ClinicSpeak: infections and bladder problems; common sense?

Do you have bladder problems? Please don't ignore them. #MSBlog #MSResearch #ClinicSpeak

"This small descriptive study reminds us what a burden bladder problems are for pwMS. In this relatively young cohort of pwMS (average age 37 years) over half already had urinary problems with a quarter having problems with incontinence. More sinister are observations from other studies that early bladder problems are a poor prognostic factor and indicate underlying structural damage to the long fibre tracts in the spinal cord and brainstem; in short pwMS with early bladder problems do worse than MSers without bladder problems."

"Not surprisingly bladder problems were associated with bladder infection. Why? The main driver of this is incomplete bladder emptying; urine left behind in the bladder acts as a reservoir for bacteria to grow in. Another problem is reduced fluid intake to control urinary frequency and urgency. When you do this you flush your bladder less frequently allowing bacteria more time to cause an infection. Please don't manage your bladder problems by restricting your fluid intake."

"There is also evidence that pwMS who have multiple infections tend to progress more rapidly. Why? The inflammatory mediators from systemic infections activate innate immune mechanisms within the brain and spinal cord that drive neurodegeneration. When it comes to the holistic management of MS it is a good idea to try and prevent recurrent urinary tract infections. This is easier said than done, which is why our group has a programme of research targeting better control of bladder problems with the aim of reducing urinary tract infections."

"Again I dream of a world when all MSers are treated early and effectively enough so that they never develop bladder symptoms. Wouldn't that be wonderful?"

Nikseresht et al. Association Between Urinary Symptoms and Urinary Tract Infection in Patients With Multiple Sclerosis.Glob J Health Sci. 2015 Sep 28;8(4):48574.

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 (95.4%) were female. Overall 56.3% of patients displayed urinary symptoms. The most prevalent urinary problems were urinary incontinence and frequency (25.3% and 24.1%, respectively). 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 (64.5% and 40% in UTI and non-UTI patients, respectively; p=0.036). Separately none of the different urinary symptoms displayed a significant difference between UTI and non-UTI patients (p>0.05).

CONCLUSION: 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.

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