Urinary tract infections are common. In fact, more than half of all women are likely to experience at least one in their lifetime. They also affect men, particularly as they grow older, and about 5% of children. Nevertheless, despite decades of research, experts are still unable to provide clear recommendations on many aspects of their prevention and treatment.
While a mild UTI can be cleared up easily with antibiotics, for some people they become recurrent and troublesome. Serious health problems can result if UTIs are left untreated, and particularly in older adults, they may be overlooked or mistaken for other conditions.
Using a new collaborative approach known as WikiGuidelines, an international network of experts has reviewed 914 studies to update the guidelines for prevention and treatment of UTIs. Dr Abdullah Aslan, of the University of Queensland, co-authored the resulting paper and says much of the advice currently given for UTI prevention doesn’t have much science behind it, making it difficult to give clear recommendations.
Drinking plenty of water, for instance, is thought to help flush bacteria from the urinary tract before an infection can be established but there isn’t a lot of proof to back that up. “While the current evidence for increased water intake isn’t sufficient to recommend it for preventing UTIs, there was one small-scale trial among healthy women that showed it reduced cystitis [a common type of UTI], and given that it’s a low-risk intervention, there’s no harm in trying it,” says Aslan.
However, you may want to fill your glass with cranberry juice instead, as the experts found some evidence that drinking it, or taking cranberry supplements, can help. “Most studies have indicated that cranberry products can reduce the risk of UTIs in people who are susceptible to recurrent infections. It’s thought that it works by preventing the bacteria from attaching to the epithelium – that’s the layers of cells lining the urinary tract system.”
Probiotics, on the other hand, don’t have enough data to support them, partly because there are so many different types of probiotic available and various ways of using them.
UTIs occur when bacteria enter the urinary tract through the urethra and begin to spread in the bladder. Generally, they involve the lower urinary tract although they can affect any part of the system. Women are particularly susceptible due to their anatomy. Females have a shorter urethra than males, which makes it easier for bacteria around the anus to reach the bladder.
Plus, hormonal shifts in midlife and beyond affect the female genito-urinary system, thinning and drying the vaginal wall and causing changes in its microbiome and PH levels. This, again, makes it easier for bacteria to enter the urethra and travel to the bladder, increasing the risk of infection.
Fortunately, there is a proven treatment to protect menopausal women. Vaginal oestrogen cream is a localised form of hormonal replacement therapy that is very low dose. Little, if any, is absorbed into the bloodstream, which means it doesn’t have the risks that have been associated with other forms of HRT. In New Zealand, the brand Ovestin is funded and available on prescription.
Being sexually active also tends to lead to more UTIs for women. Antibiotics are highly effective at preventing recurrent problems but, given the ongoing concerns about microbial resistance, these are considered a last resort.
An alternative is methenamine hippurate (Hiprex), which works by making the urine more acidic and therefore less hospitable to bugs. In this country, it is available behind the counter at pharmacies. While it won’t clear up an active infection, there is plenty of evidence that it is useful for prevention and it has a long history as a urinary antiseptic.
The symptoms of a UTI include a burning feeling when urinating, a strong urge to urinate that doesn’t go away, urinating often and in small amounts, urine that looks cloudy or pink or smells strongly, and pelvic pain in women.
Aslan is optimistic that new treatments are on their way, with vaccines being developed to prevent recurrent infections and new classes of antibiotics being designed to combat drug resistance.
“But further research is definitely needed.”
