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UTIs Are Common in MS—Here’s How to Deal

By Erica Patino
Reviewed by Dana Cooper, M.D.
August 07, 2023

Urinary tract infections (UTIs) are a common complication of MS, and they pose unique risks to people with MS. That's because infections can be a trigger for MS symptoms. So if you’re living with MS, it’s important to understand and recognize the signs of a potential UTI.

Here’s how to spot the symptoms, plus what to know about treatment and prevention.

Why Are UTIs Common in MS?

At least 80% of people with MS will experience bladder problems. MS-related inflammation, scarring, and nerve damage in the brain or spinal cord can interfere with the normal transmission of signals between the brain and the urinary system. This can lead the bladder to have trouble storing and emptying urine, which can lead to UTIs.

According to Barbara Giesser, M.D., a board-certified neurologist and MS specialist at Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, California, “When you have too much urine in your bladder, it’s kind of like a stagnant pool of water—it will breed germs.” Having trouble emptying the bladder, then, might make someone with MS more likely to get a UTI.

Giesser also explains that many people with MS who have bladder issues like difficulty storing urine (which leads to frequent urination or incontinence) may not drink enough fluids in hopes of curbing their symptoms. But avoiding fluid intake can lead to dehydration—which, as it turns out, can also lead to UTIs. “If you're relatively dehydrated, again, that leads to more concentrated urine, and that can also predispose you to a UTI,” Geisser says.

Symptoms of UTIs in MS

Classic symptoms of a urinary tract infection include:

  • Frequent need to urinate, called urinary frequency
  • Urgent need to urinate, called urinary urgency
  • Feeling urgency but urinating very little
  • Pain or a burning feeling during urination, called dysuria
  • Getting up to urinate more frequently at night, called nocturia

But UTIs in people with MS may show up slightly differently. “These classic UTI symptoms can certainly happen in people with MS—but sometimes they don't,” Geisser says. “Sometimes, a person [with a UTI] will be experiencing an increase in their other MS symptoms.” A UTI can cause a pseudoexacerbation or pseudo-relapse, which is a temporary worsening of MS symptoms without new inflammation or damage. These are brought on by things such as infection or fever.

Increased MS symptoms associated with a UTI might include:

  • Weakness
  • Spasticity
  • Back pain

Once the UTI is treated, both the UTI and worsened MS symptoms should go away.

How to Treat a UTI in MS

For many UTIs, antibiotics can be helpful. That’s because the specific cause of UTI symptoms is bacteria. “Seventy percent of urinary tract infections are related to [the common bacteria] E. coli,” says R. Mark Ellerkmann, M.D., a board-certified urogynecologist and director of the urogynecology center at Mercy Medical Center in Baltimore.

However, a doctor may only prescribe antibiotics if you’re experiencing noticeable symptoms of a UTI, even if they see bacteria in your bladder during routine lab work. That’s because if you don’t have symptoms, treatment is generally not necessary. It may also be what’s called bacterial colonization, which is very common. In this situation, the bacteria lives in or near the genitourinary tract and doesn't cause problems like infections.

What’s more, the overuse of antibiotics can cause you to become resistant or immune to antibiotic treatment, Ellerkmann says. In other words, the antibiotics may be less likely to work the next time you need them.

Avoiding UTIs in MS

Some research suggests that UTIs can actually worsen MS itself, and frequent UTIs are also associated with higher hospitalization rates in people with MS. So taking steps to try to prevent this type of infection can be important for your comfort and overall health.

Drink Plenty of Water

Lifestyle habits like hydrating well may help. The MS Trust recommends drinking six to eight glasses of water or liquid for most people per day. That’s about 64 ounces. You can talk to your doctor about how much water you should be drinking every day, especially if you’re prone to UTIs.

Supplement, with Your Doctor’s Guidance

Some supplements may also be helpful in preventing UTIs. These supplements include:

  • D-Mannose
  • Cranberry extract (not juice, which contains too much sugar)

“Both of these supplements seem to help because they stick to certain bacteria, like E. coli, and make the bacteria less able to stick to the bladder wall. So you're more likely to flush those bacteria out,” Ellerkmann says. But just how effective they are is debatable, he says. Talk to your doctor about whether you should try supplementing with either of these options.

Ask About a Prescription

For people with chronic UTIs, there's also a prescription drug called methenamine hippurate (Hiprex or Urex) that may be effective in helping prevent UTIs. It helps to minimize the breeding of bacteria, Ellerkmann notes.

Some research suggests that, in people who’ve experienced menopause, vaginal estrogen may also help reduce recurrent UTIs. More research may be needed, however. Be sure to talk to your doctor if you’re interested in this option.

What to Do If You’re Having Increased Symptoms

Check in with your neurologist if you’re having an increase in bladder symptoms or other MS symptoms. A UTI may be the culprit, but in some cases, symptoms may be due to the MS itself flaring up. “You can have MS symptoms flaring as a result of a UTI, and you could have bladder symptoms flaring as a result of the MS acting up,” Geisser explains. In cases of MS flares causing bladder or other symptoms, the right treatment would usually be a steroid—not an antibiotic.

Your neurologist will likely check for a UTI, as well. “For anybody who has an increase in MS symptoms, it's always a good idea to check for a UTI, even if they're not having any particular bladder symptoms,” says Giesser. If you experience frequent UTIs, your neurologist may want to refer you to a urologist to see if you’re having trouble voiding, which can mean you’re not releasing all the urine when you go to the bathroom. A urologist can help determine if you may need further treatment.

A UTI can be a painful and particularly common experience, but, with prompt attention, you and your doctor can generally manage the infection without too much trouble. “Bladder and bowel dysfunction is very common in people with MS, and it's all very treatable,” Giesser says.

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