Sunday, December 4, 2022

Multiple Sclerosis And Urinary Tract Infections

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Bladder Infection In Ms

Are urinary tract infections MS symptoms? How can they be managed?

For patients with multiple sclerosis , bladder infection is a serious health issue that should be reported to a doctor and treated. Also known as a urinary tract infection or cystitis, a bladder infection can be caused by several symptoms and conditions related to MS, such as untreated urinary retention or other bladder dysfunctions. It is important to have a bladder infection diagnosed and treated because an untreated infection in the urinary tract can cause a chain reaction of increased spasticity and cognitive impairment, which can lead to a relapse.

In advanced cases of multiple sclerosis, an untreated urinary tract infection can even lead to sepsis a dangerous potentially life-threatening infection that attacks the entire body.

How Are Urinary Tract Infections Treated

Management of urinary tract infection is a two-stage process:

  • Test for infection. Your health professional will ask you to bring a sample of urine and this is tested for bacteria using a small, chemically treated stick that is dipped into the urine sample. If bacteria are present it will change colour, suggesting you may have a UTI. In some instances a dipstick test may not be reliable 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 its 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 dont become dehydrated. If you use a catheter, your health professional may suggest removing or changing your catheter if its been in place for more than seven days.

If you experience three or more UTIs in six months you should be assessed by a continence specialist.

Esther’s Story: A Fictitious Case Study

Esther is 32 years old, has a new baby, is deputy head of a local school, goes kayaking and walks the dog.

Without good care

After falling a lot and noticing other symptoms she is diagnosed with MS. She starts to become isolated trying to cope with this diagnosis, a new baby, her marriage and work. She searches online for information and becomes frightened.

She develops a urinary tract infection and her mobility worsens. Without support and advice she attends A& E who do not have her notes. In her panic she has not brought any information with her. They give her a course of steroids without testing her urine. Four days later her MS team is notified and she is finally given the advice she needs to manage her symptoms. After an eight-day hospital stay, she is able to go home.

With ideal care: an aspirational digital scenario

MS unite vision is a platform for Anyone, Anywhere, Anytime with Everything in one place.

Esther now has access to information in one place, to track her symptoms, send messages to her MS team, check appointments and log her diet and exercise. When she experiences urinary symptoms she inputs them into the MS Unite platform which automatically sends her a home urine test kit. Once she has tested she has a virtual appointment at 4am with an MS nurse in Australia who advises on antibiotic treatment, which is then prescribed locally.

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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.

Its 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.

Combined Storage And Emptying Issues

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Its possible to have both emptying and storage dysfunctions if you have MS. This occurs when nerve damage causes the muscles in your bladder and urinary sphincter to fail to coordinate properly with each other. Symptoms can include all of those associated with both emptying and storage problems, and can also lead to kidney damage.

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How To Avoid Utis

  • Drink plenty of clear liquids, especially water and acidic beverages such as cranberry juice
  • Empty your bladder after sexual intercourse
  • Consider birth control methods that are less bacteria-friendly
  • Avoid feminine products that might cause irritation.

Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.

Opportunity For Further Research

A much greater number of patients than usually detected could be suffering from covert infection and are, currently, going unidentified and untreated. Bladder irritation caused by urinary stasis in patients with neurogenic bladder, may result in chronic microscopic pyuria and low-grade infection. Bacterial levels may not be elevated above normal on detailed urinalysis. However, epithelial cells, red blood cells, protein and white blood cells can be elevated or in the upper ranges of normal. Moreover, it has recently been shown that uroepithelial cells may harbor intracellular pathogens, which may be responsible for low-grade infection that is difficult to treat with antibiotic therapy. Remarkably, such intracellular pathogens may be quite distinct from those most commonly identified in urinary suspension .

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Bladder Dysfunction In Ms

Bladder dysfunction is common in the majority of patients with MS, causing significant morbidity with adverse effects on quality of life. Detrusor hyperreflexia presents as urinary frequency, urgency and incontinence. Occurring in 50-90% of patients with MS, this is due to an inability to inhibit detrusor contractions, resulting in voiding at low bladder volumes . Half of the patients with detrusor hyperreflexia develop detrusor-sphincter dyssynergia, in which there is a failure of urethral sphincter relaxation on detrusor contraction, resulting in high micturition pressures and symptoms of hesitancy, incomplete emptying, intermittent stream and dysuria. Detrusor areflexia is most commonly due to sacral cord lesions. It presents in approximately 20% of patients as urgency, frequency and urinary retention .

How Can Bowel Function Be Affected With Multiple Sclerosis

Urological Infections Multiple sclerosis with recurrent UTI Xanthogranulomatous Pyelonephritis’

Bowel dysfunction is also a common symptom for patients with MS. One study of 77 patients with clinically definite MS showed that bowel problems are not associated with bladder dysfunction, patient’s age, degree of disability, or duration of disease.

The most common bowel complaint from a person with MS is constipation, but the most distressing bowel complaint is probably that of involuntary bowel/fecal incontinence. Because MS interrupts or slows the transmission of signals to and from the brain, the electrical impulses to the muscles that are involved in emptying your bowel can become disrupted.

Depending on your particular bowel problem, helpful suggestions can be made. General interventions for bowel dysfunction include:

  • Education about the causes of bowel dysfunction
  • Encouraging dietary changes to include more fiber and fluid
  • Consulting with your healthcare provider to adjust medication regimens that may be contributing to bowel dysfunction
  • Establishing a regular bowel routine, individualized to the patient
  • Encouraging regular physical activity

Bladder and bowel symptoms are common in MS and can be effectively managed. Speak with your healthcare provider about what you can do to help keep these symptoms under control.

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Association Between Urinary Symptoms And Urinary Tract Infection In Patients With Multiple Sclerosis

  • Alireza Nikseresht
  • Masoumeh Nazeri

Abstract

BACKGROUND & OBJECTIVE: Urinary dysfunctions occur in the majority of MS patients and these patients are at higher risks of developing UTI due to multiple reasons. We determined to study the association between different urinary symptoms and UTI in MS patients.

MATERIAL & METHOD:Eighty seven MS patients that referred to our medical care center with an acute attack of the disease, from November 2012 to April 2014, were included in the study. Patients were classified into two groups based on their urine culture results: UTI positive and non-UTI patients. The prevalence of different types of urinary symptoms was then compared among the two groups.

RESULT: The mean age of our patients was 36.8 years old. From the total 87 patients, 83 were female. Overall 56.3% of patients displayed urinary symptoms. The most prevalent urinary problems were urinary incontinence and frequency . A positive urinary culture was seen in 71.3% of the patients. The prevalence of urinary problems was significantly higher in UTI patients in comparison to non-UTI patients . Separately none of the different urinary symptoms displayed a significant difference between UTI and non-UTI patients .

Not a single symptom can be diagnostic of UTI, but MS patient with urinary tract infections do present more urinary symptoms and this can be an indication for further urine analysis and screening measures for MS patients who display more urinary symptoms.

Fighting In One Part Of The Body Leaves The Rest Vulnerable

According to a February 25, 2015 article by Lauren Aguirre and published in NOVA NEXT, T- and B-cells, microphages and microglia can each do double duty as either the good guy or the bad guy in any inflammatory episode. Whatever roles they might play, theyre all putting in time-and-half when we have MS plus an infection or two. Treatments for these use anti-inflammatory drugs such as ibuprofen , corticosteroids, and antibiotics to great effect. That is, if we use them for acute episodes. If we use these for chronic conditions, they might not perform the same way. A helper immune cell can go all Hare Krishna with finger cymbals and saffron robes to heal your urinary tract infectionthen become a psycho stalker when a B-cell antigen receptor sounds the charge to attack your cervical spine. As in any war, the front is wherever the fighting is heaviest. Immune cells, like soldiers, are highly adaptable and effective in the short skirmishes, but if they seize a small region and bivouac there for a while, they could become drunken revelers, rapists or plunderers. In other words, your UTI symptoms went away all rightbut your hands are now weak and shaky. Why cant the brain call a cease fire on all fronts and order the cells to retreat to the nearest lymph node? Even the most bloodthirsty B-cell must like to kick back, drink a beer, and watch the game once in a while.

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Medical And Surgical Treatments

If lifestyle changes dont relieve your bladder dysfunction symptoms, your doctor may prescribe medication to control bladder contractions and reduce the urge to urinate.

For an emptying dysfunction, intermittent catheterization may be recommended. This involves inserting a thin tube into your bladder to drain excess urine. The process is easy to do with practice and is painless. It can prevent infections and serious kidney problems.

The Difference Good Care Makes

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The MS Leaders Academy focused on reducing emergency admissions in their workplace project, and the outcome was a vision for a digital solution called MSUnite. They produced a short animation which focused on a fictitious woman called Esther, newly diagnosed, and the impact that a UTI had on her life and condition without appropriate intervention – versus a scenario where she received timely support and information. It demonstrates the importance of access to information, preventative education, and timely interventions.

An interview with some of the healthcare practitioners behind the concept provides background and explores the exciting potential of MSUnite, and some of the ways that digital interventions might improve bladder management and prevent unnecessary hospital admissions. The short animation, ‘Esther’s story’, demonstrates how these ideas could be translated into practice.

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How Common Are Bladder And Bowel Dysfunction With Multiple Sclerosis

Impairments in bladder function with multiple sclerosis are common and may affect up to 78 to 90 percent of patients during the course of MS. The prevalence of bowel dysfunction in MS is estimated to be about 68 percent of patients. Bladder and bowel symptoms are relatively common in MS and can be treated. Goals for bladder and bowel management include maximizing independence and preventing incontinence and complications.

Symptoms Of Urinary Tract Infections

According to the NMSS, symptoms of a urinary tract infection can include:

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 theyve had before and that turned out to be a UTI, we can do urine tests to see what is happening.

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The Significance Of Polymicrobial Culture

The majority of urine samples from catheterized patients yield a polymicrobial culture. According to standard protocol, this is often dismissed as contaminated, and therefore, unreliable and clinically insignificant. However, Khasriya et al. argued that there is no evidence to disprove polymicrobial culture as clinically significant . Using spun urinary sediment from MSU samples, they found that in many patients with lower urinary tract symptoms, the urothelium was colonized by multiple bacterial species, including E. coli. This would be expected to influence the treatment regimen, as sensitivity testing on each species may reveal that a single antibiotic therapy is inadequate for the eradication of infection . In addition, in catheterised patients it may be particularly difficult to distinguish between symptoms of UTI and neurogenic bladder. As a result, clinical judgment prevails when taking the decision to treat with antibiotics.

Are Utis A Problem For People With Ms

Incontinence, Urinary Tract Infection (UTI), Pyelonephritis – Medical-Surgical (Med-Surg) – Renal

Three in 10 people with MS reported a UTI in a study of 1,261 people living in Europe.

UTIs can occur as a result of disease-related bladder dysfunction. According to MS Focus magazine, between 70 and 90 percent of MS patients will experience bladder dysfunction as a result of neurogenic bladder. Neurogenic bladder occurs when signals between the brain and bladder are delayed or interrupted.

  • Catheter use in people with urinary incontinence
  • Restricted fluid intake to avoid searching for accessible restrooms
  • Inadequate hygiene resulting from urine leakage caused by lack of sensation, urgent and frequent urination problems, or urinary retention
  • Problems with excessive sweating caused by sitting for long spells

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Are You Asking The Right Questions

But there are challenges to overcome for both the patient and the healthcare provider. Better care and a better quality of life are possible when bladder and bowel are treated together.

Weve collected testimonies from those with bladder and bowel dysfunction related to their neurogenic diagnosis, whos lives have been improved and we explore the therapies that help to improve quality of life so that both patient and professional can reach for a better quality of life.

When The Body Is Dealing With Infection And Autoimmune Disease

Multiple sclerosis develops as a result of an overactive immune system attacking the white and gray matter of the brain, optic nerve, and spine. The assault is continuous our T-cells are lobbing grenades at myelin 24/7, even though we feel okay. We arent in constant flares because some immune cells move in like Army medics to administer first aid on the battle field, thereby healing the inflammation before the damage can corrupt nerve signals and cause symptoms of a flare. But things can get complicated after that.

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Pelvic Floor Muscle Training

Pelvic floor muscle training may be used solely, or in combination with other therapies, to treat LUT dysfunction in patients with MS. PFMT is effective in patients who demonstrate the ability to contract pelvic floor muscles. The proposed mechanism of action is through the activation of an inhibitory reflex on detrusor activity when the pelvic floor muscles are voluntarily contracted . The benefits of PFMT are modest and studies are limited by low patient numbers and heterogeneous outcome measures. A recent study demonstrated that PFMT alone or in combination with neuromuscular electrical stimulation or transcutaneous tibial nerve stimulation improved storage symptoms in women with MS . Due to its non-invasiveness, PFMT should be continued whenever possible throughout the treatment course.

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Why Do People With Ms Get Frequent Utis

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Bladder dysfunction occurs when MS lesions block or delay transmission of nerve signals in parts of the central nervous system 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.

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