Urinary tract infections are a pain, in more than one sense. We asked gynaecologists to explain why we get them - and how to stop them in their tracks
Pain when peeing, cloudy, smelly wee, having to run to the bathroom constantly, feeling achy - these are all symptoms of urinary tract infections (UTIs), also known as ‘water infections’ or cystitis. And at times in a woman’s life, they can persistently rear their heads, making going about your daily business a right pain.
“UTIs are caused by bad bacteria getting into the urinary tract and multiplying, causing an infection,” says consultant gynaecologist Dr Jo Bailey. They are, she says, much more common in women than men (read on to find out why).
Luckily, there are some interesting new ways to tackle them, particularly in the field of probiotics.
Probiotics make sense because the good microbes that colonise your vagina are actually essential for fending off the nasty, infection-causing ones. But they often get nuked by the antibiotics that are given to women to treat their ‘down there’ infections, exacerbating the problem. A raft of new probiotic supplements address this issue, and other factors that threaten a healthy vaginal microbiome.
There are other treatment options too, alongside many simple things you can do to prevent UTIs, which should never go untreated as this can lead to more serious problems. Here’s exactly how to tell if you have a UTI, and, if so, what you can do about it.
What is a UTI?
A UTI is when nasty bacteria make their way up you ‘water pipe’, or urethra, or urinary tract, and set off an infection, which is most commonly known cystitis.
There is a difference, explains Bailey, between an infection in your lower urinary tract (your urethra and bladder), and your upper urinary tract (the ureters and kidneys).
“Upper UTIs can be serious if left untreated, as they could damage the kidneys or spread to the bloodstream,” she warns. You can pretty much tell from the symptoms whether you have an upper or lower tract infection (see below). If it’s an upper UTI or you’re not sure, “you must see a doctor”.
The most common UTI-causing bacteria is E. coli. It can stick to and colonise the lining of the urinary tract and inflame it. “E.coli normally lives in the gut and can travel from the anus, across the vagina, and into the urethra. This is why the advice is always to wipe from front to back,” says Bailey.
Anatomy is one reason why women suffer more than men. “Women have a shorter water pipe, and on top of that, their urethra sits much closer to the anus than it does in men,” says Bailey.
Another reason, says gynaecologist Dr Penelope Law, is that in pregnancy and menopause, the changes in women’s hormone levels often affects the pH of their urine. “This, combined with multiple reasons such as not drinking enough fluids, can encourage bacterial growth,” she says.
How do you know you have an UTI?
Most women will get a UTI at some time in their lives, and some will get many; it’s not your fault and it really just reflects your overall health at the time, says Law.
Symptoms vary depending on whether you have a lower or upper tract infection, and as we’ve seen, it’s important to distinguish between the two. Bailey lists them as follows:
Lower UTI symptoms
- a need to pee more often than usual
- pain or discomfort when peeing
- sudden urges to pee
- feeling as though you’re unable to empty your bladder fully
- pain low down in your tummy
- urine that’s cloudy, foul-smelling or contains blood
- feeling generally unwell, achy and tired
Upper UTI symptoms
- a high temperature (fever) of 38ºC (100.4ºF) or above
- pain in your sides or back
- shivering and chills
- feeling and being sick
- confusion
- agitation or restlessness
If you suspect yours is an upper UTI, or your UTI doesn’t go away with drinking lots of water or taking a home remedy, you must visit your doctor, says Law. Otherwise you risk serious illness, such as pyelonephritis - an inflammation of the kidneys.
In these cases, you will be prescribed a course of antibiotics which tend to be very effective.
Is thrush a UTI?
No, it’s a fungal or yeast infection. Bacterial vaginosis (BV) isn’t an infection of the urinary tract either, but an overgrowth of bad bacteria in the vagina. They are linked to UTIs in that they are to do with an imbalance in the vaginal microbiome, whereby with bad bacteria muscle out the good ones. “The most common reason for this is antibiotics; these change the pH of the vagina, clearing a path for BV or thrush,” says Law.
Thrush, BV and UTIs require different medications, so see your doctor if you’re not sure. If you have discharge and you want to know which infection it might point to, gen up on what your vaginal discharge is trying to tell you.
The main reasons why you get UTIs
Bailey and Law want you to be aware of the most common risk factors for getting UTIs – forewarned is forearmed, after all.
1) Female anatomy
As mentioned, a woman’s natural anatomy makes it much more likely that you will get a UTI than a man. The bacteria generally come from the gut via the bottom and the closeness of the urethra (which is also much shorter than in men) means that it is easier for the bacteria to reach the urinary tract.
2) Being sexually active
There are several things at play here. Sex can physically mix things up a bit, in that fluids an bacteria can travel from one, er, ‘passage’ to another. Spermicides on some condoms affect the delicate vaginal microbiome balance, while unprotected sex can alter your vaginal pH level: semen is highly alkaline while the vagina is slightly acidic. A healthy vagina should re-set to acidic quite quickly after sex, but if it doesn’t, bad bacteria can find it easier to travel into your urethra.
3) (Peri) menopause
The (peri)menopausal drop in oestrogen can lead to changes in the vagina and urinary tract. A lack of oestrogen can cause the lining of your urethra and your bladder to become thinner and produce less lubrication, which may change your microbiome to becomes more susceptible to bad bacteria (HRT can be a great help, but if you can’t or don’t want to use it, a targeted probiotic - see below- may be another option). The changes in hormone levels can also affect the pH of your urine, encouraging bacterial growth.
4) Pregnancy
Some women are more susceptible to getting UTIs during pregnancy because the ureters (which connect the kidney to the bladder) dilate slightly more during these times. That makes some women more prone to bacterial growth.
What can you do to prevent UTIs?
Build the following into your routine:
1) Hydration, hydration, hydration
Drinking enough water is essential. If your pee is a dark yellow colour, this can be a sign that you’re not swigging enough.
2) Swipe right
ALWAYS wipe from front to back after going to the toilet. This helps prevent the spread of bad bacteria from the anus to the urethra.
3) Have a pee after having sex
This will flush out any bacteria that have found their way into the urethra while getting jiggy.
4) Do not cleanse or deodorise your vagina
‘Feminine’ products like scented wipes, douches and deodorants can irritate the urethra and disrupt the vaginal microbiome, which is a protective shield against UTIs. You can cleanse the vulva with a soap-free wash and there are deodorising mists incorporating allergen-free fragrances (see below), but neither should go anywhere near your insides (ie the vagina).
5) Use plain condoms
Avoid spermicidal lube and condoms with spermicidal lube.
6) Cut back on alcohol and sugar
Alcohol and sugary foods and drinks compromise a healthy microbiome overall.
7) Try intravaginal oestrogen
If you are menopausal, intravaginal oestrogen can help - pessaries or creams are available on the NHS and the brand Gina has recently become available at pharmacies without prescription. Non-hormonal vaginal moisturisers can be helpful as well, to relieve and prevent dehydrated tissues.
8) Try a prebiotic
D-Mannose is a prebiotic and a ‘good’ sugar that’s been highly researched, and is known to stop bacteria sticking to the walls of the urinary tract. It helps prevent UTIs by aiding the body in flushing bad bacteria away. NICE (National Institute for Health and Care Excellence) guidelines mention that D-Mannose, when taken regularly, may reduce recurrent UTIs.
How can you treat a UTI?
As said, if drinking lots of water and trying home remedies doesn’t make your UTI go away relatively fast, you need to see your GP, who will put you on antibiotics. They are necessary but, says Bailey, “not very selective. They can also kill some of the good bacteria in your vagina, which is why lots of women get thrush after a course of antibiotics.” One way to counteract this is to take a targeted probiotic as well.
This could be particularly helpful when you suffer from a recurrent UTI, says Bailey. “This is when you have two episodes of UTI in six months, or three episodes in a year; very upsetting and painful, affecting your quality of life. Your doctor might suggest a low-dose prophylactic antibiotic which you will take for the long term, but if they do, you really need to look after your vaginal microbiome with a targeted probiotic supplement rich in lactobacilli found in a healthy vagina.”
Best products for managing UTIs
Best supplement for relieving UTI symptoms: VJJ health Ultimate UT for UTIs and Cystitis, £35.10 for a 30-day supply
Developed with the help of Dr Jo Bailey, this helps prevent and relieve the symptoms of UTIs thanks to D-Mannose and the good probiotic lactobacilli found in a healthy vaginal microbiome (the brand also do GTG Award-winning Perfect V, £26, to treat BV and thrush and for overall vaginal health) .
Best supplement for preventing UTIs: Gentil Take Care Of U Urinary Tract Support, £25 for a 30-day supply
These caps are rich in cranberries which contain proanthocyanidins (PACs), another ingredient shown to prevent bacteria from attaching to the cells that line the urinary tract. There’s zinc, bearberry leaf, echinacea and a blend of lactobacilli as well to help prevent and relieve infections and boost immunity.
Best supplement for menopause-related UTIs: The Better Gut, £52 for a 30-day supply
This aims to re-balance the gut and estrobolome (the various bacteria in the gut tasked with metabolising and modulating your body's oestrogen) with specific, clinically-backed bacterial strains. Together, they replenish bacteria that go awol in menopause, help excrete used-up oestrogen and dampen inflammation, resulting in an improvement in menopausal symptoms including and vaginal and urinary tract infections.
Best-value supplement for supporting the vaginal microbiome: Optibac Intimate Flora For Women, £19.99 for a 30-day supply
With three proven strains of lactobacilli, this will keep the vagina and urinary tract in top condition to fend off infections.
Best on-the-go refresh that won’t disrupt your vaginal microbiome: Luna Daily The Hydrating Everywhere Spray-To-Wipe, £12
Dr Law is part of the Luna Daily Medical Collective and endorses this hydrating and refreshing spray that incorporates an allergen-free fragrance. To be clear, it’s to refresh bodyparts including your vulva, not your vagina.
Best for a posh intimate wash: Barbara Sturm V Wash, £55
A fragrance, soap and sulphate-free wash that helps balance the skin microbiome of the vulva (once again for the people at the back: do not wash the vagina).