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MS research update - Can cranberry help prevent bladder infections? - 13 January 2014

Summary

This study looked at whether taking cranberry extract twice a day could help prevent bladder infections (UTIs) in people with MS.

The researchers found that the average time to experiencing a UTI was the same in the group taking cranberry as it was in the placebo group. Similarly, the number of UTIs and the symptoms experienced were the same for the two groups.

They concluded that taking cranberry extracts does not help prevent UTIs in people with MS. In addition, cranberry does not seem to help with the symptoms of a UTI once it has occurred.

Background

Bladder symptoms are common in MS. In addition, people with MS are more likely to have bladder infections, usually called urinary tract infections (UTIs) or sometimes cystitis.

There is some evidence that taking cranberry juice, pills or extracts could help prevent urinary tract infections from happening in the first place and also help with the symptoms of a UTI. This study looked at whether taking cranberry extract twice a day could help prevent UTIs in people with MS.

How this study was carried out

171 people with MS aged 18 to 70 were recruited from outpatient clinics. All had an EDSS score of three or more reflecting disability levels that were more than minimal.

All the participants had bladder symptoms due to their MS but no UTI at the time that they joined the study. The participants were randomly divided into two groups. One group took a cranberry extract twice a day for one year and the other group took a matching placebo containing no cranberry.

They were assessed by phone every month and in person every three months. The researchers noted the time it took before each person experienced a UTI. They also recorded the number of UTIs experienced over a year, the symptoms experienced with each UTI, any antibiotics taken, side effects reported, quality of life, EDSS score and the number of MS relapses.

What was found

The researchers found that the average time to experiencing their first UTI was the same in the group taking cranberry as it was in the placebo group. Similarly, the number of UTIs and the symptoms experienced were the same for the two groups.

What does it mean?

This study suggests that taking cranberry extracts does not help prevent UTIs in people with MS. In addition, cranberry does not seem to help with the symptoms of a UTI once it has occurred.

Gallien P, Amarenco G, Benoit N, et al.
Cranberry versus placebo in the prevention of urinary infections in multiple sclerosis: a multicenter, randomized, placebo-controlled, double-blind trial. .
Mult Scler. 2014 Jan 8. [Epub ahead of print] 
abstract

More about bladder symptoms and treating UTIs

Cranberry treatments

This study suggests that taking cranberry extracts is not helpful for people with MS who either want to prevent bladder infections (UTIs) or who would like to ease the symptoms of an existing UTI.

Cranberry supplements are popular with people with MS. A study published in 2012 looking at which herbal supplements were most commonly taken by people with MS found that cranberry extracts were taken by just over a third (35%) of the people surveyed.

The advice on cystitis from the NHS for the general population is that cranberry may help prevent UTIs from recurring again and again. It is suggested that high strength capsules available in the shops (not on the NHS) may work better than drinking cranberry juice which has relatively low levels of the chemical which is though to be helpful. You can find other suggestions on preventing UTIs on the NHS Choices web site.

Getting help with bladder symptoms

Bladder symptoms are common in MS. Damage to areas of the spinal cord or brain that control the bladder can cause different types of problem:

  • urgency - a desperate urge to go to the toilet with little or no warning
  • frequency - needing the toilet more than eight times a day
  • hesitancy - difficulty in emptying the bladder
  • retention - a feeling of incomplete bladder emptying

You can read more about bladder symptoms in the A to Z of MS. You can also order our book on managing your bladder. It provides a very practical approach to managing bladder symptoms and includes comments and tips from people with MS who know what it is like to live with bladder problems.

If you are experiencing bladder symptoms, you can speak to your MS nurse or GP who may refer you to continence services. These nurses specialise in helping people with bladder and bowel symptoms.

Although bladder or bowel symptoms can be hard to talk about, it is worth seeking support from health professionals and exploring what treatment options are available.

Research by topic areas...

Symptoms and symptom management

Barun B.
Pathophysiological background and clinical characteristics of sleep disorders in multiple sclerosis.
Clin Neurol Neurosurg. 2013 Dec;115 Suppl 1:S82-5.
abstract

Bauer V, Aleric Z, Jancic E, et al.
Subjective and perceptual analysis of voice quality and relationship with neurological disfunction in multiple sclerosis patients.
Clin Neurol Neurosurg. 2013 Dec;115 Suppl 1:S17-20.
abstract

Disease modifying treatments

Bonafede MM, Johnson BH, Watson C.
Health care-resource utilization before and after natalizumab initiation in multiple sclerosis patients in the US.
Clinicoecon Outcomes Res. 2013 Dec 19;6:11-20.
abstract
Read the full text of this paper

Bertolotto A, Capobianco M, Amato MP, et al.
Guidelines on the clinical use for the detection of neutralizing antibodies (NAbs) to IFN beta in multiple sclerosis therapy: report from the Italian multiple sclerosis study group.
Neurol Sci. 2013 Dec 29. [Epub ahead of print]
abstract

Drulovic J, Kostic J, Mesaros S, et al.
Interferon-beta and disability progression in relapsing-remitting multiple sclerosis.
Clin Neurol Neurosurg. 2013 Dec;115 Suppl 1:S65-9.
abstract

Thomas K, Ziemssen T.
Management of fingolimod in clinical practice.
Clin Neurol Neurosurg. 2013 Dec;115 Suppl 1:S60-4.
abstract

Ožura A, Kovač L, Sega S.
Adherence to disease-modifying therapies and attitudes regarding disease in patients with multiple sclerosis.
Clin Neurol Neurosurg. 2013 Dec;115 Suppl 1:S6-S11.
abstract

Drugs in development

Milo R, et al.
The efficacy and safety of daclizumab and its potential role in the treatment of multiple sclerosis.
Ther Adv Neurol Disord. 2014 Jan;7(1):7-21. Review.
abstract

Other treatments

Schramm A, Ndayisaba JP, Auf dem Brinke M, et al.
Spasticity treatment with onabotulinumtoxin A: data from a prospective German real-life patient registry.
J Neural Transm. 2014 Jan 10. [Epub ahead of print]
abstract

Borrini L, Bensmail D, Thiebaut JB, et al.
Occurrence of adverse events in chronic intrathecal baclofen infusion: a one-year follow-up study of 158 adults.
Arch Phys Med Rehabil. 2014 Jan 6. pii: S0003-9993(14)00003-3.
abstract

Koehler J, Feneberg W, Meier M, et al.
Clinical experience with THC:CBD oromucosal spray in patients with multiple sclerosis-related spasticity.
Int J Neurosci. 2014 Jan 6. [Epub ahead of print]
abstract

Zecca C, Digesu GA, Robshaw P, et al.
Motor and sensory responses after percutaneous tibial nerve stimulation in multiple sclerosis patients with lower urinary tract symptoms treated in daily practice.
Eur J Neurol. 2014 Jan 3. [Epub ahead of print]
abstract

Ledinek AH, Sajko MC, Rot U.
Evaluating the effects of amantadin, modafinil and acetyl-l-carnitine on fatigue in multiple sclerosis - result of a pilot randomized, blind study.
Clin Neurol Neurosurg. 2013 Dec;115 Suppl 1:S86-9.
abstract

Assessment tools

Senders A, Hanes D, Bourdette D, et al.
Reducing survey burden: feasibility and validity of PROMIS measures in multiple sclerosis.
Mult Scler. 2014 Jan 8. [Epub ahead of print]
abstract

Causes of MS

Hedström AK, Hillert J, Olsson T, et al.
Alcohol as a modifiable lifestyle factor affecting multiple sclerosis risk.
JAMA Neurol. 2014 Jan 6. [Epub ahead of print]
abstract

Genetics

International Multiple Sclerosis Genetics Consortium (IMSGC), Beecham AH, Patsopoulos NA, et al.
Analysis of immune-related loci identifies 48 new susceptibility variants for multiple sclerosis.
Nat Genet. 2013 Nov;45(11):1353-60.
abstract

Psychological aspects

Hind D, Cotter J, Thake A, et al.
Cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis: a systematic review and meta-analysis.
BMC Psychiatry. 2014 Jan 9;14(1):5. [Epub ahead of print]
abstract
Read the full text of this paper

Niino M, Mifune N, Kohriyama T, et al.
Apathy/depression, but not subjective fatigue, is related with cognitive dysfunction in patients with multiple sclerosis.
BMC Neurol. 2014 Jan 6;14(1):3.
abstract
Read the full text of this paper

Minden SL, Feinstein A, Kalb RC, et al.
Evidence-based guideline: Assessment and management of psychiatric disorders in individuals with ms: Report of the Guideline Development Subcommittee of the American Academy of Neurology.
2013 Dec 27. [Epub ahead of print]
abstract

Ožura A, Sega S.
Profile of depression, experienced distress and capacity for coping with stress in multiple sclerosis patients-A different perspective.
Clin Neurol Neurosurg. 2013 Dec;115 Suppl 1:S12-6.
abstract

Physical activity

Suh Y, Joshi I, Olsen C, et al.
Social cognitive predictors of physical activity in relapsing-remitting multiple sclerosis.
Int J Behav Med. 2014 Jan 10. [Epub ahead of print]
abstract

Spain RI, Mancini M, Horak FB, et al.
Body-worn sensors capture variability, but not decline, of gait and balance measures in multiple sclerosis over 18 months.
Gait Posture. 2013 Dec 21. pii: S0966-6362(13)00705-4.[Epub ahead of print]
abstract

Kasser SL, Jacobs JV, Littenberg B, et al.
Exploring physical activity in women with multiple sclerosis: associations with fear of falling and underlying impairments.
Am J Phys Med Rehabil. 2014 Jan 6. [Epub ahead of print]
abstract

Agiovlasitis S, Mot RW.
Step-rate thresholds for physical activity intensity in persons with multiple sclerosis.
Adapt Phys Activ Q. 2014 Jan;31(1):4-18.
abstract

Motl RW, Sosnoff JJ, Dlugonski D, et al.
Walking and cognition, but not symptoms, correlate with dual task cost of walking in multiple sclerosis.
Gait Posture. 2013 Dec 14. pii: S0966-6362(13)00696-6.[Epub ahead of print]
abstract

Economics

Parisé H, Laliberté F, Lefebvre P, et al.
Direct and indirect cost burden associated with multiple sclerosis relapses: excess costs of persons with ms and their spouse caregivers. 
J Neurol Sci. 2013 Jul 15;330(1-2):71-7.
abstract

Pathophysiology

Balk L, Tewarie P, Killestein J, et al.
Disease course heterogeneity and OCT in multiple sclerosis.
Mult Scler. 2014 Jan 8. [Epub ahead of print]
abstract

Martínez-Lapiscina EH, Ortiz-Pérez S, Fraga-Pumar E, et al.
Colour vision impairment is associated with disease severity in multiple sclerosis.
Mult Scler. 2014 Jan 7. [Epub ahead of print]
abstract

Adamec I, Habek M.
Autonomic dysfunction in multiple sclerosis.
Clin Neurol Neurosurg. 2013 Dec;115 Suppl 1:S73-8.
abstract

Gabelic T, Weinstock-Guttman B, Melia R, et al.
Retinal nerve fiber thickness and MRI white matter abnormalities in healthy relatives of multiple sclerosis patients.
Clin Neurol Neurosurg. 2013 Dec;115 Suppl 1:S49-54.
abstract

Brinar VV, Barun B.
Challenges in multiple sclerosis; how to define occurence of progression.
Clin Neurol Neurosurg. 2013 Dec;115 Suppl 1:S30-4.
abstract

Siva A.
Asymptomatic ms
Clin Neurol Neurosurg. 2013 Dec;115 Suppl 1:S1-5.
abstract

Pregnancy and childbirth

Portaccio E, Ghezzi A, Hakiki B, et al.
Postpartum relapses increase the risk of disability progression in multiple sclerosis: the role of disease modifying drugs.
J Neurol Neurosurg Psychiatry. 2014 Jan 8.[Epub ahead of print]
abstract

Review

Deckx N, Lee WP, Berneman ZN, et al.
Neuroendocrine Immunoregulation in multiple sclerosis.
Clin Dev Immunol. 2013;2013:705232. Epub 2013 Dec 8.
abstract
Read the full text of this paper

Gaby A.
Multiple Sclerosis.
Glob Adv Health Med. 2013 Jan;2(1):50-56. 
abstract
Read the full text of this paper

Work

Korchounov A, Tabatadze T, Spivak D, et al.
MS related employment and disease modifying treatment in the German working population: 1994-2009.
NeuroRehabilitation. 2014 Jan 7. [Epub ahead of print]
abstract

Wickström A, Dahle C, Vrethem M, et al.
Reduced sick leave in multiple sclerosis after one year of natalizumab treatment. A prospective ad hoc analysis of the TYNERGY trial.
Mult Scler. 2013 Dec 30. [Epub ahead of print]
abstract

Other

Thompson AJ, Chandraratna D.
Multiple Sclerosis International Federation: stimulating international cooperation in research.
Neurology. 2013 Nov 12;81(20):1793-5. 
abstract

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