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.
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 residual urine provides a good environment for bacteria to grow. Infection can happen particularly if you use a catheter or if personal hygiene after using the toilet is difficult.
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?
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.
Make simple lifestyle changes as these 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.
How are urinary tract infections treated?
Management of urinary tract infection is a two-stage process:
- Test for infection using a dipstick test. 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. Sometimes the sample of urine may be sent to a lab for analysis to determine the type of bacteria causing the infection.
- Prescription of appropriate antibiotics.
Urinary tract infections usually respond well to antibiotics and clear up in a few days.
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: managment of lower urinary tract dysfunction in neurological disease.
- 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.