Recurrent urinary tract infections (UTIs) can be a problem for many women and are caused by bacteria entering into the urethra and passing into the bladder.
Overview of Cystitis
Urinary tract infections (UTIs), also commonly referred to as cystitis, are the most common form of infection in females aged 18 to 65. More than three infections in a year or more than two in six months is then termed as recurrent UTIs and is an increasing problem worldwide, both in men and women.
Most UTIs are caused by bacteria ascending from the vaginal wall and entering the urethra (water pipe) to pass into the bladder.
Although bladder infections, cystitis, UTIs etc are common, please remember that symptoms of cystitis can be caused by sinister underlying diseases of the bladder such as cancer. Please consult your doctor if your symptoms persist, as further diagnostic reassurance is warranted.
The Urology Partnership also offers a full & comprehensive service to diagnose and treat recurrent UTIs so please don’t hesitate to contact us directly if you had any concerns.
Treatments for Cystitis
The standard treatment is with antibiotics which most patients with a single episode, respond to very well.
Our approach to the selection of antibiotics is tailored to the individual patient based on unique sensitivity profiling of urine cultures and clinical judgement of best antibiotic according to it’s specific bio-availability.
Once the infections become more chronic, antibotic treatments range from keeping antibiotics at home, to going onto a low dose antibiotic where you take one every night or just one antibiotic after sexual intercourse.
There is currently a lot of concern about long-term use of antibiotics and although they are well recognised and well established, alternative treatments are becoming more popular.
Part of the problem with patients with recurrent urinary tract infections is a deficiency in the lining of the bladder which makes them much more succeptible to infections with low levels of bacteria. A well established treatment now, is a course of bladder installations which can be performed either by the nurse or by the patient themselves once a week for six weeks, followed by a monthly course for six months. These are available in many NHS hospitals, covered by insurance companies and are very well tolerated.
Seventy percent of patients with recurrent infections respond well to intra-vesical treatments with both an increase in bladder comfort and a reduction in infection rates.
Recently the use of vaccine / immunostimulation in patients with recurrent infections has become more popular. The science behind this won a Nobel Prize for medicine in 2010 and has been very popular on the continent although very few trials have been performed to date.
At Reading the first randomised controlled trial in the use of vaccines for urinary tract infections is currently underway. It is a two-year trial so we await those results.
The vaccine has been used in a number of patients on a named-patient basis and a recent publication in the British Journal of Urology (link below) suggests a 70-80% reduction in infections in a one-year period for patients who have tried all other treatments, and is looking very promising.
Many ladies develop their urinary tract infections after the menopause due to the change in vaginal health. Routine treatments with hormone replacement therapies and local oestrogen cream can reverse some of these effects but are often unpopular with the patients.
Recently we have conducted a one-year study using laser vaginal rejuvenation to reverse these menopausal symptoms and seen improvements in vaginal health and patients becoming much more comfortable, a reduction in urinary tract infections and improvements in sexual health.
There are a few simple steps you can take to avoid UTIs.
Always wipe from the front to the back after using the bathroom. Do not try to reach from behind because germs from the rectum can be transferred to the hand and tissue. After bowel movements, clean the area around the anus gently, wiping from front to back. Never wipe twice with the same tissue.
Take showers and avoid prolonged baths. Bath water may quickly become contaminated by the bather’s own natural bacteria. Sitting in a tub allows bacteria to reach the urethra and bladder. Rinse well and remember to wipe correctly from front to back. Douches have no proven benefit in preventing bladder infections.
Use tampons for periods. Tampons are advised during the menstrual period rather than sanitary pads because they keep the entrance to the urethra drier, thereby limiting bacterial overgrowth.
Avoid long intervals between urinating. Try to empty the bladder at least every 4 hours during the day while awake, even if the urge to void is absent. When feeling the need to empty the bladder, do not try to “hold it” until a more convenient time or place.
Do not wear tight-fitting undergarments made of non-breathing materials as moisture can build up leading to bacterial over growth near the opening of the bladder. Cotton underwear for general use is suggested.
Drink more water. Start with 1 extra glass with each meal. If the urine appears any darker than a very pale yellow, this means not enough liquid is being ingested; increase the fluid intake. Cranberry juice and cranberry pills have unproven benefit in reducing UTIs but may give some benefit, particularly in younger women.
When engaging in physical activity and exercise, make sure to empty the bladder frequently and drink plenty of water and other fluids. Take special precautions after sexual activity. The bladder should be emptied after intercourse; drink 2 extra glasses of water. Avoid the use of spermicidal jelly as this kills the normal vaginal bacteria which are extremely important in suppressing infection causing bacteria.
After menopause an oestrogen vaginal cream may help increase resistance to bladder infections. The cream helps keep the tissues around the bladder healthy and more resistant to infection.
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