The urinary tract is responsible for filtering and removing waste and excess water from the body. When bacteria get into the urinary tract, it can lead to a UTI. “The bladder is a muscle, and as with any muscle, it’s controlled by nerves,” explains Ly Hoang Roberts, MD, a urologist at Cleveland Clinic. “If you have any kind of nerve damage — from a stroke, Parkinson’s, a spinal injury, or MS — it can impact the bladder.” MS can affect the bladder in two main ways, notes Dr. Hoang Roberts. First, “The bladder can squeeze too much and cause you to feel like you have to go to the restroom very often — and sometimes it can squeeze so strongly, you leak urine,” she says. “Then that turns into sitting in wet underwear, pads, or diapers throughout the day, which can increase your risk for infection.” Second, “For some people, MS can lead to not being able to pee at all, or sometimes the bladder squeezes a little bit out but doesn’t empty, and then you have some urine left in the bladder,” she says. “That becomes a stagnant pool of urine in the bladder, and bacteria love that.”

The Risk of UTIs in MS

According to a study published in 2020, UTIs in people who have MS can cause a variety of secondary health problems:

An MS flare that may, in turn, make the condition worseAn increased risk of hospitalizationA higher risk of dying

“If you don’t treat [a UTI], if that urine goes up into the kidney, it can cause kidney infection,” says Hoang Roberts. And sometimes the infection can spread to the bloodstream and cause sepsis.

Treating UTIs in MS

Your doctor can diagnose a UTI quickly and easily by checking a urine sample for bacteria. From there, your care team can recommend the best treatment for you. A course of antibiotics is the gold standard for treating UTIs, but if you have MS, your treatment may not be so straightforward. If the test shows bacteria in the urine, even though you aren’t experiencing symptoms, this is known as asymptomatic bacteriuria, which comes with different treatment recommendations. “We don’t like to treat it because every single time you get antibiotics, it increases your risk of antibiotic resistance,” says Hoang Roberts. Though if you keep getting symptomatic UTIs because you’re not emptying your bladder completely, then procedures to help empty the bladder such as catheterization or urinary diversion can help. One study found that people with MS who underwent noncontinent urinary diversion to treat lower-urinary-tract symptoms experienced significant improvement in symptomatic UTIs, as well as overall quality of life. However, this is a major surgery, so other methods such as catheterization should be attempted first. When it comes to catheterization, “One option is putting a catheter in and changing it out every month, but that could be uncomfortable. It can also increase the risk of infection, because it’s a foreign body,” says Hoang Roberts. “The other option is called intermittent catheterization, which means that you can catheterize yourself every four to six hours, depending on how much urine you make. And that is preferred, because the risk of infection is lower.”

UTI Prevention Tips

If you have MS, you can lower your risk of UTI using the same strategies otherwise healthy people do:

Drink plenty of water to flush out your urinary tract.Pee as soon as you feel the urge — don’t hold it in — but don’t push or rush to finish.Empty your bladder after sex.Wipe from front to back if you’re a woman.As often as possible, take showers rather than sitting in bathwater.Wear loose, breathable cotton underwear.

While lacking in conclusive evidence as preventative strategies, you might also try a couple of other things:

Take cranberry: “It has ingredients shown to decrease the risk of symptomatic infections,” notes Hoang Roberts.Take D-mannose: One study found that taking this supplement — made from a sugar commonly found in fruit — daily for 16 weeks significantly reduced the number of UTIs in people who have MS.

When it comes to UTIs and MS, notes Hoang Roberts, prevention is the best treatment.