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Urinary Tract Infections are very common in women. Dr Sophie Genoni, one of the Women's Health GP's at FitRight HQ, explains everything you need to know about the symptoms and management of UTI's.

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    What symptoms might suggest that I have a UTI?

    Symptoms of an uncomplicated urinary tract infection that affects the lower urinary tract include:

    • Pain when urinating
    • The urge to urinate more frequently
    • Lower tummy pain
    • Blood in the urine
    • Cloudy or smelly urine

    If you experience any of these symptoms, it is recommended to seek medical attention within 1-2 days.

    Urinary tract infections can also ascend up the urinary tract and affect the kidneys. This is called pyelonephritis (or a kidney infection) and can be serious and lead to a life-threatening condition called sepsis if untreated.

    Symptoms of pyelonephritis include the symptoms listed above plus:

    • Pain in one or both flanks (the sides of the tummy)
    • Back pain
    • Fever
    • Nausea and vomiting
    • Feeling generally unwell.

    If you experience any of these symptoms, you must seek medical attention immediately as you can become unwell quite quickly.

    The symptoms of a urinary tract infection can also be caused by many other conditions, which is why it is important to have a consultation with a General Practitioner if you think you are experiencing a UTI.

    Other conditions that can have similar symptoms include:

    • Sexually transmitted diseases
    • Vulvovaginitis
    • Genital skin conditions
    • Bladder emptying problems
    • Overactive or irritable bladder
    • Bladder cancer (rarely)

    Your GP will usually assess your symptoms, perform an examination and a dipstick urinalysis to determine whether you are experiencing a UTI.

    What are the treatment options for a UTI?

    Because UTIs are a bacterial infection the treatment is antibiotics. Mild lower urinary tract infections usually need just a short course of antibiotics. Women who have pyelonephritis and are unwell usually require intravenous antibiotics.

    There is some evidence that a minor number of women may have UTIs that may resolve without antibiotic treatment. The studies around this are not entirely clear on what proportion of women this applies to, and what factors would make a woman more or less likely to need antibiotics. For this reason, the recommendations remain that women with a confirmed UTI are treated with antibiotics. The main concern with not treating with antibiotics is that a simple UTI may progress to a pyelonephritis, resulting in more aggressive treatment being required and the woman becoming more unwell.

    As part of the assessment for a UTI, a urine sample is usually sent to the lab for culturing the bacteria that is causing the UTI. This also allows the lab to test which antibiotics are going to work against that particular bacteria. For this reason, sometimes your GP may have to change the antibiotic you are taking, because the result shows the bacteria is resistant to the initial antibiotic you were given. This happens in around 5% of UTIs, although it may become more common with emerging antibiotic resistance.

    For the treatment of symptoms while waiting for the antibiotics to start having an effect, Ural sachets can help neutralise the urine so that it does not sting as much. Drinking more water can also help make the urine less acidic, although this may result in more frequent toilet trips.

    Why am I getting recurrent UTI's and what can I do about it?

    Women who are experiencing recurrent UTIs should always have a consultation with their General Practitioner to determine the underlying reasons, and an approach to management. The most important aspect is assessing whether it is actually recurrent UTIs that are happening, and not something else going on (like the other conditions listed above that can cause similar symptoms).

    Factors that can predispose women to recurrent UTIs include:

    • Bladder emptying problems

    • Diabetes

    • Conditions that cause lowered immunity (immunosuppression)

    • Structural abnormalities of the urinary tract

    • Atrophic vaginitis (caused by low oestrogen after menopause)

    Non-medication measures to prevent UTIs have varying evidence for their use. Urinating after sexual intercourse is generally recommended as it is thought to flush bacteria out of the urethra, although there isn't any clear evidence as to how effective this is. There is some evidence that increasing water intake in women who do not drink enough water may help prevent recurrent UTIs. Most over-the-counter products do not have any evidence for preventing UTIs, with the exception being that cranberry may be effective in some women in preventing recurrent UTIs.

    In women with confirmed recurrent UTIs who have no other causative factors that can be addressed, their GP may recommend prophylactic low-dose antibiotics to take either daily or after episodes of intercourse.

    Does cranberry prevent or treat UTIs?

    This is a really common question we get as women's health GPs. It makes sense that women are interested in the answer to this, as most people would prefer to avoid antibiotics if they can. But is there any evidence behind cranberry products to prevent  or treat Urinary Tract Infections (UTIs)?

    The theory behind cranberry products in prevention or treatment of UTIs arises from the fact that cranberries contain a compound called proanthocyanidin. This compound is thought to help prevent certain bacteria from adhering to the urinary tract.

    In previous years, the literature surrounding cranberry products and UTIs was very scarce, with no high quality trials assessing the effectiveness of cranberry products. Earlier this year, there was a new review published of more recent clinical trials, which concluded that cranberry products may reduce UTI frequency in people who experience recurrent UTIs - but only in non-pregnant women, children, and those who experience recurrent UTIs due to medical procedures.

    There was not evidence to suggest cranberry products are effective in preventing UTIs in pregnant women, or people who aren't experiencing recurrent UTIs. There also was no evidence to suggest that cranberry products can treat an active UTI either. The trials did not assess which specific cranberry product or dosage is most effective.

    If you are experiencing recurrent UTIs, it is important that you have a thorough assessment by a GP, who can also guide you on whether this updated recommendation about cranberry products applies to your individual circumstances.


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