Urinary Tract Infections

What are urinary tract infections (UTIs)?

Urinary Tract Infections (UTIs) are inflammations that can occur anywhere within your urinary system, which is divided into the upper and lower tracts. The upper urinary tract includes the kidneys and ureters, while the lower urinary tract comprises the bladder and urethra.

These infections are typically caused by bacteria, although fungi can sometimes be responsible. Due to anatomical differences, women are more susceptible to UTIs than men. The experience of recurrent UTIs can be particularly troubling, making the search for effective prevention and treatment strategies essential.

Most UTIs do resolve with treatment, but understanding the risk factors is crucial. This knowledge is fundamental in developing a personalised approach to effectively manage and prevent future urinary tract infections.

Dr. Edward Calleja

Dr. Calleja offers expert urological care, specialising in the diagnosis and treatment of urinary tract infections (UTIs). With a compassionate approach, he conducts thorough evaluations to identify the underlying causes and provides personalised treatment plans to effectively manage UTIs.

What is the most common bacteria causing Urinary Tract Infections?

Escherichia, better known as E.Coli is the commonest bacteria, followed by Klebsiellaand Proteus species responsible for urinary tract infections. There are other bacteria.

A urine culture helps to determine the cause of infection and directs the course of antibiotics.

How to tell if you have a UTI

The common symptoms of urinary tract infections are;

• urinating frequently (often one feels the need to go, and only a few drops are passed)
• constant urge
• painful urinating (burning or stinging)
• foul smelling urine
• cloudy urine
• lower abdominal pain
• fever, or chills and rigors or high temperature
• tiredness
• if one develops pyelonephritis, one may experience loin pain, fever and nausea  

What increases your chances of getting a UTI?

· Lack of adequate fluid intake

· Poor hygiene techniques

· Menopause leads to vaginal atrophy

· Sexual activity

· Antibiotics lower the natural bacteria

· Weak natural defences which typically acts as a barrier to bacteria.

· Incomplete bladder emptying

· A weak immune system

· Urinary catheter

· Spinal cord injuries

What to do if you have UTI symptoms

Visit your general practitioner (GP), pharmacist, or urologist to have your urine tested.

Urine testing positive for nitrites and white blood cells (leukocytes) must be sent for culture and sensitivity. Knowing the bacteria that are causing the infection is key for appropriate oral antibiotics. Red blood cells are a common finding when there is a urinary tract infection.

Refrain from blind repeated oral antibiotics as this leads to antibiotic resistance, and recurrent urinary tract infections will persist.

The urine test is useful to confirm the presence of bacterial infection. There are certain medical conditions like interstitial cystitis that mimic recurring UTIs.

How to prevent urinary tract infections (UTIs)

Drink plenty of fluids - Look at the colour of your urine; it should be very light yellow. If it is not, you are not drinking enough. Fluid intake should be spread throughout the day. The idea is to flush the bacteria continuously.  

Perform good hygiene practices - after emptying the bladder, females should wipe front-to-back. Empty the bladder before and after sexual activity.

Vaginal dryness places a female at a greater risk of infection. Avoid using certain birth control methods that lead to vaginal dryness, such as spermicidal contraceptives, diaphragms, or hygiene products that cause vaginal dryness, such as vaginal douching, perfumed bubble bath, soap or talcum powder around your genital area. Use plain, unperfumed varieties, and have a shower rather than a bath.

Aim for regular bowel movement -Avoid long periods of constipation. Increase fluids and fibre in your diet, and become more physically active.

Preferably wear cotton underwear - Avoid using fabric softener to wash underwear as this damages the fibres.

Keep an infection diary - This helps to identify your daily patterns that are leading to recurrent infections like stressful situations or sexual intercourse or period or long distance travelling, and more.

‍Intravaginal application of natural yoghurt with live bacteria three times a week. Especially in postmenopausal women or those that experience thinning of the vaginal layer secondary to medications/medical conditions. This can be an alternative for those who cannot be prescribed local oestrogen treatment.

Antibiotic prophylaxis has a role in specific circumstances. Prophylactic antibiotic can be given if sexual intercourse leads to recurrent utis.

D-Mannose

Many patients are stating that ' D-Mannose cured my UTI'. D-Mannose has a role but it does not work on everyone. Take 2g daily (either in powder or tablet form). If taken as a regular dietary supplement, alongside other lifestyle changes, it can help by preventing UTIs. Some studies support its use. This is a non-prescription item. It may cause bloating or loose stools if it does simply lower the dose. It works by binding to the finger projections of bacteria that cause bladder infections preventing bacteria from anchoring to the bladder lining. In so doing, it helps to flush out bacteria.

Where can I find D-Mannose naturally?

D-mannose is a type of sugar. D-mannose occurs naturally in cranberries, black and red currants, peaches, green beans, cabbage, tomatoes, oranges, apples, aloe vera, mangos and seaweed

I am diabetic can I take D-Mannose?

D-mannose can potentially lead to higher sugar levels in diabetic patients. Rather than having higher doses, one would start at 1G daily or even 500mg.

If the sugar control is not affected, one may increase the dose; however, if it is getting out of control best to stop it and find an alternative.

Is there a role of D-Mannose in pregnant females and children?

There have not been any studies, and D-Mannose cannot be recommended.

Is cranberry juice good for UTIs?

Cranberries contain a substance that may prevent bacteria from adhering to the bladder, but research shows they neither prevent nor cure UTIs. People still use cranberry products for their potential benefits, such as supporting the immune system which can lower bacterial growth in recurrent UTIs.

Can a UTI vanish on its own?

In many cases, it gets better by itself. However, if you have a tendency to suffer from frequent urinary tract infections, it is important to send a urine culture.

Drinking plenty of fluids is important. This helps to flush bacteria out. Make sure to look at the colour of urine, and this has to be as close as the colour of the water.

How would I know that my UTI signs are going away?

The burning feeling or stinging of urine, discomfort, urinary frequency, fever, suprapubic pain, feeling unwell and emptying only a few drops of urine should improve day after day.

When should I be worried?

· you think you have a bladder infection and has not gone away within 72 hours

· your symptoms have not gone away after antibiotic treatment

· frequent infections

· males that have symptoms of cystitis

· pregnant women and have symptoms of cystitis

· your child has UTI symptoms

· you have a kidney infection

If you have any of the above, then contact your family doctor, NHS consultant or private urologist.

What are the latest treatments for UTIs?

Your NHS consultant or private urologist, or general practitioner will try to avoid long-term antibiotics.

They may recommend the following;

1. Methenamine hippurate (Hipprex)

2. Oestrogen

3. Bladder Instillations with Hyaluronic Acid

4. Vaccine

Methenamine hippurate (Hipprex)

‍Has antibacterial activity because the methenamine is converted to formaldehyde – an antiseptic and Hippuric acid keeps the urine acidic.

Typically this is active against E. coli, enterococci and staphylococci and less effective against Enterobacter species. This is prescribed 1G be taken twice daily on a long-term basis.

Some studies reported that around 75 per cent of those taking Hiipprex see a benefit. The evidence base of Hipprex against urine infection remains weak.

What is the best time to take Hipprex?

It is best to take it with your breakfast and your dinner with a full glass of water.

Do you have to take Vitamin C with Hipprex?

Vitamin C makes the urine more acidic. This acidic environment helps Hipprex to form formaldehyde which is key to sterilising urine.

What are the side effects of Hipprex?

Burning sensation when passing urine, nausea, vomiting, loose bowel movement, abdominal pain and lack of appetite may occur.

Oestrogen

Typically prescribed in postmenopausal females to address the thinning of the vaginal layer to regain back the natural defences against the bacteria coming from the gut. This can be prescribed either as oestrogen cream or oestrogen pessaries.

Oestrogen creams can cause local irritation, but systemic absorption and effect are minimal. These are contraindicated in patients with a history of breast cancer and known or suspected oestrogen-dependent malignant tumours (such as endometrial cancer or breast cancer).

Bladder Instillations with Hyaluronic Acid (HA).

The inner layer of the bladder has cells that are connected tightly to each other to prevent bacterial invasion. This is referred to as the glycosaminoglycan (GAG) layer. Instilling hyaluronic acid (HA) and chondroitin sulfate (CS) aims to boost the glycosaminoglycan (GAG) layer on the inner lining of the bladder, restoring the protective layer. The instillations are typically given once a week for four weeks and then once monthly for six months.

Is there a Vaccine against urinary tract infections?

Uromune UK is an immunostimulant UTI vaccine for treating recurrent urinary infections.

The most common bacteria (Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris and Enterococcus Faecalis) have been inactivated.

This self-treatment is administered daily over three months via a spray applied under the tongue each day. Once administered, it interacts with the immune system, resulting in long-term protection from UTIs in the patient.

Data has shown around an 80% reduction in infections, giving back females a better quality of life.

How to use the vaccine?

At the beginning of each vial, turn the pipette horizontally and pump the spray up to 4 times to ensure the dispenser is filled properly.

Direct the pipette under the tongue, and spray twice. Keep the dose under the tongue for around 2 minutes, and then swallow it.  Rotate the pipette back to its original position (vertically downward), and this blocks the pump action.

Meals and/or fluids should not be taken directly after the application of the spray in order to allow maximum exposure and contact of the product with the area sprayed. Brushing teeth or mouth rinsing should be avoided for at least 30 mins after taking the vaccine.