increase your risk of getting a UTI.
How many people with MS get urinary tract infections?
This is difficult to estimate as not every UTI may be recognised. However, one study of 1,261 people with MS in Europe found that three in ten reported urinary tract infections.
What can I do if I have a urinary tract infection?
If you’re worried you have a UTI, get in touch with a health professional. Your GP, MS specialist nurse or continence advisor can test your urine to find out if you have an infection and talk to you about treatment options, such as an antibiotic.
What can I do to prevent a urinary tract infection?
Making simple lifestyle changes can help you to avoid urinary infections.
- Drink around six to eight glasses of liquid a day (more if the weather is hot or you have been exercising). This will help you to avoid dehydration which can lead to concentrated urine, which is a good environment for infection.
- Avoid constipation as a full bowel can obstruct the flow of urine and result in stagnant urine in your bladder, a good environment for infection.
- Practice good personal hygiene such as wiping from front to back after you have used the toilet will help to prevent faecal bacteria entering the urinary tract.
- Increase how often you catheterise if you practice intermittent self-catheterisation (ISC) as catheterising more often may also help.
Some people suggest that drinking cranberry juice may prevent UTIs, but current evidence doesn’t support this.
D-mannose is a natural food supplement which is being investigated for treating recurrent UTIs. Some studies suggest it may help to prevent them, although further research is needed to confirm this.
One small study has been carried out in people with MS. 22 people with MS experiencing recurrent UTIs participated in the trial. 12 used catheters, the other 10 did not. They all took D-mannose power (1.5 grams) twice a day and monitored suspected UTIs themselves at home using dipstick tests. The study reported that the number of monthly UTIs decreased in both catheter users and non-users. The researchers concluded that further studies are needed to work out how effective D-mannose is in reducing recurrent UTIs.
Probiotics are another food supplement which is sometimes suggested to prevent UTIs. It’s not yet clear from the evidence whether probiotics are beneficial in reducing your chance of getting a UTI.
Results from a randomised controlled trial published in 2019 found that probiotics were not effective at preventing UTIs in people with spinal cord injuries and neurogenic bladder.
Similarly, a Cochrane review in 2017 concluded that it was uncertain whether probiotics can prevent UTIs in people with bladder dysfunction and further research is necessary.
How are urinary tract infections treated?
Management of urinary tract infection is a two-stage process:
- Test for infection. Your health professional will ask you to bring a sample of urine and this is tested for bacteria using a small, chemically treated stick (dipstick) that is dipped into the urine sample. If bacteria are present it will change colour, suggesting you may have a UTI. In some instances a dipstick test may not be reliable (such as if you use a catheter) so your sample of urine will be sent to a lab for further testing to determine the type of bacteria causing the infection – this is known as urine culture and susceptibility testing.
- Prescription of appropriate antibiotics. Most UTIs are treated with an antibiotic – some are taken orally as tablets, others are injected into your bloodstream through an infusion. Your health professional will prescribe one based on the type of bacteria found in your urine. Some bacteria is resistant to certain antibiotics so it’s important that your urine is analysed in a lab to make sure the right antibiotic is given. Common side effects of antibiotics include diarrhoea and nausea.
Your health professional may recommend paracetamol for managing the pain associated with UTIs. They may also encourage you to drink plenty of fluids so you don’t become dehydrated. If you use a catheter, your health professional may suggest removing or changing your catheter if it’s been in place for more than seven days.
Urinary tract infections usually respond well to antibiotics and clear up in a few days. If your symptoms worsen or don’t improve within 48 hours of taking an antibiotic, get in touch with your GP, MS nurse or continence advisor.
Antibiotics are not recommended for use on a regular basis to guard against urinary infection. However, for people who have a recent history of frequent or severe UTIs this may be an option and will be regularly reviewed by your health professionals.
If you experience three or more UTIs in six months you should be assessed by a continence specialist.
- London: NICE; 2012. Full guideline Urinary incontinence in neurological disease: assessment and management.
- Multiple Sclerosis 2014;20(9):1252-1259. Summary Cranberry versus placebo in the prevention of urinary infections in multiple sclerosis: a multicenter, randomized, placebo-controlled, double-blind trial.
- Multiple Sclerosis 2012;18(2 Suppl):7-15. Summary Treatment experience, burden and unmet needs (TRIBUNE) in MS study: results from five European countries.
- Multiple Sclerosis Journal 2016;22(7):855–861. Full article Urinary tract infections in multiple sclerosis.
- Neurology and Urodynamics 2017;36(7):1770–1775. Abstract Open label feasibility study evaluating D-mannose combined with home-based monitoring of suspected urinary tract infections in patients with multiple sclerosis.
- Spinal Cord 2019; Feb [Epub ahead of print]. Full article Probiotics [LGG-BB12 or RC14-GR1] versus placebo as prophylaxis for urinary tract infection in persons with spinal cord injury [ProSCIUTTU]: a randomised controlled trial.
- Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD010723. Full article Probiotics for preventing urinary tract infection in people with neuropathic bladder.
- London: NICE; 2018. Full guideline Urinary tract infection (catheter-associated): antimicrobial prescribing.
- London: NICE; 2018. Full guideline Urinary tract infection (lower): antimicrobial prescribing.
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Catheters are tubes used to drain urine from the bladder.