Urinary Tract Bladder Infection

urinary tract infection (uTi) is an example of what is termed a secondary problem in MS. UTI is not a direct result of the demyelina-tion process but occurs as the result of (secondary to) the retention of urine in the bladder. Mild infection may result only in increased frequency and urgency of urination, whereas severe infection produces fever and generalized illness.

The incidence of urinary tract infection is higher than normal in (1) those who have a flaccid bladder, because bacteria may grow in the retained urine; (2) those who need to perform intermittent self-catheterization; and (3) those who have an indwelling Foley catheter, which may provide bacteria with a direct route into the bladder. Women generally are at higher risk for the development of bladder infection than men. The diagnosis of a urinary tract infection is made by a urine culture, in which urine is collected in a sterile fashion and tested for the presence of bacteria. The presence of bacteria in the urine does not necessarily mean that there is an infection that requires treatment. Many people with Ms have what is described as "asymptomatic bacteriuria," especially if they have an indwelling Foley catheter. if the person is asymptomatic, without pain, fever, or other signs of the spread of infection, it is appropriate simply to watch the process.

other symptoms of a urinary tract infection may include frequent urination, urgency, burning, or discomfort when urinating, fever, or foul-smelling urine accompanied by the presence of blood or mucus. Because some of these symptoms are similar to symp toms frequently experienced by an individual with MS, treatment should not be started until the presence of infection has been confirmed. Generally, infection is suspected when symptoms occur suddenly or if fever is present. A urine specimen is cultured in the laboratory to confirm that bacteria are present before treatment is initiated with an antibiotic specific for the organism causing the infection; the antibiotic generally is taken for seven to ten days. New antibiotics are being developed constantly, and they have been very helpful in managing severe bladder infection.

Bladder infection may largely be prevented by complete bladder emptying, using self-catheterization techniques if necessary. Bacterial growth is prevented or retarded when the urine is acidic, which is best achieved by taking high doses of vitamin C. A person who has a history of urinary tract infection may be helped by substances that suppress the growth of bacteria in the urine and low doses of antibiotics, usually sulfa or nitrofurantoin. Prevention is the key to avoiding bladder infections.

• Urination should be frequent and complete, and holding urine in the bladder for long periods should be avoided.

• Women should be careful to wipe from front to back, especially after a bowel movement, and should avoid undergarments that are made of synthetic materials, which tend to trap moisture. Women who have recurrent infection should empty the bladder both before and after intercourse.

• Adequate amounts of fluid should be taken to keep the bladder "flushed." Generally six to eight glasses per day is sufficient.

• Those who are prone to the development of bladder infection should take up to 1000 mg of vitamin C four times each day to make their urine more acidic, because higher acidity inhibits bacterial growth.

People who have an indwelling Foley catheter should be especially careful to keep the catheter, tubing, and drainage bag as clean as possible. The catheter should be changed at least once a month, using proper sterile technique.

Urinary tract infection may pose a serious threat to health if it is not properly treated, so it is very important to seek medical attention if symptoms occur.

When a urinary tract infection does occur, the key to treatment is the use of an appropriate antibiotic, as indicated by the results of the urine culture and a related test for the antibiotic sensitivity of the infect-

'Urinary tract infection may pose a serious threat to health if it is not properly treated, so it is very important to seek medical attention if symptoms occur.

ing organism. It is important that this medication be taken as directed for the complete time period indicated to ensure that all the invading bacteria will be destroyed. It is a mistake to stop taking an antibiotic if you are feeling better because not all the bacteria will have been destroyed; the remaining bacteria will reinvade and cause further problems.

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