Understanding and Preventing UTIs in MS

  Managing Bladder Problems with MS

Urinary tract infections (UTIs) are a common problem for people with multiple sclerosis. In this video, Sophia Starke, an MS nurse specialist, discusses the increased risk of UTIs in people with MS, the signs and symptoms to watch for, and strategies for prevention and treatment.

View the video above or read the transcript below.

Transcript

I'm back with Sophia Starke, MS nurse specialist at St. George's Hospital in London. What we're going to talk about today is about urinary tract infections and how they affect people with multiple sclerosis. We do use the term UTI, which means urinary tract infection.
So that's the terminology we're going to use today. So, Sophia, are people with MS more prone to UTIs? Yes. Approximately a quarter of people who have MS experienced frequent urine infections.
That's mainly because if they don't empty their bladder properly, the urine can become stagnant and making it more prone to an infection. Also, using a catheter can make you a little bit more prone to infection. Women are more susceptible to urinary tract infections and that's due to their anatomy. They have a shorter urethra, therefore, it's a shorter path for any bugs to pass up into their bladder, sexual activity, certain forms of contraception like spermicides or diaphragms.
And the menopause can also make women more prone to urine infections. And I suppose if people aren't drinking enough, that's going to make them more prone to infections as well, isn't it? Because the urine is going to be more concentrated. Yes.
So how would the person know that they had a urinary tract infection? Well, they might be going to the toilet more often. They might find that their urine smells more strongly than normal. They might have pain when they're passing urine.
They might feel abnormally hot or unwell. And if the urine tract infection is becoming serious, then they might find that they actually have pain around their kidneys. So how does a urinary tract infection affect multiple sclerosis? Well, having a UTI can cause an exacerbation of symptoms that you've already been experiencing, so it makes your MS symptoms worse, but it doesn't make any new, does it make any new symptoms?
No, it's not due to new damage. It's due to the body reacting in such a way that it makes your symptoms that you've had before come to the fore again. And that's really important to explain to people, isn't it, because they know if it's a pseudo relapse because of a UTI, because it's the same symptoms that they already have, that they're not going to experience something new. Exactly.
So the treatment for that is quite different. So once we found out that you have a urine infection, and that will be the first thing we would ask you to do if you are having an exacerbation of your MS symptoms, is to ask you to have your urine checked for an infection. So we would need to treat that infection with antibiotics. We wouldn't be giving any other treatment at that time.
Like steroids. Yeah, exactly. Because I think it's really important because some people aren't aware, are they, that because multiple sclerosis is generated by immune activity. If you have a UTI, you're going to have immune activity because the immune system is going to be activated to fight the urinary tract infection.
And unfortunately, once you call the immune system to start to be active, it's also going to be active against the MS, so it's going to start being active and affecting the myelin sheath. So does everybody with a UTI have these symptoms? No, they may not experience any urinary symptoms at all, but they may find that they are experiencing an exacerbation of their MS symptoms and just not realize that they actually do have an infection that is causing this. So it's really important that if you do have if you are feeling worse in terms of your MS, that you seek medical advice and the appropriate treatment.
So the first thing we would do as MS nurses and GP can do this as well, is to test, do a simple dipstick test where you can see when there's signs of a urinary infection, because it could be this that is making your MS symptoms worse. I think sometimes people just want to have steroids, they have an increased symptoms, they're getting really fearful and they think the only treatment then is to have steroids. But if they have an infection already, they shouldn't have a steroid. No, that can actually be really dangerous.
So it's important that any urine infection is treated appropriately with antibiotics before considering steroids, and that you seek advice from your GP and your MS team about this. Because often what people will find those who are experiencing a pseudo relapse or an increase in their symptoms is that once their urinary tract is treated with antibiotics, that these symptoms will settle down as well. But I suppose there's always some that find, even though they've been treated, that they've still got these symptoms. So what would you advise them?
Well, then you need to get back in touch with your MS team and your GP just to check that you don't need any other treatment after that. So how can people stop these urinary tract infections happening again in the future? OK, well, it's really important to keep the fluid intake up, so we would suggest that people should drink about six to eight glasses of fluids a day. For women, we would advise that after they've been to the toilet, to wipe from front to back and also to have a wee after any sexual activity.
We would advise to try and avoid constipation, because constipation can help put pressure on the urinary tract and stop it emptying properly, which can then lead to a urine infection. If you have an indwelling catheter, it's really important that you attend or changes regularly and not to miss any of those and to maintain general cleanliness around a catheter. I suppose if you've got symptoms, it's important to urinary tract symptoms, it's important to report them quite early, isn't it? Exactly.
Because if you leave it for longer than the infection can get more serious. Yeah. A lot of people with MS ask me about the use of cranberry. What would you recommend to your patients.
The evidence for this is sketchy. However, people do say that they do find it beneficial. So if people want to try it, then that's absolutely fine. But it's not something we would necessarily recommend.
Okay, so I suppose the take home messages from this video are that people with MS are more prone to urinary tract infections than the general population. It's important to seek advice and treatment early, that sometimes the urinary tract infection can be asymptomatic, but the person can find that they have an increase in MS symptoms. But this is what we call a pseudo relapse, and it's important that we treat the infection first before we treat the relapse. And you can find that once the urinary tract infection reduces that the MS symptoms will start to reduce as well.
And again, it's that emphasis time and time again about drinking sufficiently. And we believe drinking sufficiently means six to eight glasses of water per day.

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