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

Why are people who have multiple sclerosis prone to UTIs? And how can you prevent more of them? Find the answers here.
UTIs and MS: How to Prevent This All-Too-Common Problem
Canva (3); Everyday Health
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Updated on May 20, 2024
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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.

 Urine that stays in the bladder too long breeds an abundance of bacteria, which can eventually lead to infection. A bladder infection is the most common type of UTI.

 Holding urine also allows mineral deposits to form stones in the bladder that can lead to a bladder 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.

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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

Symptoms of a urinary tract infection can include:

  • A more frequent or urgent need to urinate
  • Burning sensation when urinating
  • Abdominal pain
  • Elevated body temperature
  • Increased spasticity (Spasticity, or involuntary muscle stiffness or spasms, is a common symptom of MS)
  • Dark-colored or cloudy urine that smells unusual
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.

“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. Untreated bladder issues can cause:

  • Worsening of other MS symptoms
  • Kidney stones
  • Difficulty with daily 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:

  • 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.
If you’ve had recurrent UTIs, work with your MS neurologist to arrange a consultation with a urologist, who can oversee additional recommendations for treatments. A urologist would also have the expertise to implement the therapies and procedures, described just below, for bladder dysfunction.

Other Interventions for Bladder Dysfunction

Nonsurgical and 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 has been shown to reduce urinary frequency, urgency, nighttime urination, and incontinence. Treatment is typically 30 minutes per week for 12 weeks, with monthly follow-ups.

  • 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.

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Jason Paul Chua, MD, PhD

Medical Reviewer
Jason Chua, MD, PhD, is an assistant professor in the Department of Neurology and Division of Movement Disorders at Johns Hopkins School of Medicine. He received his training at the University of Michigan, where he obtained medical and graduate degrees, then completed a residency in neurology and a combined clinical/research fellowship in movement disorders and neurodegeneration.

Dr. Chua’s primary research interests are in neurodegenerative disease, with a special focus on the cellular housekeeping pathway of autophagy and its impact on disease development in diseases such as Parkinson disease. His work has been supported by multiple research training and career development grants from the National Institute of Neurological Disorders and Stroke and the American Academy of Neurology. He is the primary or coauthor of 14 peer-reviewed scientific publications and two peer-reviewed online learning modules from the American Academy of Neurology. He is also a contributing author to The Little Black Book of Neurology by Osama Zaldat, MD and Alan Lerner, MD, and has peer reviewed for the scientific journals Autophagy, eLife, and Neurobiology of Disease.
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David Spero, RN

Author

David Spero has been a nurse for 40 years and has lived with MS for 30 years. Spero has also been a health educator for 20 years and a health writer for about 12 years. He was a leader and trainer in the Stanford University's Chronic Disease Self-Management Program, and has coached people with a wide variety of chronic conditions. Spero is the author of three health books: The Art of Getting Well: Maximizing Health When You Have a Chronic Illness (Turner Publishing), Diabetes: Sugar-coated Crisis (New Society Publishers) and Diabetes Heroes, (Jim Healthy Publications). He has written articles for Diabetes Self-Management, Arthritis Self-Management, RN, Health, Diabetes Health, and several other magazines. He writes a weekly blog on Diabetesselfmanagement.com and is creating a series of e-books based on his blog called The Inn by the Healing Path, a collection of healing stories and spiritual exploration. Spero is a father of two and grandfather of one, and often gives talks on MS, diabetes, self-care, sexuality, and relationships.

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Resources
  1. Bladder Dysfunction in Multiple Sclerosis. National Multiple Sclerosis Society.
  2. Urinary Tract Infections. Multiple Sclerosis Trust. November 22, 2023.
  3. Bladder Infection (Urinary Tract Infection) in Adults. National Institute of Diabetes and Digestive and Kidney Diseases. March 2017.
  4. Bladder Stones. Mayo Clinic. September 24, 2021.
  5. Urinary Dysfunction and MS. National Multiple Sclerosis Society. 2016.
  6. What You Can Do to Prevent Urinary Tract Infections. Planned Parenthood. February 13, 2018.
  7. Ginsberg DA et al. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Diagnosis and Evaluation. The Journal of Urology. 2021.
  8. Percutaneous Tibial Nerve Stimulation (PTNS). University of Colorado Urogynecology.
  9. Evaluating and Getting an InterStim System. Medtronic.
  10. Intermittent Self-Catheterization (ISC). American Urogynecologic Society. 2023.