Urinary tract infection, or UTI, is a miserable condition that affects at least one in two women at some time in their life. A UTI can occur anywhere from the kidneys down to the bladder. As infection usually finds its way up from the urinary tube (urethra) that leads to the bladder, cystitis (infection of the bladder) is the most common form of UTI. Having worked as a GP, hospital and sexual health doctor, here are what I believe are the best self-help treatments to prevent and cure recurrent UTI.

Symptoms of urinary tract infection

Symptoms of UTI depend on the severity of the infection. In mild cases, only one or two symptoms may occur. In severe cases you may experience every symptom:

• an overwhelming need to rush to the toilet (urgency)
• burning, stinging or discomfort on passing urine (dysuria)
• passing frequent, small amounts of urine
• low abdominal pain or tenderness
• backache
• unpleasant smelling urine which may appear cloudy or blood-stained.

If left untreated, a urinary tract infection of the bladder (cystitis) can spread up to the kidneys to cause pyelonephritis and may spread into the blood stream to cause sepsis. Always seek medical advice if

• symptoms last longer than a day or keep recurring
• you are pregnant
• your urine is cloudy or stained with blood
• you develop a fever or uncontrollable shakes (rigors).

Cystitis in men, children or the elderly should always be referred to a doctor.

Causes of urinary tract infection

Cystitis symptoms may be due to infection of the bladder, friction or chemical irritation of the urethra.

Infection is usually due to bacteria from the vagina or bowel. Seventy per cent of cases are due to Escherichia coli which normally live in the large intestines.

Some attacks of cystitis are thought to result from wearing tight trousers or nylon tights. This increases warmth and humidity which encourage bacterial growth.

Urethral syndrome

Symptoms of cystitis with no evidence of infection are sometimes referred to as urethral syndrome. This occurs when friction or chemical irritation causes inflammation around the urethral opening, which results in symptoms of urgency, frequency and dysuria. This is usually brought on by vigorous sexual intercourse but may be triggered by activities such as horse-riding or cycling.

Detergents and perfumes can cause a chemical irritation of the urethra or may trigger an allergic reaction. They can also make a bacterial infection more likely by upsetting the normal acidity of the vagina.

To reduce urethral irritation, use an intimate wash that is acid balanced to provide the correct pH for this sensitive area, and to discourage the growth of bowel bacteria which are less acid tolerant. Use to wash the outer regions only – never douche.

Dehydration and UTI

Dehydration is another common trigger for UTI, as this reduces the natural flushing that occurs when the urine is dilute and the bladder is emptied regularly. When urine becomes concentrated and the bladder is not emptied regularly, the retained fluid can become stagnant and an attractive place for bacteria to thrive. The concentrated urine can also cause chemical irritation to mimic a urinary infection even if bacteria are not present.

Dehydration quickly occurs during hot weather, during and after exercise and when travelling by air. Many people avoid drinking on planes so they don’t have to queue for the toilet, but if you are prone to cystitis, take a bottle of water with you and book an aisle seat so you can easily get up to keep your urinary system flushed.

Urinary tract infection in women

As many as one in two women experiences symptoms at some time during her life.Urinary tract infections are more common in women than men, partly because the urethra is shorter in females (around 2cm) than males (around 20 cm), so bacteria do not have to travel so far to reach the bladder. Another reason is that bacteria are often pushed up into the urethra during sex – sometimes known as honeymoon cystitis. Research suggests that sexual activity can multiply a woman’s risk of a UTI by fourteen times. Some attacks of cystitis are thought to be caused by wearing tight trousers or nylon tights as these can increase warmth and humidity which encourage bacterial growth.

Having worked in a sexual health clinic for many years, I’ve noticed that women who experience recurrent UTI often have their urethral opening just inside the vagina, rather than just outside, which makes it even easier for bacteria to find their way up.

Women who tend to develop cystitis after intercourse should wash before sex (with a pH balanced wash) and encourage their partner to do the same. Aim to drink water before intercourse and to urinate soon afterwards.

If you have vaginal dryness, the urethral opening is more likely to become inflamed as a result of intercourse, so use a non-perfumed lubricant.

If vaginal dryness is only a problem during sex, then I recommend using Sylk Natural Intimate Moisturiser. Sylk is based on natural fruit extracts from kiwifruit vine gum and citrus seed extract, with citric acid to provide the correct pH for the vagina.

Sylk Natural Intimate Moisturiser is ideal if dryness is mild and mostly associated with sex. Use as required. Sylk is compatible with condoms and hormone-free. Click here for more information on how to solve vaginal dryness.

Urinary tract infection in men

Urinary tract infection in men can result from having an enlarged prostate gland, which may cause some urine to remain trapped in the bladder after voiding.  It can also result from other abnormalities of the urinary tract, from sexually transmissible infections (eg Chalmydia) or from diabetes, so always see your doctor if you develop symptoms to find out the cause.

Treatment for UTI

As soon as symptoms start, drink a pint of water. Then drink half a pint every 20 minutes for the next three hours if you can. Fluids help to flush the urinary system through and you will soon start passing water regularly.

As soon as you start symptoms of cystitis, drink 600ml (a pint) of water. Then drink another 300ml (half a pint) every 20 minutes for another hour or so. Fluids help flush the urinary system through and may be enough to cure the problem. You’ll soon start going to the loo regularly. This may sting at first but will improve as you continue to empty your bladder. It’s best to drink water but camomile tea, yarrow infusion, milk or other bland substances will do. Avoid normal tea, coffee, fruit juice and alcohol as these can irritate inflamed tissues.

Unless you suffer from high blood pressure or heart problems, you could also take a teaspoon of sodium bicarbonate dissolved in water every hour for three hours. This makes the urine less acid, relieves discomfort and helps to stop bacteria from growing in your urinary tract. Recent research suggests that this simply approach of alkalinizing urine can have significant positive effects in reducing lower urinary tract symptoms.

Antibiotics UTI

Your doctor will diagnose a  bacterial urinary tract infection by testing a urine sample with a dipstick that detects white blood cells, hidden blood, protein and substances produced by bacteria (nitrites). If present, the sample of urine is cultured to identify which bacteria are causing your symptoms, and to determine the antibiotics to which they are sensitive or resistant. As culture resutls take a few days to come back, your doctor will prescribe a first-choice  antibiotic. These may need to be changed if your results come back to show the causative bacteria are resistant to the antibiotic prescribed.

Probiotics for urinary tract infections

If you are taking antibiotics, a probiotic supplement is vital to replenish the healthy bacteria that live in your gut. Even if you are not taking antibiotics, a probiotic can help to prevent recurrent UTIs.

Nine out of ten urinary tract infections are caused by the bowel bacterium, Escherichia coli, which finds its way into your bladder from the bowel. E. coli usually spreads via the anus, but bacteria can also pass through tissues or the blood or lymph circulation (translocation) if your immunity is reduced, if you have increased intestinal permeability (leaky gut) or impaired liver or spleen function (as these organs filter bacteria from the circulation).

Probiotic bacteria help to protect against urinary infections. Research suggests that certain strains of Lactobacillus can reduce the risk of urinary tract infections compared with placebo.

Data from 9 studies, involving 735 people, found that taking probiotics reduced the relative risk of a urinary tract infection by 18% compared with placebo; although this was not statistically significant, numerous women have found benefit from taking probiotic supplements. Research suggests that the most beneficial strains of probiotic bacteria against urinary tract infections are Lactobacillus rhamnosus GR-1, Lactobacillus reuteri B-54, Lactobacillus reuteri RC-1. I also recommend Super50 Pro from Healthspan (for whom I act as a medical consultant).

Cranberries for cystitis

Cranberries contain unique antioxidants known as PACs which bind to E. coli bacteria and stop them sticking to the urinary tract wall so they are more easily flushed away. The results from 7 randomized controlled trials involving 1,498 healthy women at risk of UTI showed that taking cranberry products reduced the risk of UTI by 26%.

When cranberry extracts were used in hospital to prevent UTIs in women following catheterization during gynae surgery, the number of post-operative urinary infections was halved.

Cranberry products are also at least as effective as antibiotics in preventing recurrent UTIs in menopausal women and UTI in children although they should always be used under medical supervision as antibiotics may be needed if symptoms worsen.

Research shows that people drinking 300ml cranberry juice per day are 42% less likely to develop pus  cells in their urine than controls. And if puse cells do develop, the chance of them remaining after one month were only 27% of the odds in those not drinking cranberry juice.

Drinking 300 ml cranberry juice daily can almost halve the risk of developing cystitis. Studies also suggest that cranberries contain an anti-adhesin that prevents bacteria from sticking to the urinary tract wall. Concentrated cranberry extracts are also beneficial.

Cysticlean 240mg PAC are the highest strength supplements available and are made to a pharmaceutical standard known as GMP. In a study involving 30 people with uncomplicated cystitis, 21 were ‘cured’ by treatment with Cysticlean, and only 9 needed the addition of antibiotics to achieve a cure. No adverse effects were reported. I also recommend cranberry extracts from Healthspan (for whom I act as a medical consultant).

Click here to read my full review of cranberry supplements for urinary infections.

Prevention of UTI

Wear loose-fitting clothes, cotton underpants and stockings instead of tights

Wash with warm, unperfumed soapy water after every bowel movement and after sex.

Don’t put off answering a call of nature because you are too busy

When sitting on the toilet, tilt your pelvis so the anus is lower than the urethra. A ‘squatty potty’ will help. A Squatty Potty fits around the base of your toilet so you can put your feet on it to achieve an optimal pelvic tilt by raising your feet so your knees are positioned above your hips. Beginners may prefer a 7″ Squatty Potty, while more experienced squatters will find the 9″ size works best.

After passing water, lean forwards to squeeze out the last few drops of urine.

Wipe your bottom from front to back only.

After voiding or urinating, and while still sitting on the toilet and tilting the pelvis, use a clean bottle to pour warm  soapy water between the legs and down towards the anus. This washes bacteria  away from the urethra.

Wash with warm water and a pH balanced feminine intimate wash after every bowel movement and after sex.

Avoid vaginal deodorants, perfumed soap and talcum powder.

NEVER douche.

Drink two to three litres of fluid per day to maintain pale, straw-coloured urine.

Take a probiotic supplement.

Take a cranberry supplement.

Use a vaginal moisturiser.

Many people have found that pumpkin seed oil helps to combat urinary tract infections.

Recurrent UTI

If you experience recurrent urinary tract infections, such as cystitis, your doctor will want to check for any underlying conditions such as diabetes, anaemia or anatomical abnormalities of the urinary tract or kidneys.

What approaches have worked for you?

Image credit: aslysun/bigstock 

Dr Sarah Brewer ex-Medical Director (20 years)

Dr Sarah Brewer MSc (Nutr Med), MA (Cantab), MB, BChir, RNutr, MBANT, CNHC, Dip IoD qualified from Cambridge University with degrees in Natural Sciences, Medicine and Surgery. After working in general practice, she gained a master's degree in nutritional medicine from the University of Surrey. Sarah is a registered Medical Doctor, a registered Nutritionist and a registered Nutritional Therapist. She is an award winning author of over 70 popular self-help books and a columnist for Prima magazine. Her debut novel is White Powder Of Gold. Dr Sarah Brewer is a registered medical doctor, nutritionist, nutritional therapist and author of over 70 self-help books.

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