Urinary Tract Infections (UTI)

Please note: the information below does not constitute medical advice. If you have any concerns at all, speak to your GP or consultant.

 

 

 

Approved: April 2024

 

 

 

Review date: April 2026

 

 

 

Disclaimer: These resources on UTI do refer specifically to Male and Female anatomy but are relevant for all genders.

Urinary Tract Infections (UTI) about

What Exactly Is a UTI?

A Urinary Tract Infection (UTI) is an infection in any part of your urinary system, which includes your kidneys, bladder, ureters, and urethra. Understanding how UTIs develop and the symptoms associated with different stages can help in effective management and timely treatment.

Most UTIs begin when bacteria, typically from the skin or rectum, enter the urethra—the tube through which urine exits the body. Once inside the urethra, these bacteria colonise, or establish themselves, before they ascend to the bladder. This colonisation can lead to cystitis, or inflammation of the bladder. If this infection is not adequately treated, the bacteria can continue moving up to the kidneys, resulting in pyelonephritis, a more serious kidney infection

Understanding the potential progression of a UTI through the urinary system

  • The urethra, which is the tube that carries urine out of the body, gets contaminated by germs (pathogens) that begin to grow and multiply. This is the starting point of most UTIs.
  • Urethritis involves inflammation of the urethra, which is the tube that carries urine from the bladder to the outside of the body. The symptoms can overlap with bladder infection (Cystitis).
  • Cystitis : As the pathogens move up from the urethra to the bladder, they attach to the bladder walls and start to multiply, causing inflammation and damage. This inflammation can cause symptoms like pain and frequent urination.
  • Infection Spreads to Kidneys: Sometimes the pathogens can travel further up through the ureters to the kidneys, leading to pyelonephritis (a kidney infection). This is more serious and can cause symptoms such as severe back pain, fever, and nausea.
  • Potential Complications: In the most severe cases, the bacteria may cross into the bloodstream, a condition known as septicaemia. This can quickly progress to sepsis, a life-threatening response to infection.

Understanding simple or uncomplicated UTI

Simple UTIs Explained

An uncomplicated UTI is defined as an infection of the urinary tract occurring in an otherwise healthy individual who does not have any abnormalities in the urinary structure or function. This type of UTI typically affects people with a normally functioning urinary tract and is generally straightforward to treat with standard antibiotics.

Exclusions from the Uncomplicated UTI Category:

  • If you are male – usually excluded from this category because their urinary tracts are anatomically more complex due to the presence of the prostate, and infections may often involve these additional structures.
  • If you are pregnant – you are excluded because hormonal and physical changes during pregnancy can affect the urinary tract and its function, thereby complicating the diagnosis and treatment of UTIs.

In both of these cases you will require a longer dose of antibiotics if you develop a UTI.

Understanding Complicated UTIs

A complicated UTI is an infection of the urinary tract that presents additional challenges compared to the more straightforward, uncomplicated UTI. This type of infection typically occurs under conditions that predispose the urinary tract to either frequent UTIs or to infections that are difficult to treat. Here are the key factors that characterise complicated UTIs:

  • Physical or functional abnormalities in the urinary system. These can include structural issues such as strictures (narrowing) in the urethra, kidney stones, or other conditions that obstruct urine flow and make it difficult for the body to clear the infection naturally.
  • Problems with Immune System: Patients with weakened immune systems, whether due to conditions like diabetes, cancer treatments, or use of immunosuppressive medications.
  • Presence of multi-anti biotic resistant bacteria: Infections caused by bacteria that are resistant to multiple antibiotics are harder to treat and require more complex medical management. This resistance can result from previous antibiotic use, hospital-acquired infections, or community-spread resistant strains of bacteria.
  • Use of Medical Devices: The use of catheters or other urinary devices can increase the risk of developing a UTI because they can introduce bacteria directly into the urinary tract and provide a surface for bacterial growth.
  • Other Risk Factors: Including (but not limited to) recent urinary tract surgery, neurological conditions affecting bladder function, or a history of recurrent UTIs.

Understanding the difference between Recurrent and Chronic UTIs

If you experience two UTIs in six months or three within one year, you might be dealing with recurrent UTIs. This can manifest as –

  • A new infection: the original infection has been resolved by treatment to be followed by the same or a different bacterium causing a new infection.
  • A persistent or resurgent infection: Here the pathogen that caused the UTI was not completely eradicated by the treatment and escalates to repeat the same symptoms. Unfortunately, this cycle can repeat itself and presents like a new infection. This persistent pattern of UTIs is also known as chronic UTI and unfortunately in many females and some males it’s a cycle that can be relentless.

Causes Of UTIs

Bacterial Infection

  • E. coli: The most common cause of UTIs, this bacterium normally lives in the intestines but can spread to the urinary tract.
  • Other bacteria: While E. coli is the predominant cause, other bacteria like Staphylococcus saprophyticus, Proteus mirabilis, Klebsiella pneumoniae, and others can also cause UTIs.

Risk/ Trigger Factors

  • Inadequate fluid intake
  • Sexual activity: Especially frequent, intense, or recent sexual activity can introduce bacteria into the urinary tract.
  • Female anatomy: Females are more prone to UTIs due to having a shorter urethra, which shortens the distance bacteria must travel to reach the bladder.
  • Bowel issues due to bacteria being transferred from anus to urethra.
  • Urinary catheters: The use of catheters can also introduce bacteria directly into the bladder.
  • Menopause: The decrease in oestrogen levels during menopause and perimenopause can affect the protective lining of the bladder and urethra, making it easier for bacteria to adhere and colonise (develop)
  • Urinary Retention: Incomplete emptying of the bladder can lead to UTIs, as bacteria that remain in the bladder have a chance to grow.
  • Blockages in the urinary tract: Kidney stones or an enlarged prostate can block the flow of urine, increasing the risk of UTIs.
  • Surgery that has rearranged the urinary system plumbing such as urinary stomas and bladder reconstructions.
  • Weakened immune system: Conditions that impair the immune system can make it harder to fight off infections.
  • Diabetes: High blood sugar levels can promote bacterial growth and reduce the body’s ability to fight off infections.
  • Genetic predisposition: Some individuals may have a genetic susceptibility to UTIs, affecting how their bodies respond to bacterial invasion

Urinary Tract Infections (UTI) symptoms

Symptoms of simple or uncomplicated UTIs (Bladder and Urethra – cystitis/urethritis)

  • Urgency to pass pass urine
  • Burning sensation during urination
  • Irritated / stinging sensation in urethra (water pipe)
  • Difficulty / unable to pass urine
  • Frequent trips to the toilet with small amounts of urine passed
  • Frequent trips to toilet through the night (nocturia)
  • Cloudy or strongly smelling urine
  • Blood in urine (haematuria)
  • Hurts to have sex
  • Pain or heavy feeling in pelvic region and/or lower part of your tummy
  • Urine leakage
  • Back pain

Symptoms Chronic UTI

Symptoms may be in line with the above but you may also experience the following symptoms. These symptoms may occur frequently and may never completely disappear between episodes.

  • Kidney pain
  • Urethral pain
  • General malaise: Feeling generally unwell, fatigued, or shaky, especially if the infection is ongoing or recurrent.

Sepsis – Symptoms

As mentioned above, in the most severe cases, the bacteria may cross into the bloodstream, a condition known as septicaemia. This can quickly progress to sepsis, a life-threatening response to infection. It is important to recognise the symptoms of sepsis which include:

  • Fever and Chills: Often one of the first signs of a kidney infection.
  • High Fever: A higher fever can indicate that the infection has reached the kidneys or that the body is fighting off a serious infection.
  • Flank Pain: Pain on one or both sides of the back where the kidneys are located.
  • Nausea and Vomiting: Making it difficult to keep fluids down, which is essential in treating a UTI.
  • Feeling confused or noticing confusion in someone you are caring for.
  • Increased Fatigue: A general feeling of being unwell.

Timely medical intervention is crucial, especially if any signs of kidney infection or sepsis are present. Recognizing these symptoms early and consulting a healthcare provider can prevent the progression of the infection and lead to a safer, more effective treatment outcome.

https://sepsistrust.org/about/

https://www.nhs.uk/conditions/sepsis

Urinary Tract Infections (UTI) diagnosis

Diagnosing a UTI: Understanding the process and its challenges

If you suspect you have a urinary tract infection (UTI), it’s important to get medical advice from your GP or pharmacist so you can begin the right treatment if necessary. Here’s how UTIs are typically diagnosed and some insights into the limitations of these methods:

Common diagnostic tests for UTIs

Rapid Dipstick Strip Test

This test can be performed quickly at your surgery or can be done at home. It checks for signs of infection, such as nitrites and leukocytes (white blood cells), in your urine.

Limitations: While convenient, dipstick tests are not foolproof. They can miss infections, especially if the bacteria causing the UTI don’t convert nitrate to nitrite.

Urine Culture

This standard testing has remained unchanged for decades. The test involves sending a urine sample to a lab where it’s tested to identify the type of bacteria and determine the best antibiotic for treatment. This process can take 24-48 hours.

Challenges: Despite its widespread use since the 1950s, urine cultures can fail to grow bacteria under certain conditions, leading to false negatives.

Addressing Diagnostic Challenges

Despite these methods being standard, they are not always accurate, and there can be instances of negative UTI test results even when an infection is present, and symptoms are experienced. This has prompted a change in how UTIs can be managed:

Updated Guidelines: Recent guidelines, such as those from NICE (National Institute for Health and Care Excellence), now advise that treatment for UTIs can be initiated based on symptoms alone, especially if you have two or more typical symptoms of a UTI (see section above on symptoms). This approach helps to start treatment sooner, even before test results are available.

​​https://www.nice.org.uk/guidance/ng109/resources/urinary-tract-infection-lower-antimicrobial-prescribing-pdf-66141546350533

Easier Access to Treatment: These guidelines have been adapted into practice, allowing patients to access antibiotics directly from a pharmacy without a prescription, provided they meet certain criteria and symptoms. Your GP or Nurse Practitioner or Pharmacist will ask you a series of questions to ensure you are accessing the right treatment.

These updates aim to reduce delays in treatment and address the limitations of standard testing, ensuring that those who experience UTIs can receive timely and effective care.

What This Means for You:

  • If you’re experiencing symptoms of a UTI, such as a burning sensation when urinating, an urgent need to urinate frequently, or pain in the lower abdomen, you don’t necessarily have to wait for test results before starting treatment. Discuss your symptoms with your pharmacist to determine the best course of action. You may be able to access a three-day course of antibiotics from your pharmacist or from an online pharmacy where you will need to answer a few questions on your symptoms and medical history.
  • Not all urinary symptoms require antibiotics. Taking antibiotics when they aren’t necessary can lead to changes in your gut bacteria, making some bacteria resistant to treatment. This can make future urinary tract infections (UTIs) more challenging to treat. Some UTIs do resolve on their own and can be managed with increased fluid intake and across the counter pain relief such as paracetamol or ibuprofen. Over-the-counter preparations that change the PH of your urine can help with stinging and burning symptoms’.
  • It is important to remember that accessing a 3-day course of antibiotics applies to uncomplicated UTIs only, and if you have additional health concerns or this is a recurrent UTI you should see your GP for a more in-depth assessment as you may need a longer course of antibiotics which would need to be prescribed.
  • If you see your GP, they may give you back up or ‘self-start’ antibiotics to start taking if your symptoms do not improve within 48 hours (or they worsen)
  • Common side effects from antibiotics include yeast infections, rashes, vomiting, and diarrhoea. If you experience any of these side effects, it’s wise to consult with your GP or pharmacist.

Understanding Asymptomatic Bacteriuria

What is Asymptomatic Bacteriuria?

This happens when bacteria are present in your urine but are not causing you any symptoms of a UTI. This means you may not be experiencing the typical symptoms of burning, urgency, or frequency in urination.

Should I be concerned?

In most cases, asymptomatic bacteriuria does not require treatment with antibiotics. It is becoming increasingly understood that it may be part of your body’s natural bladder environment, where different bacteria can live without causing harm. This is part of the ‘Bladder Biome’ Traditionally the bladder was thought to be sterile, but recently research has shown that even healthy bladders can contain a complex mix of various bacteria.

When is treatment necessary?

Treatment is generally not needed unless.

  • You are pregnant to avoid any potential complications
  • You are undergoing a procedure on the urinary system which may disrupt the lining of the bladder and potentially lead to an active infection.
  • You have other medical conditions which put you at higher risk of infection such as any impairment to your immune system

Remember

Asymptomatic bacteriuria is a common condition and is typically not a cause for concern.

However, it’s important to be on the look out for any symptoms suggestive of an active UTI and seek advice from your GP.

Understanding why your prescription may be changed/or is longer than three days

  • If a urine sample has been sent off at your surgery the results may later indicate a change of antibiotic.
  • If you are pregnant antibiotics will be given (at least 7 days) and ideally a urine sent off for culture – antibiotics can be changed according to the result when available.
  • If you are male antibiotics will be given (at least 7 days) and ideally a urine sent off for culture – antibiotics can be changed according to the result.
  • If you are Trans antibiotic treatment will be dependent upon gender reassignment surgery and structural changes made to the urethra.

Seeing your GP for complex, recurrent, and persistent symptoms

Your GP will review your symptoms and medical history. A physical examination may also be conducted as this can identify any obvious causes or complicating factors such as a vaginal prolapse in females, or an enlarged prostate in males.

If you are experiencing recurrent UTIs it’s important to ask your GP to look back in your records for your UTI and symptom history, especially if you are seeing a different doctor. Previous urine results and previously prescribed antibiotics can be checked. This helps ensure the antibiotic is effective and reduces the risk of resistance.

Despite concerns about antibiotic resistance on a global level, sufferers of recurrent infection often have little choice but to rely on these medications to manage symptoms effectively. Work is being done to find antibiotic alternatives [see section on Methenamine Hippurate (Hiprex) and UTI Vaccines].

Tests

  • A urine sample is typically tested (urinalysis) to detect signs of infection and inflammation, such as the presence of white blood cells, red blood cells, or bacteria.
  • A urine culture may be done to identify the specific type of bacteria causing the infection.
  • Although we have outlined the limitations of such testing in many cases, having a record of which bacteria has caused your infections will be very useful in establishing patterns and getting you on the correct treatment.

Further Testing

If recurrent infections are suspected, more detailed evaluations like ultrasound, cystoscopy (telescopic examination of the bladder), or CT scans may be recommended to rule out underlying causes. This is especially important if you are experiencing blood in your urine.

Handling a Negative Test Result

Persistent Symptoms with Negative Urine Culture:

Sometimes, symptoms typical of a UTI persist even though the urine culture comes back negative. This situation can be frustrating and confusing for both the patient and the doctor. Patients can often feel like they are not believed or not being listened to.

Possible Explanations:

Sample issues:

  • Antibiotic influence: If antibiotics were taken before collecting the urine sample, they could suppress the growth of bacteria, leading to a negative result.
  • Dilution from hydration: Excessive fluid intake can dilute your urine, making it harder to detect bacteria.
  • The ability of standard testing is limited.

Embedded infections:

  • Bladder biome complexities: Sometimes, bacteria can embed themselves deep within the layers of the bladder wall or form biofilms that are not easily reached or detected by standard urine tests. These embedded infections can cause recurring or chronic symptoms that are similar to UTIs but do not show up in standard cultures.
  • Other conditions that can mimic the symptoms of a UTI such as an STI.

What You Can Do

If you frequently receive negative test results despite having UTI-like symptoms, discuss these possibilities with your GP.

  • Further diagnostic testing: Additional tests, such as a cystoscopy (telescopic bladder examination) or more sensitive microbial testing, might be necessary to explore other causes or detect difficult-to-capture bacteria.
  • Specialist consultation: Seeing a specialist, such as a Urologist or a Gynaecologist, can provide more targeted insight into complex cases where standard tests fail to explain the symptoms.

Urinary Tract Infections (UTI) treatment

Treating UTIs

Every individual experience urinary tract infection (UTIs) differently, influenced by unique bodily responses, lifestyle factors, and underlying health conditions. Recognising this diversity is crucial, as it shapes the approach to effectively treating and managing UTIs.

It’s important to try to take proactive steps in managing your health where you can. By actively understanding your symptoms and triggers, you can actively participate in decisions about your treatment options and preventative strategies.

Point of access care of UTIs can vary widely and there can be a lack of joined up thinking and different interpretations of the guidelines when it comes to UTI care. We hope that these resources can enable you to understand more about available treatments and steps you can take to try to prevent future infections, manage symptoms effectively, and navigate the healthcare system more confidently.

If you recognise some of these symptoms and patterns of infections in yourself or someone you care for, it’s important that you speak with your GP who can refer you on to a specialist Urology centre for UTIs.

Managing recurrent urinary tract infections (UTIs) requires a layered approach, starting with practical self-care measures and progressing to more specialized treatments if needed. Our goal is to empower you with the information and resources needed to manage your condition effectively.

First-Line Advice: Self-Care and Prevention

Hydration and bladder habits

  • Stay hydrated: Drink plenty of fluids throughout the day to help flush bacteria from your urinary system.
  • Complete bladder emptying: Take your time to empty your bladder fully, especially before and after sexual activity, to reduce the risk of bacteria build-up. The double void is a helpful strategy where you pass urine then wait, count to ten then try to pass urine again.

Dietary supplements: Evidence for common across the counter remedies

Vitamin C (ascorbic acid)

  • Proposed to help prevent urinary tract infections by acidifying the urine. Bacteria that cause UTIs, like E. coli, often thrive in a neutral or slightly alkaline environment. By lowering the pH (increasing the acidity) of urine, vitamin C might inhibit the growth of these bacteria, making it harder for them to multiply and cause an infection.
  • The effectiveness of vitamin C in acidifying the urine can vary greatly among individuals, depending on their metabolism and baseline urine pH.
  • There is some evidence that vitamin C can help with certain bacteria like Escherichia Coli (Ecoli) and a study found it beneficial reducing UTIs in pregnancy, but more evidence is needed for the general population of UTI sufferers.
  • While slightly more acidic urine can discourage some bacterial growth, extremely acidic urine might cause discomfort or other health issues like kidney stones, especially if consumed in high amounts over long periods.
  • It is known to have a role in boosting the immune system and as an antioxidant Vitamin C protects and helps reduce inflammation.
  • Anecdotal accounts suggest that Vitamin C may irritate the bladder so is not recommended in those who may have Interstitial cystitis or painful bladder syndrome.
  • The evidence from the pregnancy study highlighted an daily intake of 100mg of ascorbic acid was beneficial but anecdotal evidence suggests a supplement between 500- 1000mg is often taken as a prevention strategy along with other measures.

Cranberry Preparations

  • Cranberry products, particularly cranberry juice and capsules have been studied extensively for their potential to prevent urinary tract infections (UTIs).
  • They cannot be taken if you are prescribed the blood thinner Warfarin.
  • Cranberries contain compounds called proanthocyanidins (PACs) which are believed to prevent bacteria, especially E. coli, from adhering to the lining of the urinary tract. This anti-adhesion effect is thought to reduce the incidence of infections by preventing bacteria from establishing a foothold that could lead to infection.
  • Some studies have shown that cranberry products can reduce the frequency of UTIs, particularly in women with recurrent infections. However, results are mixed. A significant number of systematic reviews and meta-analyses have concluded that while there is some evidence suggesting a preventive effect, it tends to be modest.
  • Varied responses: The effectiveness of cranberry products may vary among different population groups. They tend to be more effective in some groups, such as younger women and those experiencing recurrent UTIs, compared to others like the elderly or those with neurogenic bladder or spinal cord injuries.
  • Due to mixed evidence, cranberry products are not universally recommended in clinical guidelines as a primary method to prevent UTIs. However, they are often suggested as a complementary measure.

D Mannose

  • D-Mannose is a simple sugar that is structurally related to glucose but is metabolized differently by the body. It is naturally found in small quantities in fruits like apples, oranges, and cranberries.
  • D-Mannose works by inhibiting the adhesion of bacteria, particularly Escherichia coli (E. coli), to the walls of the urinary tract. E. coli is the most common cause of UTIs. The bacteria have hair-like structures called pili that allow them to attach to and invade the lining of the bladder and other parts of the urinary tract.
  • D-Mannose binds to these pili, preventing the bacteria from sticking to the urinary tract cells. Instead, the bacteria remain suspended in the urine and are flushed out of the body during urination.
  • A 2013 study published in the “World Journal of Urology” found that D-Mannose powder significantly reduced the risk of recurrent UTIs, and it was as effective as the antibiotic nitrofurantoin but with fewer side effects.
  • D-Mannose is generally well-tolerated, with few reported side effects. The most common side effects include minor gastrointestinal symptoms such as bloating or diarrhoea.
  • More research is needed to fully establish its role in UTI management and to determine the optimal dosage and duration of treatment.
  • D- Mannose is available to buy across the counter.
  • The recommended dose is 2g daily either in tablet or powder form

Vaginal Oestrogen

  • For women in peri or post menopause, vaginal oestrogen therapy may help restore the natural flora of the vagina and reduce the risk of UTIs.
  • Topical vaginal oestrogens in cream or pessary form are available on prescription from your GP.
  • They can also be bought across the counter at your local pharmacy.

Probiotics

  • Probiotics are live microorganisms, primarily bacteria and yeasts, which are similar to beneficial microorganisms found naturally in the human gut. They are often referred to as “good” or “helpful” bacteria because they help maintain the health of the gut microbiome.
  • Probiotics are available in several forms including capsules, tablets, powders, and foods. They are also incorporated into certain yogurts, fermented foods like kimchi and sauerkraut, and beverages like kefir.
  • Probiotics can help prevent recurrent urinary tract infections (UTIs) by restoring the balance of good bacteria in the body, particularly in the urinary tract and vagina. This helps inhibit the growth of harmful bacteria that can cause infections. Specifically, probiotics like Lactobacillus strains are often recommended because they can colonize the vagina and reduce the risk of pathogen overgrowth.
  • Evidence is mixed. Deemed generally safe in studies, effectiveness can depend on strains and dosage.
  • Current advice is that probiotics can be tried in tandem with other supportive measures, but to take advice on strains and dosage.

Second-Line Strategies: Antibiotics and current Alternatives

Preventative antibiotics

  • Low-Dose Antibiotics: If non-antibiotic measures are insufficient, and you are experiencing recurrent UTIs, a low-dose antibiotic regimen might be prescribed for preventative purposes.
  • Self-start therapy: For known triggers such as sexual activity, a ‘self-start’ prescription may be provided, allowing you to take antibiotics as soon as symptoms appear.

Antibiotic alternatives

Methenamine Hippurate (Hiprex)

  • Methenamine Hippurate, commonly known by the brand name Hiprex, is a medication used primarily as a preventive measure against recurrent UTI and is classed as a urinary antiseptic.
  • Hiprex works by turning into formaldehyde when it reaches your urine. Formaldehyde is a strong antibacterial agent that can kill bacteria directly in the urine.
  • The key to its effectiveness is the acidity of the urine – it needs to be acidic for the medication to turn into formaldehyde.
  • Current advice advocates taking vitamin C along with Hiprex to help keep urine acidic.
  • It is not used for acute UTIs and is taken as a ‘preventer’.
  • If you develop a UTI when taking Hiprex, the advice is to keep taking the medication along with any antibiotics prescribed until the course is completed then continue on Hiprex.
  • Recent research has proven that Hiprex is as effective as taking low dose daily antibiotics without the problem of antibiotic resistance.
  • The dose is 1g twice daily
  • Hiprex is only available on prescription and is available in some areas of the UK. It is waiting for a NICE update for it to be available across the country.

Different Antibiotic regimens for treating UTIs

Uncomplicated UTIs

Simple and uncomplicated UTIs can sometimes resolve with increased fluids and over the counter pain medication. However, if your symptoms persist you can now access a short course of antibiotics (three days) from your local pharmacist or your GP/ online pharmacist.

If you are experiencing two or more symptoms of UTI such as pain/stinging on passing urine, frequency, and urgent feeling to pass urine you can receive antibiotics as long as you meet the criteria for a short course of antibiotics.

Treatments-care tips: Increasing fluid intake. using over-the-counter pain relievers and preparations to change the PH of your urine will help relieve your symptoms. It’s tempting to reduce your fluids to avoid painful urination, but this is the most effective way of getting the bacteria out of your bladder.

Frequent UTIs

If you are experiencing frequent UTIs or have identified a certain trigger to a UTI. The following is a useful guide to how antibiotics can be prescribed in a different, more individual way for your needs.

Targeted Antibiotic Use

Tailored Dosage: Antibiotics may be necessary, but the type and duration are chosen based on your specific health situation and past medical history.

  • Post-Coital Prophylaxis: If your UTIs are related to sexual activity, a single dose of antibiotics after intercourse might be recommended.
  • Daily low dose antibiotic may be recommended for a lengthy period 6-12 months.
  • Longer course of antibiotics can be indicated 7-10 days.
  • Self-start antibiotics – this is a good option for you if you recognise the start of a UTI in yourself. This option is useful for holidays as a standby.
  • Explore current alternatives to antibiotics – Methenamine Hippurate (Hiprex).
  • Vaginal Oestrogen: For peri and postmenopausal women, vaginal oestrogen therapy may help restore the natural flora of the vagina and reduce the risk of UTIs.

Chronic UTIs

If you have UTIs that either don’t fully go away after treatment or keep returning very frequently this is termed chronic UTIs. These may require a longer-term antibiotic treatment plan to manage the infection and prevent new flare-ups. The persistence of chronic UTIs can be due to a variety of factors, including bacterial biofilms that protect bacteria from antibiotics, incomplete antibiotic penetration, or immune system factors. Ongoing research aims to better understand these mechanisms to develop more effective treatments.

  • It’s sometimes necessary to have extended antibiotic therapy sometimes for a few months to treat embedded infection.
  • Self-start antibiotics.
  • Explore current alternatives to antibiotics – Methenamine Hippurate (Hiprex).
  • If these measures fail, you will benefit from a referral to Urology who can offer more treatment options depending on your individual symptoms.

Advanced treatments: specialised urology care

  • UTI vaccines: available from some specialised centres and private clinics.
  • Bladder instillations: for severe cases, medication (Sodium Hyaluronate) may be instilled directly into the bladder via a self-administered catheter to try to restore the protective lining of the bladder.
  • Antibiotic instillations: similar to bladder instillations but specifically involves the introduction of antibiotics (Gentamycin) into the bladder with a catheter to target persistent infections directly.

Clinical trials

For general information about clinical trials, including what they are and advice on how to find a clinical trial, click here.

Living with and Beyond UTIs

Experiencing a urinary tract infection (UTI) can be distressing, but understanding how to manage and potentially overcome this condition can empower you. As we look to the future, new treatments are on the horizon, and ongoing research continues to offer hope. Here’s how you can approach life after UTIs with optimism and proactive strategies.

Emerging areas and therapies

Microbiome analysis: Understanding the role of the bladder and gut microbiomes in health and disease could lead to targeted probiotic treatments to restore balance and prevent UTIs.

Vaccine development: Research into vaccines to prevent recurrent UTIs is promising. These vaccines aim to enhance the body’s natural defences potentially reducing the incidence of infections. They are currently used ‘off license’ and are not available on the NHS. They are available from some private clinics and specialist urology centres under strict criteria.

Phage therapy: Under research – persistent or recurrent urinary tract infections (UTIs) often occur when antibiotics fail to completely eliminate pathogenic bacteria. These bacteria can hide within biofilms deep within the bladder’s cell layers, making them highly resistant to both antibiotics and the immune system.

Bacteriophages are viruses that infect and kill bacteria and can penetrate biofilms and reach hidden bacteria They can be used alongside antibiotics but research is currently looking at using ‘phages’ on their own.

Genetic testing: Advances in genetic testing offer more precise diagnoses, helping to tailor treatments based on individual susceptibility to UTIs.

The role of nutrition in enhancing immunity

Dietary adjustments

  • Probiotics: Incorporating fermented foods and probiotic supplements can support the health of your gut and urinary tract microbiomes, enhancing your body’s natural defences.
  • Cranberries and D-Mannose: These have been studied for their potential to prevent bacterial adhesion to the urinary tract, reducing the likelihood of infection recurrence.
  • Vitamin C: Increasing your intake of vitamin C-rich foods may boost immune function and increase the acidity of urine, creating an environment less favourable for bacteria.
  • Hydration: Staying well-hydrated is crucial. Water helps to dilute urine and ensure regular bladder emptying, flushing out pathogens before they can establish an infection.

Living with and beyond

“Embracing Healthy Habits for Urinary Health”

“Maintaining good urinary health is a vital part of our overall well-being, and there are many proactive steps we can take to support this. Adopting a few positive habits can significantly reduce the risk of urinary tract infections (UTIs) and enhance our comfort and health. Here are some gentle suggestions for incorporating beneficial practices into your daily routine:

Stay hydrated: Drinking plenty of water helps flush bacteria from the urinary tract, keeping it clean and functioning smoothly.

Wiping from front to back following urination can greatly minimise the transfer of bacteria to the urinary tract.

Urinate when needed: Avoid holding in urine for too long. Going to the bathroom when you feel the urge ensures that bacteria don’t have the chance to settle and multiply. Try the double void technique. Pass urine, wait and count to 10, pass urine again.

Mindful bathroom habits: Changing sanitary/continence products can help reduce the risk of bacteria entering the urethra.

If you are male pay attention to your urinary flow and see your GP if you feel that you are not emptying your bladder, an important risk factor for UTIs in men.

Barrier method of contraception: use of the diaphragm cap with spermicide can be an extra risk if you are prone to UTIs due to changes to the vaginal flora and possible irritation to the vagina and urethra.

Use of condoms with a male partner can help reduce exposure to bacteria. As above avoiding spermicide use. Condoms can sometimes cause irritation to your vagina and urethral tissues if this is the case you could try extra lubrication.

Consider your diet: Incorporating foods with high water content and possibly reducing irritants like caffeine and spicy foods can support urinary health.

Looking After Your Bladder Health: Dietary Tips and Tricks

Water and juice intake – aim for 1.5 – 2 litres daily depending on your level of activity.

Many fruit and herb teas are widely available.

Avoid caffeinated drinks: remember de caffeinated coffee still contains caffeine. Switch to chicory root coffee, which tastes similar to coffee but is naturally caffeine-free, helping to reduce bladder irritation.

Swap out alcoholic beverages: opt for non-alcoholic alternatives like ginger tea or ginger water, which can soothe the stomach and don’t dehydrate the body. Ginger is known to have anti-inflammatory and anti-oxidant properties.

Many low or non-alcoholic alternatives are widely available now, which makes it easier when you are out socialising.

Cranberries – how do you take yours?

Cranberry juice:

  • Pros: Widely available and may offer immediate relief for UTI symptoms by flushing the urinary tract when consumed in large amounts.
  • Cons: Many commercial cranberry juices are diluted with other juices and contain high amounts of added sugars, which can counteract the health benefits and contribute to other health issues like weight gain or diabetes.

Cranberry capsules or powders:

  • Pros: These supplements usually provide a concentrated form of cranberries without the added sugars found in juice. They’re also standardized, meaning they contain specific amounts of the active ingredients (like proanthocyanidins or PACs) known to inhibit bacteria from adhering to the bladder wall.
  • Cons: Supplements are not regulated as strictly as pharmaceuticals, so quality can vary between brands. It’s important to choose products from reputable manufacturers who provide information about PAC content.

Whole cranberries or dried cranberries:

  • Pros: Eating whole cranberries or dried cranberries (with no added sugar) can be a healthy way to ingest PACs naturally. Whole cranberries also contain other beneficial nutrients and fibre.
  • Cons: Dried cranberries often contain added sugar, similar to juices, which can negate some health benefits. Whole cranberries are tart and may be less palatable for some people to take.

Anti-Inflammatory Foods

Eat a rainbow: incorporate a variety of colourful fruits and vegetables, which are high in antioxidants and can reduce inflammation. Think blueberries, spinach, bell peppers, and carrots.

Include healthy fats: add pumpkin seeds, nuts, and oily fish (like salmon or mackerel) to your diet. These foods are rich in omega-3 fatty acids, which are known for their anti-inflammatory properties.

Foods supporting immunity and bladder health

High-fibre foods: incorporate a diet rich in fibre to help soften stools and promote regular bowel movements. Foods high in fibre include fruits, vegetables, whole grains, and legumes.

Fermented foods: include sauerkraut, kimchi, and kefir in your diet. These foods are not only great for gut health but can also support the urinary tract due to their probiotic content.

Antibacterial and antimicrobial foods: consume raw garlic, and herbs like oregano, thyme, and rosemary. These have natural antibacterial and antimicrobial properties that can help maintain a healthy urinary tract.

Avoid certain foods: reduce salt intake. High salt intake can be dehydrating and may lead to water retention, putting pressure on the bladder. Try to limit salty snacks and opt for fresher alternatives.

Balanced diet: ensure a balanced diet rich in vegetables, fruits, whole grains, and lean proteins to supply all necessary nutrients for immune health.

Vitamins and minerals: focus on vitamins C, D, and zinc supplements, which are crucial for immune defence. Vitamin C can be found in citrus fruits, bell peppers, and strawberries; vitamin D can be fortified in foods like milk or taken as a supplement; zinc is abundant in meat, shellfish, legumes, and seeds.

Remember, it’s always a good idea to consult with your GP or health care professional before starting new supplements, especially if you have pre-existing health conditions. Consider talking to a BANT registered nutritional therapist for individual advice.

 

 

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