Recurrent Urinary Tract Infections (UTI)

Infections of the urinary tract are very common; affecting most women at least once in their lifetime, but up to one in five women will have problems with repeated infections.

They are most likely in women who are sexually active, pregnant or post menopausal – but they can happen at other times.

The persistence of visible blood in the urine in post menopausal /smokers should be discussed with your GP.

A UTI is the invasion of your urinary tract (urethra, bladder and kidneys) with bacteria, which then causes you symptoms.

These symptoms you may experience with a UTI may include:

  • A need to frequently pass urine.
  • An inability to hold your urine with a feeling of needing to pass your urine urgently.
  • A feeling of burning or stinging in the water pipe (urethra) on passing urine or pain at the end of passing urine.
  • Sometimes you may even notice that your urine becomes cloudy, smelly or even stained with blood.

If you have a mild infection, it can often clear within a few days and may not always need antibiotics. More severe infections will probably require treatment.

Why do women get UTI’s?

In women, there is only a short distance between the water pipe (urethra) and back passage (anus).

The most common bacteria that cause UTI are E. Coli. These bacteria ordinarily live inside our colon and are essential to keeping the colon healthy.

These bacteria from the colon often spread when people open their bowels and because the water pipe is so close then this can lead to the bacteria gaining access to the urinary tract.

The body has its own defence mechanism to try and stop this happening – vaginal secretions. These secretions are rich in healthy bacteria that help to stop these colonic E.coli from reaching the water pipe.

Common things like sexual intercourse, constipation and urinary or bowel incontinence can increase the risk of UTI by either disrupting the vaginal secretions/bacteria or by allowing overgrowth of the healthy bacteria with colonic bacteria.

How to try to avoid getting a UTI

One of the most effective things you can do to help prevent cycles of recurrent infection is to make some simple changes to your lifestyle.

These include:

  1. Wiping ‘front to back’.
  2. Drinking plenty of fluids-the lowest amount per day should be 1.5-2 litres unless you have been advised otherwise.
  3. Avoid soaps, shower gels and intimate hygiene products-washing with soaps or other products removes the natural protection of the vaginal secretions and can even cause chemical irritation, which promotes infection.
  4. Limit washing the vaginal area to once a day.
  5. Sexual hygiene-Passing water and washing gently with warm water after sex can help reduce the amount of bacteria present which may cause infection.
  6. Constipation-Avoid constipation with a diet full of fibre and a healthy intake of fluid. If this is a continuing problem please discuss with your GP.
  7. Incontinence-treating incontinence whether urinary or faecal, can help reduce the risk of UTI.

Self Help

Not everyone needs to see their GP for a simple UTI. Increasing your intake of water at the first sign of symptoms can sometimes be enough to flush out the bacteria before an infection can fully take hold. Other  ‘over the counter’ preparations are available from pharmacies, which some people find effective. These include:

Cranberry juice and increasing fluids- In mild cases of UTI simply increasing your fluids can be enough to simply flush through the infection. Having a glass of cranberry juice a day is used by many people as a preventative measure – however the juices contain a lot of sugar. Cranberry capsules are easily available as an alternative. There is evidence that it can reduce the risk of UTI.

Cystitis remedies-There are several preparations available from pharmacies that help to change the acidity of the urine using a chemical called sodium citrate. These can make it more comfortable to pee while you are trying to flush out the infection. These are not suitable for people who need to avoid salt but are safe to use in all other people.

Soda water or bicarbonate of soda-Their use is along the same principle as cystitis remedies to change the acidity of the urine making it more comfortable to pass water.

What to do if the symptoms are not going away

If your symptoms are not going away after trying the self help techniques  it is important to seek help from your GP.

You may need treating with antibiotics – it is important to complete the course even if you start to feel better, to make sure all of the bacteria are dealt with. Stopping the course early may mean your infection is not properly treated and may come back again very quickly.

If you have fevers, vomiting, uncontrollable shakes and shivers (rigors) during your UTI, you must seek urgent medical help as it may mean you have an infection of your kidney.

Low dose prophylactic antibiotics

Prophylaxis means prevention of re-infection. This is where your GP gives you a low dose antibiotic tablet, usually taken at night, in order to prevent a build up of bacteria in your urine. Antibiotics can be given for 3 months. If you are on low dose antibiotics it is still possible to get a UTI. If you become symptomatic while on low dose antibiotics it is important to take a urine sample to your GP to send away for analysis and to change your antibiotics.

The local microbiologists recommend using Methenamine ahead of the use of rotating antibiotics.

This option is avoided as much as possible for the fear of creating multi resistant UTI and so is usually only employed when other methods have failed.

Investigations

Please make sure you provide a urine sample for your GP every time you have a UTI. This allows a pattern of bacteria to emerge, which can guide further antibiotic use.

Overall, the chance of finding a condition that explains why you are getting recurrent UTI is very low.

Hospital based treatments

Generally a combination of the treatments suggested will treat and control most women’s recurrent UTI’s.

However, if these fail then use of agents that can be placed in your bladder using a small catheter can help some women. The medication aims to reline your bladder making it harder for bacteria to attack its lining.

It is much more likely that with careful attention and a combination of lifestyle measures together with sensible use of antibiotics, your recurrent infections can be managed successfully or even resolved.

Further Information

Urology CNS Team – 01935 384394
NHS Choices

Ref: 18/20/46
Review: 02/22