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Understanding Urinary Tract Infections (UTIs) and Cystitis in Women



Urinary tract infections (UTIs) are common infections that can affect the bladder (cystitis), urethra (the tube that carries urine out of the body), and kidneys. Over half of all women will experience a UTI at some point in their lives, with some suffering from recurrent episodes. UTIs often become more frequent and troublesome during perimenopause and postmenopause due to hormonal changes.


Why Are UTIs More Common During Perimenopause and Menopause?

As women enter perimenopause and menopause, the decrease in estrogen levels can cause the lining of the urethra and bladder to become thinner and more susceptible to harmful bacteria. The natural balance of bacteria in the vagina can also change, making the urinary system more vulnerable to infection.


Signs and Symptoms of a UTI

When a UTI occurs, the lining of the bladder and/or urethra becomes inflamed, leading to several symptoms:

  • Discomfort, pain, or a burning sensation when urinating

  • Increased frequency and urgency of urination

  • Night-time urination

  • A constant feeling of needing to urinate, even with an almost empty bladder

  • Lower abdominal pain

  • Cloudy, dark, or strong-smelling urine, possibly with blood

  • Confusion or increased 'brain fog'

  • Fever or an unusually low body temperature

If the infection spreads to the kidneys, it can cause fever, nausea, and vomiting, requiring prompt medical attention.


Causes of UTIs

The most common cause of UTIs is the entry of bacteria, often from feces, into the urinary tract. Escherichia coli (E. coli), commonly found in the bowel, can easily enter the urinary tract due to the proximity of the urethra, vagina, and anus. During perimenopause and menopause, a lack of estrogen can make the urinary tract lining more vulnerable to infection due to a decrease in beneficial bacteria and thinning of the tissue around the urethra, vulva, and vagina. UTIs can also be triggered by sexual intercourse.


Additionally, the urethra (the tube that empties the bladder) can prolapse or protrude more than it should due to the lack of estrogen. The natural balance of good and bad bacteria also shifts due to the decline or lack of estrogen. Estrogen, progesterone, and testosterone levels drop with age, but it is now understood that testosterone is important for the health of the pelvis and urinary tract.


Low dose vaginal estrogen can be quite effective at preventing recurrence of UTIs. Your doctor may also recommend a tablet that stops bacteria in your bladder from growing but is not an antibiotic; Methamine hippurate (Hiprex).


These podcasts from 2 different urologist with an interest in good menopause care will help.

https://www.podbean.com/ep/pb-5xn44-121cf28 - Dr Rajvinder Khasriya is a urogynaecologist who leads the Lower Urinary Tract Symptoms clinic at the NHS Whittington Hospital in North London, and is also involved in research work at University College London.


https://www.podbean.com/ep/pb-sefhv-132a48e - Professor Chris Harding is a Consultant Urologist working at the Freeman Hospital in Newcastle upon Tyne and at Newcastle University. He has a particular interest in bladder dysfunction, continence and urinary tract infections (UTIs). In recent years, his research has focused on non-antibiotic treatments for recurrent UTIs and developing targeted treatments for specific patient groups.


Treating UTIs

There are several self-help measures to ease the symptoms of a UTI and reduce recurrence risk:

  • Drink plenty of water

  • Avoid strong coffee, tea, acidic fruit juices, and fizzy drinks

  • Take painkillers such as paracetamol or ibuprofen

If symptoms persist or you feel unwell, consult your doctor, as you may need antibiotics. It's important not to use leftover antibiotics from previous infections.

For recurrent UTIs, some doctors prescribe 'self-start' antibiotics, which can be taken as per an agreed plan with your healthcare provider.


Preventing UTIs

Here are some steps to reduce the likelihood of developing a UTI:

  • Drink around two liters of water daily

  • Wipe from front to back after using the toilet

  • Keep the genital area clean and dry

  • Consider Hormone Replacement Therapy (HRT) or vaginal estrogen

  • Use gentle, unperfumed soap for intimate areas

  • Avoid bubble baths, talcum powder, and feminine wipes

  • Wear breathable, loose-fitting underwear

  • Wash the genital area before and after sex

  • Urinate after sex to flush away bacteria

  • Avoid spermicidal lubricants; opt for non-spermicidal alternatives

  • Limit alcohol and sugary food and drink intake


When to See Your GP

Contact your GP if your symptoms persist or if you experience fever, nausea, or vomiting. You may need antibiotics and will likely be asked to provide a mid-stream urine sample.


References

  1. Mayo Clinic: Comprehensive information on UTIs, including symptoms, causes, and treatment options.

  2. National Health Service (NHS): Guidelines on preventing and managing UTIs.

  3. American Urological Association (AUA): Research and recommendations on UTI management and prevention.

  4. Healthdirect Australia: Provides reliable health information and resources on UTIs and cystitis.

  5. Jean Hailes for Women's Health: Australian organization offering health information and resources specifically for women, including UTI prevention and treatment.

  6. https://www.wsh.nhs.uk/CMS-Documents/Services/Urology/Recurrent-UTI-Booklet.pdf



By Dr Purity Carr



GP & Menopause doctor

Harvey. WA

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