Urinary tract infections (UTIs) are downright miserable. From the moment they strike, you’re in so much discomfort that you can barely remember what it was like to socialise with friends, go for a jog or use the loo without feeling like you’re sitting in nettles.

More common in women than men, UTIs can happen in any part of your urinary system (the kidneys, bladder, uterus and urethra) but most take place in the lower urinary tract. Symptoms include feeling like you constantly need to pee, cramping pain and cloudy, strong-smelling urine. Sometimes they can cause flu-like symptoms such as a fever and chills. When left untreated, serious cases can develop into kidney failure, with UTIs also being a big contributor to urosepsis (a life-threatening condition). Worryingly, 30% of all cases start in the urinary tract. In other words, UTIs may be common (50% of women will have an acute UTI at some point) but they absolutely shouldn’t be ignored. 

If you have recurring UTIs, a chat with your GP can help you develop a treatment plan and, where relevant, get you signposted to the most appropriate health services. But going to the doctors armed with all the facts can help you to get the care you need quicker. 

To help us along the way, we’ve been chatting with Dr Sachin Malde, a consultant urological surgeon at Guy’s and St Thomas’ NHS Foundation Trust. Below are the key facts he believes that any woman who keeps getting UTIs should know when trying to tackle them. 

It’s common to get a UTI

While they can sometimes feel embarrassing and isolating, UTIs affect a lot of us. And that’s something Dr Malde wants to make clear from the get-go. “UTIs are extremely common,” he says. “At least one in five women will have a UTI, but 25% of those will experience repeated infections again and again over the next few years.”

UTI dipstick tests often get it wrong

It can be frustrating to feel all the symptoms that accompany a UTI only to keep doing dipstick tests that keep coming back negative. If your intuition (and your constant urge to pee) is telling you that something just isn’t right, you’re best off trusting your gut.

“Standard urine dipstick testing and standard cultures can miss infection in about 50% of people,” says Dr Malde. “This means that even if your test results don’t show an infection, you could still be dealing with one. It’s really important that if someone feels they have symptoms of a UTI – even if the standard testing doesn’t show a cause – they should see a urologist who specialises in chronic infections or bladder pain.”

You can boost your vaginal bacteria

As with your mouth and gut, the microbial make-up of your vagina may play a bigger role in our health than previously thought and when it comes to UTIs, they might determine whether or not we keep getting recurrent infections. “For some women, maintaining a healthy vaginal microbiome is one of the key things in preventing repeated infections because that’s often the underlying source,” says Dr Malde.

“You can boost the healthy vaginal microbiome with probiotics, either taken orally or directly in the vagina. There are many different types, and while none have been studied against each other to know if one is better, any vaginal probiotic can help,” he says.

If probiotic pills and creams as a preventative for UTIs don’t quite sound like your bag, he says that what you munch on throughout the day can also play a big role in what your vaginal microbiome looks like. “Dietary probiotics or prebiotics from natural, fermented foods are definitely a good way to maintain the gut microbiome, which could help with vaginal health too.”

Try Hiprex instead of antibiotics

Antibiotics can be a handy short-term fix for women with UTIs. But if you keep getting recurrent infections, the bacteria can start outwitting your body in what’s known as antimicrobial resistance. Overuse of antibiotics can lead to thrush and can cause damage to the careful balance of bacteria that are living in your gut. Dr Malde says asking your GP for a Hiprex prescription could be a great solution.

“Hiprex, also known as methenamine hippurate, is a very good way to avoid antibiotic use,” says Dr Malde. “It’s a prescription-based supplement that works as a urinary antiseptic, clearing bacteria from the bladder without the side effects of antibiotics. It’s equally as effective as daily antibiotics but without the negative effects like thrush or gastrointestinal problems. Plus, it helps maintain the healthy microbiome, which antibiotics often disrupt.”

Oestrogen has a role to play in UTIs

The trio of hormones that make up oestrogen (oestradiol, oestriol and oestrone) play a role in our menstrual cycles, mood and sex drives. And, according to Dr Malde, they can also impact our health when it comes to UTIs. That may be why we can start to experience more UTIs as we enter perimenopause and then menopause.

“Oestrogen is critical in keeping the vaginal microbiome healthy,” explains Dr Malde. “In the years leading up to menopause and just before, oestrogen levels in the vagina start to drop. This decrease leads to lower levels of good bacteria, making the vaginal environment much more hospitable for infection-causing bacteria.”

“Replacing oestrogen locally in the vagina is probably the number one thing – especially in the perimenopausal and postmenopausal age groups – for preventing recurrent infections. It’s very safe and has been shown in lots of studies to be effective,” he adds.

“You can replace oestrogen either with a cream or a pessary that you can then insert into the vagina or apply the cream to the vagina. Women just do it on an ongoing basis, normally twice a week, long term.”

If you’re struggling, speak with a specialist

Living with recurrent UTIs can be seriously tough. As such, Dr Malde says it’s important to chat with your healthcare provider about treatment options – making clear how these infections are impacting your quality of life. Your GP can then refer you to a specialist who can help to nip your UTI in the bud for good. 

“This condition massively affects quality of life, but there are specialist centres that deal with this,” says Dr Malde. “Once you’re on the right treatment plan, the results can be really positive.” 

Images: Getty