A urinary tract infection (UTI) is a bacterial infection of the urethra, bladder, ureters or kidneys. When infection is confined to the lower urinary tract (the bladder) it is called cystitis. If infection spreads to the upper urinary tract (the kidneys) it is called pyelonephritis, and is considered more serious. Inflammation of the urethra, the channel between the bladder to the outside of the body, is known as urethritis.

The symptoms vary, but often include:

Burning or pain upon urination

Urgency to urinate

The need to urinate frequently

Incontinence (an uncontrollable urge to urinate)

Nocturia (the need to urinate frequently during the night)

Strong-smelling urine

Pain in the lower back or abdomen

Chills and/or low-grade fever

Blood in the urine

Pain during sexual intercourse

UTI's occur when organisms enter the urinary tract and multiply. Most infections are caused by Escherichia coli (E. coli) bacteria, which are abundant in the intestinal tract and therefore in the rectal area.

UTI's are common among patients with MS. Plaques on the nerves of the brain and spinal cord interrupt the messages between the bladder and the brain, which creates problems with bladder function. There are two types of bladder function problems common to MS that increase the risk for a UTI.

Failure to empty syndrome, or a "flaccid" or "big" bladder, occurs when bladder fullness is not correctly perceived and the bladder is not emptied. The bladder also may not completely empty because the sphincter muscle that allows the flow of urine is tight and spastic and does not open properly.

In a different condition known as conflicting bladder, or "combined dysfunction," the activity of the bladder muscle is not coordinated with the sphincter muscle. This lack of coordination can mean that the bladder is contracting to empty but the sphincter will not allow urine to pass or that the sphincter relaxes to release urine when the bladder is not contracted.

Failure to empty syndrome and conflicting bladder cause urine to be retained. Urine that pools in the bladder longer than normal can encourage bacterial growth, which can lead to a urinary tract infection.

The risk for UTI increases further when a patient must use a catheter to manage bladder disorders. This is because it is easier for bacteria to enter the urinary tract via the catheter.

After a review of the patient's symptoms and a physical examination, which may include a pelvic exam for women, lab tests will be ordered. A urine analysis that reveals white blood cells and bacteria confirms UTI. A urine culture may be needed to identify the best treatment. This test allows bacteria from the urine sample to grow in a laboratory medium for three days. The bacteria are then tested for sensitivity to various antibiotics.

A UTI requires a course of antibiotics, usually for 3 to 10 days. It's important for patients to take all the medication as directed -- they should not stop taking it when they feel better; if they do, the bacteria may regain a foothold and the infection can return.

Patient are usually also advised to increase fluids and specifically instructed to drink cranberry juice. Researchers have discovered that cranberry juice changes the shape of E. coli bacteria in a way that prevents them from attaching to the wall of the bladder. This allows the bacteria to be more easily "rinsed out" during urination. Vitamin C (at least 1000 mg/day) may also be recommended because it increases urine acidity. Pain medicine may be prescribed as well. Severe infections may be treated in a hospital with intravenous antibiotics. Infection that has spread to the kidneys can enter the bloodstream and become life threatening. Patients with recurrent UTI's or severe UTI's with kidney involvement should be seen by an urologist or nephrologist.

Drink 6 to 8 glasses of water every day

Take vitamin C and drink cranberry juice on a regular basis.

Try not to hold urine long after the urge to urinate is felt.

Try to empty the bladder as completely as possible, straining or applying external pressure with the hand if necessary.

Extra tips for women:

Wear all-cotton or cotton-crotch underwear and pantyhose.

Change underwear and pantyhose daily.

Urinate after sexual intercourse and drink a glass of water.

Wipe from front to back after using the bathroom to keep bacteria away from the urethra.

Take showers instead of tub baths.

References

First published October 1, 1999
Last updated September 12, 2003
Copyright © 1999 Accordant Health Services, Inc. All Rights Reserved.

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