Can Multiple Sclerosis Cause Blood in the Urine, and When Is Urgent Care Needed?

Blood in the urine (hematuria) is not a typical direct effect of multiple sclerosis (MS), but people with MS can have bladder dysfunction that raises the risk of urinary tract problems which may include hematuria. ^[1] Neurogenic bladder caused by disrupted nerve signaling due to MS can lead to urinary retention, urgency, frequency, and incontinence; these issues increase the chance of urinary tract infections (UTIs), and UTIs can present with blood in the urine. ^{[2] [3]} In addition, certain MS treatments and catheter use may contribute to bleeding risk or urinary complications. ^{[4] [1]}

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How MS Relates to Hematuria

• Neurogenic bladder and UTIs: MS commonly causes lower urinary tract symptoms (LUTS) like urgency, frequency, retention, and incontinence, which predispose to UTIs; UTIs can cause gross (visible) or microscopic blood in the urine. ^{[1] [5]}
• Catheters and instrumentation: Clean intermittent catheterization is often used to manage retention and is preferred over indwelling catheters to lower infection risk; however, any instrumentation can occasionally cause irritation or bleeding. ^[1]
• Medications: Some MS disease‑modifying therapies (for example, alemtuzumab) carry bleeding‑related warnings; if you notice blood in urine while on such treatments, prompt medical review is recommended. ^[4]

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Common Causes of Blood in the Urine in People With MS

While MS itself doesn’t directly cause hematuria, several conditions more likely in MS can lead to it:

• Bladder infection (cystitis): Typical signs include frequent, painful urination, pelvic pressure, cloudy or foul-smelling urine, and blood in the urine. ^{[6] [3]}
• Kidney infection (pyelonephritis): Symptoms can include fever, chills, back or side pain, nausea, and sometimes blood in the urine. ^[7]
• Bladder irritation from neurogenic dysfunction or catheter use: Irritation or trauma can lead to trace bleeding. ^[1]
• Non-urinary causes that change urine color: Foods or medicines can redden urine without true blood; however, red or cola-colored urine should still be checked. ^[8]

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When to Seek Urgent Care

• Immediate care: If you have visible blood in the urine with clots, severe pain (back/side/groin), fever, chills, nausea or vomiting, or you appear unwell, you should seek urgent or emergency evaluation. ^{[7] [9]}
• Prompt medical review: Any new episode of visible blood in the urine should be evaluated; red urine should be discussed with a clinician even if it isn’t painful. ^[8]
• MS-specific considerations: Because UTIs can worsen neurological symptoms in MS, timely identification and treatment is important; early evaluation helps prevent relapses being confounded by infection. ^[10]

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What to Expect in Evaluation

Clinicians typically start with a focused assessment:

• Urinalysis and urine culture: To check for infection, blood, and inflammation. ^{[6] [3]}
• Symptom review and exam: Including bladder emptying, catheter use, and neurological symptoms. ^[1]
• Further testing if needed: Imaging or urology referral if bleeding persists, recurs, or if there are red flags (fever, flank pain, severe symptoms). ^[11]

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Practical Management Steps

• Treat UTIs promptly: Early antibiotics are usually recommended when UTI is confirmed; managing infection can reduce MS symptom aggravation. ^[10]
• Optimize bladder care: Scheduled voiding, avoiding bladder irritants, and using medications or therapies for neurogenic bladder (e.g., anticholinergics, botulinum toxin, neuromodulation) may lower UTI risk and bleeding episodes. ^{[1] [12]}
• Use the safest catheter strategy: Clean intermittent catheterization is preferred over indwelling catheters to reduce infection risk and complications. ^[1]
• Medication review: If on therapies associated with bleeding risks, report any unusual bleeding including hematuria right away for guidance. ^[4]

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Quick Reference: Symptoms and Actions

• Blood in urine with pain or burning, frequent urination, lower belly discomfort: Consider bladder infection; seek prompt medical care. ^[3]
• Blood in urine plus fever, chills, back/side pain, nausea/vomiting: Possible kidney infection; seek urgent care. ^[7]
• Red or cola-colored urine without pain: Still contact a clinician to exclude true hematuria or other causes. ^[8]

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Summary

• MS doesn’t directly cause hematuria, but MS‑related neurogenic bladder increases the risk of UTIs and urinary complications that can present with blood in the urine. ^{[1] [2]}
• Visible blood in urine should be evaluated, and urgent care is warranted if bleeding is accompanied by systemic or severe symptoms (fever, chills, flank pain, nausea/vomiting, clots, or marked discomfort). ^{[7] [8]}
• Proactive bladder management and prompt treatment of UTIs are important in MS to prevent symptom worsening and complications. ^{[1] [10]}