The Frequency of Asymptomatic UTIs in Persons With Multiple Sclerosis

Background: UTIs have been reported to occur in greater than 70% of MS patients who report lower tract symptoms.  These symptoms include urgency, frequency, urge incontinence, hesitancy, feeling of incomplete emptying, straining to void, nocturia, and slow or intermittent stream. In studies, these MS patients have higher disability and lower quality of life.  Therefore, early detection and management of lower tract symptoms has been shown to improve quality of life.   Although, urinary dysfunction has been well studied in MS patients as a common symptom related to disease progression and optimizing quality of life, no studies have been done to evaluate the prevalence of this symptom in MS patients who are not reporting symptoms or free of relapse.

It is common practice for providers to exclude UTIs in patients who report new or worsening symptoms possibly suggestive of a relapse or change in disability.  It is well documented in MS relapse management guides and studies of persons presenting with encephalopathy or delirium that coexisting UTIs should be excluded.   Studies document well UTIs frequently accompany or precede deterioration of neurologic function in persons with chronic preexisting neurologic disorders like MS.

In this study, the frequency of UTIs in MS patients who are not reporting any lower tract symptoms will be determined.  In addition, a evaluation of the correlation between patients with asymptomatic UTIs  and with MS patients who suggest their disease modifying drug (DMD) is not effective and/or report higher relapses,  report poor quality of life and are at higher risk of lack of adherence will be determined.  In MS patients who may have UTIs undiagnosed, this would present a great risk, but current medical and nursing practice does not suggest screening urine samples when MS patients do no report symptoms. 

Objectives: What is the frequency of asymptomatic UTI in MS patients and does this correlate to level of disease modifying medication adherence, reported relapses, disability, and quality of life

Methods: This is a prospective, descriptive correlational study of 40 patients designed to examine the frequency of UTIs in MS patients who do not report urinary symptoms and to determine a correlation between relapses, disease modifying medication adherence, disability, and quality of life.  Data collected: Source Documentation is a standard questionnaire of patient demographics and history. MSQol 54, PDDS, Dipstick Urine Urine Culture and Sensitivity

Results: 17.5% actually confirmed UTI and had no symptoms and even larger had some clinical findings with positive dip stick, 42.5%.  Statistically significant differences in α=0.05, results for most of the variables except the mental health portion of the MSQoL

Conclusions: There is confirmed evidence of significant frequency of asymptomatic UTIs and this correlates with decreased quality of life and increased disability, but not significant evidence to evaluate adherence and relapses.