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Britain is in the grip of an epidemic. Not one that grabs the news headlines, triggers lockdowns or dominates the agenda at Cabinet meetings.
And it certainly doesn’t have the same fear factor as Covid-19.
Yet urinary tract infections make life a misery for millions. One in two women in the UK are affected at some point in their lives.
Nearly a third suffer repeat episodes that can leave them doubled up in agony (‘like peeing razor blades’ is how many describe the symptoms), suffering broken sleep from frequent trips to the toilet and even, among the elderly, dangerously delirious and confused.
And men don’t get off the hook either – studies suggest about 12 per cent fall victim to a UTI at least once in their life, with the risk doubling once they get into their seventies and beyond.
UTIs can occur when potentially harmful bacteria – such as E. coli – manage to sneak from outside the body into the urethra, the tube which disposes of urine.
They can affect the urethra, the bladder and the kidneys – all covered by the term urinary tract.
From there, bugs can either cause an infection in the urethra itself, or travel up to the bladder and kidneys, triggering inflammation that can have serious consequences – such as severe kidney damage.
Infections make you pee much more often and more urgently than usual – it’s easy to get caught short. Many patients are also alarmed to find they have blood in their urine and pain in their tummy or lower back.
So just how big is the problem? In October last year, the UK Health Security Agency revealed UTIs were responsible for a staggering 800,000 NHS hospital admissions over the past five years, mostly in those aged over 65 and mainly women.
Other research shows the annual NHS bill for dealing with UTI patients who need emergency hospital treatment is a whopping £386 million.
If you’re really lucky, you may go through life with nothing more than a single UTI to contend with. But for many women especially, infections come and go so frequently that it impairs their ability to work, socialise or live a normal family life.
And for the desperately unfortunate – potentially a million or more women in the UK – it becomes a chronic, long-lasting infection which never really goes away and regularly causes agonising flare-ups, despite long-term treatment with antibiotics. What’s more, there’s often a blame culture attached to women who get UTIs – as if it’s somehow their fault through being promiscuous or unhygienic.
The fact is we still have little, or no, idea why some people are more prone to them than others.
But I’ve been working in this area of medicine for over a decade and the good news is that there are vital steps you can take to at least reduce the chances of contracting a UTI – or the frequency of them if you are a regular sufferer.
Drink enough fluid but don’t overdo it
Proper hydration is likely to be a key factor in keeping UTIs at bay – in simple terms, it helps to flush out bacteria from the urinary tract before they get a chance to trigger an infection.
A 2020 randomised controlled trial – the gold standard of medical research – published in the Journal of Family Practice found women who were susceptible to recurrent UTIs but drank very little fluid had nearly half the number of infections when they upped their intake to 1.5 litres every day.
As a result, their antibiotic use also almost halved. But let’s be clear – more is definitely not better. Consuming three litres of water a day or more is not only unwarranted, it’s potentially dangerous.
If you’re prone to UTIs, it could be a good idea to cut down on sugary snacks such as doughnuts
Drinking too much water effectively washes away any ‘defender’ cells which may have been despatched to the urinary tract when the immune system detects that an invading organism is present and an infection is imminent.
It basically stops the immune system from doing its job properly. Stick to a maximum of 1.5 to two litres a day — and count other drinks (such as juice or squash) as part of your intake.
Go easy on the coffee too, or any other drinks that contain caffeine – it’s a diuretic (which increases the excretion of water from the body) and so may add to the discomfort.
Cut down on sweeteners
Artificial sweeteners – such as saccharin and aspartame – won’t cause a UTI. But if you are prone to recurrent infections, they can make symptoms worse.
That’s because the chemicals in them have been shown to irritate the lining of the bladder and the urinary tract. If these are already inflamed, due to the presence of foreign bacteria, the added effect of sweeteners could make your symptoms worse – and slow down any recovery.
Never put off a pee – it can cause problems
Sometimes you just can’t help it. You may be stuck in an important meeting, or struggling to find a public toilet while out and about.
But as a general rule, it’s not a good idea to make a habit of delaying trips to the loo – as it can heighten the risk of a UTI in both men and women.
The longer urine sits in the bladder, the more opportunity any foreign bacteria lingering there have to multiply and cause an infection.
And if you are unlucky enough to develop a UTI, emptying a full bladder can be painful and difficult – inflammation from the infection narrows the urethra, reducing the flow of urine and making it harder to empty the bladder completely.
Don’t waste cash on cranberry juice
As a nation, we spend millions of pounds every year on cranberry juice — which many believe combats the risk of UTIs.
In fact, studies show more than one in four women in the UK have relied on it at some point to protect them against infection.
But I’m afraid to say they are probably wasting their money. Cranberries do contain a type of sugar, called proanthocyanidins, which has been found in laboratory studies to block E.coli (the bug that commonly causes UTIs) from binding to the lining of the bladder. This could, in theory, prevent a UTI from being caused and sustained.
But the trouble is there is no strong, conclusive scientific evidence that drinking it regularly actually cuts infection rates in the population. Studies that do show it helps tend to be small and not terribly rigorous.
What’s more, many types of cranberry are loaded with sugar – which can help bacteria flourish.
Even the National Institute for Health and Care Excellence (NICE) – the NHS spending watchdog – now says there is no UTI-protective benefit from cranberry juice.
So save yourself a small fortune and drink 1.5 to two litres of water a day instead.
Wee immediately after having sex
Studies show that urinating straight after sex reduces a woman’s chances of suffering recurrent UTIs. There’s a widely held belief that sex allows new bacteria to enter the bladder.
However, why sex increases the risk is a mystery – the most likely theory is it’s because intercourse tips the vaginal and urethral microbiome out of kilter, making it easier for ‘bad’ bacteria to populate the area and multiply. This could explain why going for a precautionary wee after intercourse is effective in reducing the risk of a UTI – because it rids the urinary tract of any bacteria that might have already been present in the urethra during intercourse.
A long soak in a tub full of bubbles might not be very good for your urinary health
It’s less important for men because their urethras are roughly five times the length of a woman’s (up to 20cm versus 4cm) so infectious bacteria take much longer to navigate up to the bladder or kidneys – which means they can still be washed away by going to the toilet several hours after sex.
Treat yourself to cotton underwear
Tight leggings or underwear can create a breeding zone for UTI-causing bacteria – especially if they’re made of non-breathable materials like nylon or Lycra.
The lack of air flow creates a warm, damp environment which can disrupt the natural bacterial flora of the vagina and the urethra and create the ideal conditions for bugs to multiply.
If you’re a recurrent UTI sufferer, opt for loose-fitting cotton garments that will cool the area and make it harder for bacteria to flourish.
Ask for longer antibiotics course
For years, UTI treatment guidelines in the UK have specified that GPs should only issue three days of antibiotics to clear up an infection.
Yet it’s estimated that a third of patients fail to recover on this dose. This was never a problem when GPs would routinely see patients three days later for a follow-up – at which point more, or different, antibiotics would be prescribed if things weren’t improving.
But in the modern NHS, it’s almost impossible to get a prompt follow-up appointment, so many women end up back where they started – with another full-blown infection. Worse still, says the Chronic Urinary Tract Infection Campaign group – which lobbies for greater awareness on the condition – repeatedly taking three-day courses of antibiotics simply heightens the chances of a woman’s infection evolving into a long-term condition that could have a devastating effect on her life.
If you suffer recurrent UTIs that don’t normally respond to a three-day course, then don’t be afraid to demand five or even seven days of antibiotics.
Or ask your GP if you should try Hiprex (also known as methenamine hippurate) – a twice-daily antiseptic tablet that’s been around for decades but is not widely used as an alternative to antibiotics. It works by creating a hostile environment in the urine, which makes it hard for bacteria to grow.
Crucially, it can also be used for long periods as – unlike antibiotics – bacteria don’t develop resistance to it.
But stay away from Hiprex if you have kidney or liver problems, or gout, as it can make them worse.
The National Institute for Health and Care Excellence (NICE) is currently reviewing evidence on the drug to decide whether it should be deployed more widely in cases of hard-to-treat infections.
Quitting soapy washes stopped my infections
Mary Stephenson, 78, suffered recurrent urinary tract infections every few months for more than 30 years – but they instantly disappeared when she stopped using bubble bath.
‘It was a nightmare,’ says Mary, a retired receptionist and grandmother from Leicestershire. ‘I was miserable and depressed all the time and in so much pain – the burning sensation when I went to the loo was awful.
‘I only had to read the word toilet and I would have an overwhelming urge to go. If I went out anywhere, I always had to be close to a loo as I was peeing so much all the time.’
Mary Stephenson first developed recurrent UTIs in her mid-40s
Mary first started to develop recurrent UTIs in her mid-40s. Down the years she was prescribed countless short courses of antibiotics, but on each occasion the infection returned within weeks or months.
In 2022, a gynaecologist who was treating her for an unrelated condition recommended a few lifestyle changes – including avoiding bubble bath due to the chemicals it contains.
‘I followed his advice and instead of an infection every few weeks or months, I’ve only had two in the past two years,’ says Mary.
‘It was an almost immediate improvement and it’s carried on to this day.
‘Now I’m pain-free and not frightened to leave the house any more in case I need the loo. I feel great.’
Dr Rajvinder Khasriya is a consultant urogynaecologist and head of the chronic UTI clinic at the Whittington Health NHS Trust in London.
