Women's health

Patient information for Translation

Management of recurrent lower urinary tract infection of non-pregnant non-catheterised females in the community

What is a urinary tract infection?

Urinary tract infections (UTIs) are very common and are caused by bacteria that live in the digestive system. If these bacteria get into the urethra or bladder they can cause infection.

It’s estimated half of all women in the UK will have a UTI at least once in their life, and 1 in 2,000 healthy men will develop one each year.

Women are more likely than men to have a UTI. This is because in women, the urethra is closer to the anus than in men. Also, the urethra is much shorter in women, making it easier for bacteria to reach the bladder.

What are the symptoms of a urinary tract infection?

When you have a urinary tract infection you may feel:

• A need to frequently pass urine
• An inability to hold your urine with a feeling of needing to pass your urine urgently
• A feeling of burning or stinging in the urethra on passing urine or pain at the end of passing urine.
• Sometimes you may also notice that your urine becomes cloudy, smelly, or even stained with blood.

Having Recurrent UTIs

Unfortunately, some people keep getting UTIs.

It is more common in women after the menopause as the hormone oestrogen helps to protect women against urine infection. However, after the menopause, oestrogen levels become low.

Sometimes, bladder infections (cystitis) can be triggered by sexual intercourse.

Other situations that may increase your risk to have recurrent UTI are:

• a condition that obstructs or blocks your urinary tract, such as kidney stones
• a condition that prevents you fully emptying your bladder (it is easier for bacteria to multiply if urine stays in the bladder longer.)
• a weakened immune system – from chemotherapy, for example

How can I prevent recurrent urinary infections?

Some simple measures include:

• Wipe from front to back when you go to the toilet.
• Do not delay urination after sex
• Maintain adequate hydration (6 to 8 glasses including water, decaffeinated and sugar-free drinks)
• Avoid tight underwear (e.g., cotton is usually better than manmade fabrics).
• Only use a gentle plain soap for washing the genital area.

When should I contact my doctor?

The following symptoms are possible signs of serious infection and should be assessed urgently.

• You have shivering, chills and muscle pain.
• You feel confused, or are very drowsy.
• You have not passed urine all day.
• You are vomiting.
• You see blood in your urine.
• Your temperature is above 38◦C or less than 36◦C.
• You have severe kidney pain in your back just under the ribs.
• Your symptoms are not improving within 48 hours of taking antibiotics.
•  

Preventative measures including antibiotics

Taking antibiotics too often may contribute to antibiotics becoming less effective so it is best to avoid an antibiotic unless absolutely necessary.

Occasionally conservative measures are not enough to reduce the frequency of recurrent urinary tract infections and your doctor could prescribe prophylactic antibiotics.

If a “trigger” for your recurrent infections is identified, the doctor will recommend you take one dose of antibiotic after the trigger (e.g., sexual intercourse).

If there have not been any causes identified you may be offered long-term antibiotic prophylaxis that will need to be reviewed in 6 months.

You could also try non-antibiotic prescription only preventatives such as

• Vaginal oestrogen (e.g., Estriol 0.1% cream) applied to the vagina for post-menopausal women
• Methenamine Hippurate 1g orally twice daily

Preventative antibiotics may be prescribed if you have 2 or more UTIs within 6 months or 3 within 12 months.

Your GP or hospital doctor may prescribe one of the following antibiotics. It is important you note the name of the doctor who started this medication.

• Nitrofurantoin       ¨                  Trimethoprim       ¨
• Amoxicillin            ¨                  Co-trimoxazole    ¨
• Cefalexin              ¨                  Other……………………

Please note that antibiotics may cause side effects such as nausea and vomiting. Please read the enclosed medicine leaflet carefully and contact your doctor if side effects become troublesome.

References

1. NICE Clinical Knowledge Summary. Urinary Tract Infection (lower) – women. January 2019. https://cks.nice.org.uk/urinary-tract-infection-lower-women#!scenario:2

2. British Association of Urological Surgeons. Self-help information for women with recurrent cystitis. April 2017 (Review date April 2020)

https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Recurrent%20cystitis.pdf

3. Urinary tract infection (UTI) information leaflet. Public Health England. V17. 30th November 2016

https://www.westhertshospitals.nhs.uk/patientinformation/documents/urology/Urinary_Tract_Infection_UTI_Information_Leaflet_Public_Health_England.pdf

4. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews. 2012;10. DOI:10.1002/14651858.CD001321.pub5.

5. Urinary tract infection (recurrent): antimicrobial prescribing NICE guideline Draft for consultation, May 2018

https://www.nice.org.uk/guidance/ng112/documents/draft-guideline

6. Kranjčec, B., Papeš, D. & Altarac, S. World J Urol. 2014;32: 79. https://doi.org/10.1007/s00345-013-1091-6

7. Albert X et al. Antibiotics for preventing recurrent UTI in non-pregnant women. Cochrane Database of Systematic Reviews. 2004;3. DOI: 10.1002/14651858.CD001209.pub2.

Large print and other languages
This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages, upon request. For more information, speak to your clinical team.
 

এই তথ্যগুলো সহজে পড়া যায় অথবা বৃহৎ প্রিন্টের মত বিকল্প ফরম্যাটে পাওয়া যাবে, এবং অনুরোধে অন্য ভাষায়ও পাওয়া যেতে পারে। আরো তথ্যের জন্য আপনার ক্লিনিক্যাল টিমের সাথে কথা বলুন।

Na żądanie te informacje mogą zostać udostępnione w innych formatach, takich jak zapis większą czcionką lub łatwą do czytania, a także w innych językach. Aby uzyskać więcej informacji, porozmawiaj ze swoim zespołem specjalistów.

Macluumaadkaan waxaa loo heli karaa qaab kale, sida ugu akhrinta ugu fudud, ama far waa weyn, waxana laga yabaa in lagu heli luuqaado Kale, haddii la codsado. Wixii macluumaad dheeraad ah, kala hadal kooxda xarunta caafimaadka.

Bu bilgi, kolay okunurluk veya büyük baskılar gibi alternatif biçimlerde sunulabilir, ve talep üzerine Alternatif Dillerde sunulabilir. Daha fazla bilgi için klinik ekibinizle irtibata geçin.

یہ معلومات متبادل فارمیٹس میں دستیاب کی جا سکتی ہیں، جیسا کہ پڑھنے میں آسان یا بڑا پرنٹ  اور درخواست پر متبادل زبانوں میں بھی دستیاب ہو سکتی ہیں۔ مزید معلومات کے لیے، اپنی کلینکل ٹیم سے بات کریں'۔

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Reference: BH/PIN/942

Publication date: January 2020

All our patient information leaflets are reviewed every three years.

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