What are my options? A doctor answers your UTI treatment questions

Side view of senior woman standing on balcony

Urinary tract infections, or UTIs, are pretty common, and the majority of women will experience them in their lifetime. And often, women are able to spot the signs: perhaps you notice a burning sensation when peeing, or find yourself needing to pee a lot more than usual.

Usually, when talking about a UTI, we are generally referring to a lower urinary tract infection, that is in your bladder or urethra, which typically presents with two or more symptoms ranging from mild to severe. These symptoms include discomfort when passing urine (dysuria), needing to pass urine more often than normal (frequency), and getting little warning when you need to pass urine (urgency). Your urine may be cloudy or have a strong smell as well. Occasionally visible (frank) blood may be present, but make sure you are reviewed immediately if you see this as it can be caused by other more serious problems, too.

Most women will pay a visit to their GP if their symptoms don’t clear up quickly. But how will your GP treat your UTI? And what should you be doing yourself? We’ve answered the most common questions regarding UTI treatment to help you ensure you make a speedy recovery.

What medical information should I share with my doctor before treatment?

Firstly, think whether this is the first infection you have had or whether they keep happening (recurrent), as this can affect how they are managed. Also, consider whether there is a chance you may be pregnant (when your last period was and whether it was normal for you). In addition, knowing what medications you are on, including over-the-counter remedies and any drug allergies that you may have, will be useful for your doctor.1

What is the most common form of treatment for UTIs?

The most common form of treatment for UTIs in women is a short course of antibiotics. Most simple, non-severe urine infections are usually successfully treated by a short (three day) course of antibiotics. Some individuals, for example those who are pregnant or who have recurrent infections, may benefit from a longer course, but your GP will decide what is safest for you. Most women aged 16-65 years will usually be given the antibiotics trimethoprim or nitrofurantoin, but this may differ slightly depending on other health problems, whether you are pregnant, allergies you may have, or how severe the infection is.2

Can antibiotics interact with any other medicines I am taking?

Most antibiotics are very safe to take. They do however interact with certain medications, in particular certain drugs used to treat epilepsy, and medications in the group called enzyme inducing drugs. Be careful of the over-the-counter remedy St John’s Wort as this can interact with a lot of these medications, so be sure to tell your doctor if you are using this.

The current advice is that there is no interaction between antibiotics commonly used to treat urinary tract infections and hormonal contraception (the combined or mini pill). In the past, the advice was to use alternative contraception for the duration of the course and for a week after. However, recent evidence has shown this is unlikely to be necessary unless the antibiotics (or an illness) cause you to have diarrhoea and vomiting as well.3

Will I get any unwanted side effects from treatment for my UTI?

All broad spectrum antibiotics (antibiotics that target a wide range of bacteria) such as trimethoprim and nitrofurantoin may cause side effects in some women. Usually these are mild, but may also include nausea, vomiting, diarrhoea, and headaches. These are typically not troublesome and stop at the end of the course. Occasionally, like all medication, an allergy to an antibiotic can cause a severe allergic reaction, which could necessitate seeking urgent help, although this is very rare.

Following a course of treatment with any broad spectrum antibiotic, some women may develop vulvovaginal thrush. Antibiotics strip the vaginal flora of healthy bacteria, causing a fungal overgrowth. Thrush is easily treated using over-the-counter treatments, but if it is your first time having thrush then visit your GP.

Can a UTI spread to my kidneys?

Upper UTIs (infection in the kidneys or ureters) are usually more serious and are also known as pyelonephritis. These are less common than lower UTIs. Pyelonephritis is caused usually by an infection in the bladder travelling up the ureters into the kidney. Usually your body is able to respond to a lower UTI stopping the infection travelling further. Occasionally, the infection unfortunately does travel further, resulting in pyelonephritis. Typically, women with these infections may present with a very high temperature, flank (side) pain, and urinary symptoms.4 The principal symptoms differentiating pyelonephritis from a lower UTI are pain over the kidneys (flank pain), very high temperatures and feeling much more unwell.

Will my UTI eventually resolve on its own or is it always necessary to treat it with antibiotics?

Uncomplicated urinary tract infections in women aged 16-65 (who are not pregnant and who don’t have other health problems) are usually self-limiting and may well improve within a few days even without treatment. However, evidence has shown that antibiotics may help you feel better up to one to two days sooner than if you didn’t take them.5

However, if you have an upper UTI, have significant symptoms, or are unwell, then you do need antibiotics. This really is important because without treatment you could become very unwell. This is also true if you have other health problems (eg diabetes), if you are over 65, or if you are pregnant, as these groups are more likely to need help fighting the infection.6

Can painkillers help cure a UTI?

Unfortunately, painkillers do not help ‘cure’ a UTI. However, they may make you feel more comfortable while the antibiotics are working. As a result, it is okay to take a simple over-the-counter painkiller such as paracetamol, which does not interact with antibiotics, for a short time as long as the manufacturer’s instructions are followed correctly and you have no other health problems. People should be wary of using ibuprofen if they have pyelonephritis, as it can be harsh on the kidneys.

What else can I do to help get rid of my UTI?

There is little else that you can do to make yourself feel better more quickly. The general advice is to drink plenty of water and to finish your course of antibiotics if you are given them. Drinking a lot of water will dilute your urine, making it less likely to irritate the bladder. As mentioned, painkillers may make you feel more comfortable (when used safely).  Reducing your intake of caffeine could also reduce discomfort because caffeine is a slight irritant to your bladder.

General advice is that cranberry products and urine alkalinising agents (over-the-counter cystitis powders) are not recommended. Although they are traditional remedies, there is no good evidence to suggest they are effective in helping treat or relieve the symptoms of urinary tract infections.7

If you are otherwise fit and well, and the symptoms are not too severe, your doctor may issue you a short course of treatment based on symptoms alone. If you have unusual symptoms, recurrent problems, other health problems, or are over the age of 65, your doctor may well test your urine with a dipstick test and send it off for culture. This is not necessary in uncomplicated cases, however.8

References

  1. SIGN, Management of suspected bacterial urinary tract infection in adults: a national clinical guideline, [website], 2012, http://www.sign.ac.uk/pdf/sign88.pdf (accessed 11 April 2017).
  2. Ibid.
  3. FSRH, ‘Drug Interactions with Hormonal Contraception’, CEU Clinical Guidance, 2017, http://www.fsrh.org/standards-and-guidance/documents/ceu-clinical-guidance-drug-interactions-with-hormonal/ (accessed 11 April 2017).
  4. HPA, Diagnosis of UTI: quick reference guide for primary care for consultation and local adaptation, Health Protection Agency, 2011, https://www.gov.uk/government/publications/urinary-tract-infection-diagnosis (accessed 11 April 2017).
  5. Ibid.
  6. SIGN, Management of suspected…
  7. NICE, ‘Urinary Tract Infection (lower) – Women’, Clinical Knowledge Summaries, 2015, https://cks.nice.org.uk/urinary-tract-infection-lower-women (accessed 11 April 2017).
  8. HPA, Diagnosis of UTI…

Dr. Jennifer Kelly MBChB(hons) MRCGP DRCOG

Jennifer is a General Practitioner, medical writer, parent, and founder of the Grace Kelly Ladybird Trust, registered charity for childhood cancer awareness and research (www.gracekellyladybird.co.uk). She also has a particular interest in women’s and children’s health, and enjoys medical writing, particularly helping make medical information easily accessible to those who want to find out more.

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