From the Guidelines
Yes, urinary tract infections (UTIs) can exacerbate multiple sclerosis (MS) symptoms, and prompt treatment is essential to prevent worsening of symptoms and improve quality of life. The relationship between UTIs and MS symptoms is complex, but it is believed that the infection causes inflammation and raises body temperature, leading to temporary worsening of existing MS symptoms or the reappearance of dormant symptoms 1. Common signs of UTI-exacerbated MS symptoms include increased fatigue, weakness, spasticity, balance problems, and cognitive difficulties.
When managing UTIs in patients with MS, it is crucial to consider the potential impact on bladder function, as patients with MS are at risk of developing neurogenic lower urinary tract dysfunction (NLUTD) 1. In fact, the American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) recommend onabotulinumtoxinA injections for NLUTD patients with MS who are refractory to oral medications, to improve bladder storage parameters, decrease episodes of incontinence, and enhance quality of life measures 1.
Key strategies for managing UTIs in patients with MS include:
- Prompt treatment with antibiotics, such as nitrofurantoin, trimethoprim-sulfamethoxazole, or ciprofloxacin, for 3-7 days depending on severity
- Prevention techniques, including staying well-hydrated, urinating regularly, practicing good hygiene, and emptying the bladder completely
- Monitoring for signs of UTI-exacerbated MS symptoms and adjusting treatment accordingly
- Considering the use of onabotulinumtoxinA injections for NLUTD patients with MS who are refractory to oral medications, as recommended by the AUA and SUFU 1.
Overall, the goal of managing UTIs in patients with MS is to prevent worsening of symptoms, improve quality of life, and minimize the risk of complications associated with NLUTD 1.
From the Research
UTI Exacerbation of MS Symptoms
- Urinary tract infections (UTIs) can exacerbate multiple sclerosis (MS) symptoms, leading to a worsening of the disease and increased damage to the central nervous system (CNS) 2, 3, 4.
- The high prevalence of UTIs in MS patients is mainly due to the occurrence of urinary disorders, such as bladder dysfunction, urinary urgency, polyuria, nocturia, urinary retention, and incontinence 2, 5, 4.
- UTIs can precipitate outbreaks and worsen the disease, causing more damage and a severe neurological condition deterioration 2, 3, 4.
Risk Factors and Prevalence
- MS patients have a high UTI prevalence, with Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae being the most common organisms found 2, 6.
- The risk factors for UTIs in MS patients include urinary disorders, catheterization, and upper urinary tract infections 5, 4, 6.
- UTIs are associated with a high hospitalization rate and a high mortality rate in MS patients 2, 6.
Diagnosis and Management
- The diagnosis and management of UTIs in MS patients require a careful clinical evaluation, including urinalysis and the presence of symptoms 2, 5, 3.
- Treatment of UTIs in MS patients is based on antibiotic therapy, and patients should be educated to contact their doctor in case of systemic symptoms of infection 2, 3.
- Preventative and management strategies can be applied in primary and secondary care settings, with an emphasis on bladder, catheter, and general physical care 6.