UTIs and MS: How to Prevent This All-Too-Common Problem

At least 80 percent of people who have multiple sclerosis (MS) have some bladder dysfunction, which can lead to frequent bladder or urinary tract infections (UTIs), according to the National Multiple Sclerosis Society (NMSS).

It’s common for people who have MS to have difficulties fully emptying their bladder, which puts them at increased risk of UTIs, notes the NMSS. Urine that stays the bladder too long breeds an abundance of bacteria, which eventually leads to infection. Holding urine also allows mineral deposits to form stones that can lead to infection and irritate bladder tissues.

Talking to your doctor about any bladder dysfunction issues you may have can help stave off repeated UTIs, which can be serious in some cases for people who have MS. Taking steps to prevent UTIs, and seeking prompt diagnosis and treatment when you’re having symptoms, can also be helpful.

Why Do People With MS Get Frequent UTIs?

Bladder dysfunction occurs when MS lesions block or delay transmission of nerve signals in parts of the central nervous system (CNS) that control the bladder and urinary sphincters, explains the NMSS. A spastic or overactive bladder that can't hold the normal amount of urine, or a bladder that does not empty properly can cause symptoms that can lead to a UTI.

Complicating matters further, “Some MS treatments, such as steroid drugs, weaken the immune system and make it harder to fight infections,” says Antonio Otero, MD, a urologist at San Francisco Medical Center. 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.”

Symptoms of Urinary Tract Infections

According to the NMSS, symptoms of a urinary tract infection can include:

• Urgent need to urinate
• Frequent need to urinate
• Burning sensation
• Abdominal or lower back pain
• Elevated body temperature
• Increased spasticity (Spasticity, or involuntary muscle stiffness or spasms, is a common symptom of MS caused by an abnormal increase in muscle tone.)
• Dark-colored or cloudy, foul-smelling urine

What a person with MS may notice instead of or along with common UTI symptoms is a worsening of MS symptoms known as a pseudoexacerbation, per the NMSS. This occurs when the urinary tract infection along with the rise in body temperature causes other MS symptoms to flare up temporarily. While these symptoms mimic a true exacerbation or flare, there is no underlying disease activity.

Because these are atypical symptoms for a urinary tract infection, a first UTI in a person with MS may be hard to diagnose, says Dr. Otero.

RELATED: Pelvic Floor Physical Therapy for MS Bladder and Bowel Control

“After that,” Otero adds, “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.”

Treating Urinary Tract Infections

If you’re experiencing symptoms of a UTI or having any bladder dysfunction, be sure to seek prompt diagnosis (via a urine test) and treatment. According to the NMSS, untreated bladder issues can cause:

• Worsening of other MS symptoms
• Kidney stones that can cause serious pain along with other health issues
• Difficulty with work, home, and social activities
• Loss of independence, self-esteem, and self-confidence
• In serious cases, untreated urinary problems can lead to infections in the blood (urosepsis) and skin breakdown — both of which can shorten life in people who have MS.

If you do test positive for a UTI, your doctor will most likely prescribe an antibiotic to treat the infection. It’s very important to take the full amount as directed even if your symptoms improve, because stopping too soon is likely to cause a recurrence of symptoms.

If your symptoms persist, or you have repeated infections, your healthcare provider will likely refer you to a urologist to figure out what type of ongoing bladder dysfunction might be causing your urinary symptoms.

Tips for Preventing Urinary Tract Infections

Elizabeth Crabtree, MD, neurologist and MS specialist at Tulane Medical Center in New Orleans, has several recommendations for preventing urinary tract infections.

• To keep urine flowing, Dr. Crabtree 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. Drink enough water to keep the urine light yellow, to flush waste, bacteria, and mineral deposits from the urinary system, notes the NMSS.
• “Clean up after sex,” says Crabtree. “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. “Consider taking magnesium citrate at bedtime to promote a bowel movement in the morning.”
• Avoid tight, synthetic underwear and clothing, which encourage germ growth. Wearing cotton underwear and other breathable fabrics may help, according to Planned Parenthood.

A few more tips from the NMSS include:

• Cranberry may help to prevent bacteria from sticking to the cells that line the bladder. Generally, taking cranberry tablets daily is better than drinking sweetened juice. Never use cranberry to self-treat an existing UTI.
• If you've had recurrent UTIs, ask your doctor about taking medication for your specific symptoms.
• Limit intake of fluids that contain caffeine or alcohol, which can irritate the bladder and contribute to storage dysfunction.
• Do pelvic floor (Kegel) exercises regularly to help control incontinence in women (can also be adapted for use by men). Kegel exercises involve contracting and relaxing the muscles that support the urethra, bladder, uterus, and rectum.
• Pelvic floor physical therapy can strengthen the pelvic floor muscles, improve muscle control, and promote muscle relaxation that's necessary for urination.
• Plan to urinate every two hours while you're awake, which can help train the bladder and reduce overfilling.

Surgical Interventions for Bladder Dysfunction

According to the NMSS, surgical interventions for bladder dysfunction include:

• Percutaneous Tibial Nerve Stimulation (PTNS) During PTNS, a very small needle electrode is inserted in the ankle. The electrode transmits a signal to the nerves that control the bladder and pelvic floor muscles. Treatment for 30 minutes per week for 12 weeks has been shown to reduce urinary frequency, urgency, nighttime urination and incontinence.
• InterStim InterStim is a small device surgically implanted under the skin to stimulate the nerves that control the bladder and muscles related to urination. It is used to treat overactive bladder, urinary retention, and some types of bowel dysfunction.
• Intermittent Self-Catheterization (ISC) In ISC, a small catheter is inserted into the urethra to empty the bladder, and then removed. ISC one or more times per day can help control bladder leakage, urgency, and frequency, and nighttime urination in people who can't completely empty their bladder on their own.