Dealing with Recurrent Urinary Tract Infections in Women aged 16-64

Dealing with Recurrent Urinary Tract Infections in Women aged 16-64

This article is going to look at conventional treatments for Urinary Tract Infections (UTI's), and new emerging treatments for people with recurrent urinary infections, not responsive to antibiotics. I'm specifically looking at women, as UTI's are more common in women. 

Women get UTIs up to 30 times more often than men do. Also, as many as 4 in 10 women who get a UTI will get at least one more within six months. Women get UTIs more often because a woman's urethra (the tube from the bladder to where the urine comes out of the body) is shorter than a man's

I will talk through conventional antibiotic treatments, and long term antibiotics for women who have regular relapses. There are also some new non antibiotic medicines emerging and probiotics that I will discuss - that can prevent a relapse.

However, and this is important -  you should always discuss these treatments with your GP or pharmacist. These treatments are only recommended for women aged 16-64, They are not recommended for men or children or the elderly - as these usually require specialist treatment. They are also not recommended for anyone using a catheter, or is acutely unwell with a UTI - fever, passing blood and severe back/stomach pain.

What is a UTI?

UTIs are best divided into two categories: infections involving only the lower urinary tract (the components of the urinary tract below the ureter, ie, the bladder and urethra) - more commonly known as cystitis.

Infections involving both upper and lower tracts - ureters and kidneys are less common and usually more severe. When the kidneys are involved, the term “acute pyelonephritis” is applied.


Causes of urinary tract infections (UTIs)

Urinary tract infections (UTIs) are usually caused by bacteria from poo entering the urinary tract.

The bacteria enter through the tube that carries pee out of the body (urethra). The most common bacteria found to cause UTIs is Escherichia coli (E. coli).

Women have a shorter urethra than men. This means bacteria are more likely to reach the bladder or kidneys and cause an infection.

Things that increase the risk of bacteria getting into the bladder include:

  • having sex
  • pregnancy
  • conditions that block the urinary tract – such as kidney stones
  • urinary catheters (a tube in your bladder used to drain urine)
  • having a weakened immune system – for example, people with diabetes or people having chemotherapy
  • not drinking enough fluids
  • not keeping the genital area clean and dry


Do I have a UTI - one or more of these symptoms could mean you have a UTI

Symptoms of a urinary tract infection (UTI) may include:

  • pain or a burning sensation when peeing (dysuria)
  • needing to pee more often than usual during the night (nocturia)
  • pee that looks cloudy, dark or has a strong smell
  • needing to pee suddenly or more urgently than usual
  • needing to pee more often than usual
  • blood in your pee
  • lower tummy pain or pain in your back, just under the ribs
  • a high temperature, or feeling hot and shivery
  • a very low temperature below 36C

Women should always see a GP if theY have following symptoms

  • you have symptoms of a urinary tract infection (UTI) for the first time
  • you're pregnant and have symptoms of a UTI
  • you have symptoms of a UTI after surgery
  • your symptoms get worse or do not improve within 2 days
  • your symptoms come back after treatment
  • have a very high temperature, or feel hot and shivery
  • have a very low temperature below 36C
  • are confused or drowsy
  • have pain in the lower tummy or in the back, just under the ribs
  • can see blood in your pee.


Treatment from a GP

If a GP thinks you may have a urinary tract infection (UTI), they may do a urine test, although this is not always needed. Often, if it's your first UTI, the GP will work with your symptoms, and only request a sample of your pee if they are unsure of the diagnosis, or if they are unsure which antibiotic to give. 

A GP may also:

  • offer self-care advice and recommend taking a painkiller
  • give you a prescription for a short course of antibiotics. The most commonly prescribed antibiotics are nitrofurantoin and trimethoprim. The choice of antibiotics will depend on how many infections you've had, any allergies you have, local resistance to antibiotics etc.
  • give you a prescription for antibiotics, but suggest you wait for 48 hours before taking them in case your symptoms go away on their own. Sometimes if it's a lower urinary tract infection like cystitis, it may go away on its own. 

It's important to take all the medicine you're prescribed, even if you start to feel better.

Treatment from a GP for UTIs that keep coming back

If your UTI comes back after treatment, or you have 2 UTIs in 6 months, a GP may:

  • prescribe a different antibiotic or prescribe a low-dose antibiotic to take for up to 6 months. A low dose antibiotic for 6 months is called prophylaxis, and is given to prevent you getting a UTI in the first place. There is no evidence that giving a long term antibiotic beyond 6 months is of any benefit.
  • prescribe a vaginal cream containing oestrogen, if you have gone through the menopause. Post menopausal women are more prone to UTIs as the vagina becomes drier. In addition, the length of the vagina shortens.
  • refer you to a specialist for further tests and treatments

In some people, antibiotics do not work or urine tests do not pick up an infection, even though you have UTI symptoms.

This may mean you have a long-term (chronic) UTI that is not picked up by current urine tests. Ask the GP for a referral to a specialist for further tests and treatments.

Long-term UTIs are linked to an increased risk of bladder cancer in people aged 60 and over.

 Things you can do yourself

To help ease symptoms of a urinary tract infection (UTI):

  • take paracetamol up to 4 times a day to reduce pain and a high temperature – for people with a UTI, paracetamol is usually recommended over NSAIDs such as ibuprofen.
  • rest and drink enough fluids so you pass pale urine regularly during the day
  • avoid having sex

Some people take cystitis sachets or cranberry drinks and products every day to prevent UTIs from happening, which may help. But there's no evidence they help ease symptoms or treat a UTI if the infection has already started.


Other ways to prevent some UTIs coming back (non antibiotic treatment)

If you keep getting a bladder infection (cystitis), and antibiotics are not helping, there's some evidence it may be helpful to take:

  • D-mannose – a sugar you can buy as a powder or tablets to take every day
  • Hipprex Tablets
  • A probiotic such as Symprove. 

How does D Mannose work?

E. coli bacteria cause 90% of UTIs. Once these bacteria enter the urinary tract, they latch on to cells, grow, and cause infection. Researchers think that D-mannose might work to treat or prevent a UTI by stopping these bacteria from latching on.

After you consume foods or supplements containing D-mannose, your body eventually eliminates it through the kidneys and into the urinary tract.

While in the urinary tract, it can attach to the E. coli bacteria that may be there. As a result, the bacteria can no longer attach to cells and cause infection.

There isn’t much research on the effects of D-mannose when taken by people who have UTIs, but a few early studies show that it might help. It is usually taken for a few months to prevent you getting a UTI in the first place. It may be of some use to some people, but it contains a lot of sugar. So it may not be a suitable option for type 2 diabetics. 

A 2013 study  evaluated D-mannose in 308 women who had frequent UTIs. D-mannose worked about as well as the antibiotic nitrofurantoin for preventing UTIs over a 6-month period.

In a 2014 study, D-mannose was compared to the antibiotic trimethoprim/sulfamethoxazole for treatment and prevention of frequent UTIs in 60 women.

D-mannose reduced UTI symptoms in women with an active infection. It was also more effective than the antibiotic for preventing additional infections.

A 2016 study tested the effects of D-mannose in 43 women with an active UTI. At the end of the study, most women had improved symptoms.

You can buy D Mannose in your local pharmacy without a prescription. However, if you develop an acute infection while using D Mannose, you MUST go to your GP and get antibiotic treatment. 


Available to purchase in Melvin Pharmacy or in our online store

How does Hiprex Work? 

Hiprex® (methenamine hippurate tablets USP) are used to prevent or control recurring urinary tract infections caused by certain bacteria. Hiprex is not used to treat an active infection; Hiprex should only be used after the infection has been treated with other antibiotics.

Hiprex is an antibacterial that stops the growth of bacteria in urine. Hiprex also contains an ingredient that helps to make the urine acidic. When the urine is acidic, Hiprex turns into formaldehyde to kill the bacteria. The recommended dose is one tablet (1g) twice a day

Hiprex is effective only against bacterial infections in the urinary tract. It will not work for other types of bacterial infections or for viral infections (such as the common cold or flu). Unnecessary use of Hiprex can lead to its decreased effectiveness and the development of antibiotic-resistant bacteria.

Hiprex can be used for up to 6 months. 

You can buy Hiprex in your local pharmacy without a prescription. It is also available on prescription at the discretion of the GP.  However, if you develop an acute infection while using Hiprex, you MUST go to your GP and get antibiotic treatment. 

You can buy Hiprex in the pharmacy

The Probiotic Symprove

Anyone that knows me, knows I love the probiotic Symprove. I will recommend it over all probiotics, because unlike other probiotics, I know it reaches the gut alive. Clinical trials have proven this. Billions of good bacteria will be delivered to your gut. 

There is increasing clinical evidence to support the use of probiotics in UTI management. The mechanisms by which they have an effect have been shown to include balancing the immune system, reducing the bacteria moving up from the intestines and preventing bacteria from colonising and surviving in the urinary tract.

Following a healthy balanced diet, drinking plenty of water and reducing intake of sugary food and drinks can also help to support immunity generally and to maintain the balance of healthy bacteria throughout the body. Increasing water content is especially critical if you are urinating more frequently, as it’s important to replace any lost fluids.

Symprove is available to buy in Melvin Pharmacy or in our online store.


Cranberry Juice

There is very little evidence to support the use of Cranberry Juice. It is unlikely to do people any harm, but it will not treat or prevent a UTI. It may contain alot of sugar and if you're taking warfarin, you should avoid cranberry products.


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