It's time to say goodbye to frequent UTIs

Getting a UTI is no fun, but if you’re experiencing 3 or more a year, there may be something more going on. 

‍By Paula Goodyer     

If you’ve ever felt like you’re peeing razor blades, you’ll know how a urinary tract infection feels. And if you’re on the other side of menopause you could be one of the 20 percent of women who’ll experience recurrent UTIs - meaning 3 infections in a year.

These repeat doses become more common after menopause when lack of oestrogen makes female bladders more infection-prone.

They can also mess with your sex life. Having sex can trigger a UTI by nudging bacteria into the urethra. Just when you’ve stopped worrying about contraception, along comes a higher risk of pesky UTIs.

Oh my, not another UTI

UTIs are often simple and easily treated with antibiotics, however, there’s growing recognition that they can also be more frequent and complex.

Standard testing doesn’t detect all infections, leaving some women feeling gaslighted by doctors who insist there’s no infection, says Dr Malcolm Starkey who heads Monash University’s Urinary Tract Immunology and Microbiology Research Group.

Why UTIs can be tricky

"UTIs are starting to be seen as a spectrum of infections, ranging from those with no symptoms to those that lead to people developing sepsis - once known as blood poisoning - which can be life threatening," Dr Starkey says.  

This spectrum includes chronic UTI, a condition caused when bacteria dig into the bladder wall and set up home, generating chronic infection. Since they hide in bladder tissue instead of floating in urine, they’re not always picked up with standard testing. That’s one reason most countries, including Australia, are still not convinced chronic UTIs are a real thing, he explains.

"Chronic UTIs are a genuine problem yet there’s debate about whether they exist and they’re not seen as serious, even though they can affect quality of life. But chronic UTIs are now recognised in the UK where there’s a specialist clinic for treating them."

So what kicks off a UTI? Bacteria called E.coli are common culprits - they live in the gut but can cause a UTI if they drift into the urethra. Having sex or a new sexual partner can trigger an infection. Diabetes and urinary or faecal incontinence can boost the risk of UTIs, so can family history or having a first UTI before the age of 15. 

Although UTIs are less common in men, they can be a problem for men with an enlarged prostate - this can make it harder to fully empty the bladder, raising the risk of infection.

UTI tests aren’t always effective

Ever been told that your urine test showed no signs of infection - yet you still have symptoms? It’s not just you - UTI testing can miss infections.

"Some studies suggest as many as 70% of tests are wrong. This is especially true in the case of chronic UTIs - if they’re buried in the bladder wall instead of floating in urine, the standard test won’t detect them," Dr Starkey explains.

"The usual way UTIs are diagnosed is by taking a urine sample to identify bacteria that might be causing an infection - but the standard test is based on 1950s research, and it favours detection of E.coli bacteria rather than any other bacteria that might be the cause."

What about treatment? Antibiotics remain the best bet, but with the threat of antibiotic resistant infections, the race is on to find alternatives - Dr Starkey’s research on immunotherapy is working on ways to boost the immune system’s ability to resist UTIs.

Myths versus facts: preventing UTIs

• Most women know the rules for avoiding UTIs off by heart: always pee after having sex; wipe from front to back when going to the loo. They do make sense - although there’s no actual evidence that they work, he says.
  
  
• Drinking plenty of water is another and one small study suggests this can help. Better hydration can also help prevent constipation which can make it harder to empty your bladder.
  
  
• Using vaginal oestrogen cream or pessaries can make a difference for women past menopause - recent research found that it can reduce UTIs by 50 % in this age group.
  
  
• What about cranberries? Don’t count on cranberry supplements or juice to fix a UTI- but they may help prevent one. They contain polyphenols called proanthocyanidins that stop bacteria from sticking to the bladder wall. A new Australian review of existing research found that cranberry capsules or cranberry juice reduced the number of UTIs in women with recurrent infections. However, it didn’t help elderly people in residential aged care or anyone having problems with emptying their bladder.
  
  
• Would probiotics help? UTIs can also be caused when E.coli gets into the vagina and then drifts into the urethra. Some studies suggest using oral probiotic supplements or probiotic pessaries can help prevent UTIs by maintaining a healthy balance of microbes in the vagina. “When we understand more, it could be that they have a benefit, but at the moment there’s no hard evidence that any off-the-shelf products will help,” Dr Starkey says.  

Living with chronic UTI

"Sometimes the pain was enough to make you cry." Having a pee shouldn’t be enough to make you weep, but this was the reality for 72 year-old Marilyn who fought UTIs for most of her life.

They became so frequent that for 50 years she took daily low dose antibiotics to help control them - until the drugs stopped working. Despite symptoms of pain and trips to the loo as often as every 30 minutes, standard tests showed nothing.

Searching for answers, she found Chronic UTI Australia, an advocacy organisation working to raise awareness of chronic UTIs. They put her in touch with a UK clinic established by the late Professor James Malone-Lee from University College London who found that bacteria could hide undetected in the bladder lining.

"After two years of high dose antibiotics daily, my life is different. I now know what it’s like to pee normally. I’m not cured yet but well on the way," Marilyn says. 

“It’s appalling that I, like many others, had to go overseas for treatment but the condition isn’t accepted in Australia yet. It doesn’t help that UTIs are often trivialised as something minor that happens mostly to women, especially after sex and can be easily fixed. For many of us this is untrue.”

Next steps for chronic UTI

What if you think you have a chronic UTI? With treatment options still limited in Australia, Chronic UTI Australia suggests getting informed about the condition and booking a long appointment to discuss it with your GP. There’s good advice for going about this here.