Urinary tract infections (UTIs) are common in MS. They can cause a frequent urge to urinate and make urinating feel painful.
A health professional can check if you have a UTI by testing a sample of your urine. UTIs are treated with a course of antibiotics and usually clear up within a few days.
It's important to find out if you have a UTI as they can make MS symptoms, such as spasticity or thinking problems, worse. In some cases, they can trigger an MS relapse if left untreated.
What is a urinary tract infection?
The urinary tract includes the kidneys, ureters, bladder and urethra. This is the body’s system for removing waste products and getting rid of extra water from your blood. Urine drains from the kidneys – via two tubes called the ureters – to the bladder, where it's stored. When it's time to empty the bladder, the urine exits through the urethra (the tube through which urine leaves the body).
An infection can affect any area of the urinary tract, although most commonly they occur in the bladder and urethra.
A UTI 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 can include:
a frequent urge to urinate
a painful or burning sensation when urinating
generally feeling tired or washed out most of the time
a painful bladder or abdomen, even when not urinating
passing a small amount of urine, even though there's an urge to pass more
milky or cloudy urine that smells unusual
a high temperature
a pink, red or brown tinge to your urine.
Most people experience some or all of these symptoms if they have a urinary tract infection, although for some people there are no symptoms at all.
In some cases – particularly in older people and people with a urinary catheter – a UTI can cause:
unusual behaviour changes (such as confusion and agitation)
Symptoms of a UTI can be confused with other MS symptoms, such as fatigue or existing bladder problems. It's 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. This is where the infection spreads from the urinary tract to other parts of the body, causing the immune system to go into overdrive. 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 left over urine provides a good environment for bacteria to grow and a UTI to develop.
It’s thought that a number of other factors may increase the risk of UTIs in people with MS. For instance, infection can happen particularly if you use a catheter to empty your bladder. Similarly, if your MS makes personal hygiene after using the toilet more difficult, this may increase your risk of getting a UTI.
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?
If you’re worried you have a UTI, get in touch with a health professional. Your GP, MS specialist nurse or bladder and bowel specialist can test your urine to find out if you have an infection and talk to you about treatment options, such as an antibiotic.
What can I do to prevent a urinary tract infection?
There are simple lifestyle changes you can make to reduce your chances of getting a urinary tract infection.
Drink six to eight glasses of fluid in 24 hours (more if the weather is hot or you've been exercising) to avoid dehydration. This will stop your urine becoming too concentrated and reduce the chance of bacteria growing.
Make sure you're not constipated. A full bowel can obstruct the flow of urine and result in stagnant urine in your bladder, which provides an environment for infection.
Practise good personal hygiene. This includes wiping from front to back after you've used the toilet. This will help to prevent faecal bacteria entering the urinary tract.
Anecdotally, some people find complementary options helpful for reducing the frequency of UTIs. This includes food supplements – in particular d-mannose and probiotics – and cranberry juice. These options are generally considered safe, however high quality evidence supporting the effectiveness of these treatments is lacking.
D-mannose is a natural food supplement which is being investigated for treating recurrent UTIs. Some studies suggest it may help to prevent them, although further research is needed to confirm this.
One small study has been carried out in people with MS. 22 people with MS experiencing recurrent UTIs participated in the trial. 12 used catheters, the other 10 did not. They all took D-mannose powder (1.5 grams) twice a day and monitored suspected UTIs themselves at home using dipstick tests. The study reported that the number of monthly UTIs decreased in both catheter users and non-users. The researchers concluded that further studies are needed to work out how effective D-mannose is in reducing recurrent UTIs.
Probiotics are another food supplement which is sometimes suggested to prevent UTIs. It’s not yet clear from the evidence whether probiotics are beneficial in reducing your chance of getting a UTI.
Results from a randomised controlled trial published in 2019 found that probiotics were not effective at preventing UTIs in people with spinal cord injuries and neurogenic bladder.
Similarly, a Cochrane review in 2017 concluded that it was uncertain whether probiotics can prevent UTIs in people with bladder dysfunction and further research is necessary.
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. Your health professional will ask for a sample of urine. This is tested for bacteria using a small, chemically treated stick (dipstick). The stick is dipped into your urine sample. If bacteria are present, it will change colour, suggesting you have a UTI. In some instances, a dipstick test may not be reliable (such as if you use a catheter) so your sample of urine will be sent to a lab for further testing to determine the type of bacteria causing the infection. This is known as urine culture and susceptibility testing.
Prescription of appropriate antibiotics. Most UTIs are treated with an antibiotic – some are taken orally as tablets, others are injected into your bloodstream through an infusion. Your health professional will prescribe one based on the type of bacteria found in your urine. Some bacteria is resistant to certain antibiotics so it’s important that your urine is analysed in a lab to make sure the right antibiotic is given. Common side effects of antibiotics include diarrhoea and nausea.
Your health professional may recommend paracetamol for managing the pain associated with UTIs. They may also encourage you to drink plenty of fluids so you don’t become dehydrated. If you use a catheter, your health professional may suggest removing or changing your catheter if it’s been in place for more than seven days.
Urinary tract infections usually respond well to antibiotics and clear up in a few days. If your symptoms worsen or don’t improve within 48 hours of taking an antibiotic, get in touch with your GP, MS nurse or continence advisor.
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.
Bladder and Bowel Community – a charity providing information and support for people with all types of bladder and bowel related problems
Bladder Health UK – a charity supporting people with cystitis, overactive bladder and continence issues through publications, forums and an advice line
Bladder & Bowel UK – a charity providing information on, and raising awareness of, bladder and bowel issues
Gallien P, et al. Cranberry versus placebo in the prevention of urinary infections in multiple sclerosis: a multicenter, randomized, placebo-controlled, double-blind trial. Multiple Sclerosis 2014;20(9):1252-1259. Summary (link is external)
Karampampa K, et al. Treatment experience, burden and unmet needs (TRIBUNE) in MS study: results from five European countries. Multiple Sclerosis 2012;18(2 Suppl):7-15. Summary (link is external)
Phé V, et al. Open label feasibility study evaluating D-mannose combined with home-based monitoring of suspected urinary tract infections in patients with multiple sclerosis. Neurology and Urodynamics 2017;36(7):1770–1775. Abstract (link is external)
Thomas S, et al. Expert opinion consensus document. Management of bladder dysfunction in people with multiple sclerosis. London: British Journal of Nursing 2022; 31 (3 Suppl 3), S1–32. Full article (link is external)
Toh SL, et al. Probiotics [LGG-BB12 or RC14-GR1] versus placebo as prophylaxis for urinary tract infection in persons with spinal cord injury [ProSCIUTTU]: a randomised controlled trial. Spinal Cord 2019; Feb [Epub ahead of print]. Full article (link is external)
Toh SL, et al. Probiotics for preventing urinary tract infection in people with neuropathic bladder. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD010723. Full article (link is external)
National Institute for Health and Clinical Excellence. Urinary incontinence in neurological disease: assessment and management. London: NICE; 2012. Full guideline (link is external)
National Institute for Health and Clinical Excellence. Urinary tract infection (catheter-associated): antimicrobial prescribing. London: NICE; 2018. Full guideline (link is external)
Managing your bladder looks at why bladder problems can be part of MS and provides a practical approach to their management. It includes comments and tips from people with MS who know what it is like to live with bladder problems.