What do you need to know about urinary tract infections?

Urinary tract infections (UTIs) are a common and painful condition that affect many women. Despite the prevalence of this issue, a recent study conducted by researchers at the Female Pelvic Medicine and Reconstructive Surgery Clinic at Cedars-Sinai found that women are frustrated with limited management options and critical of healthcare providers for failing to understand their experiences while over-prescribing antibiotics as a treatment option. The study, published in the Journal of Urology, conducted a focus group study of 29 women who experienced recurrent UTIs to learn about gaps in their care.

UTIs are infections of any part of the urinary tract, including the kidneys, ureters, bladder, or urethra. One of the biggest concerns expressed by study participants revolved around the frequent prescribing of antibiotics and fears of the potential adverse and long-term effects of the medication. Many of the participants were aware of the risks of bacteria developing resistance to antibiotics and the disruption they can have on the normal balance of good and bad bacteria throughout the body.

Limited Research and Frustration with Medical Providers

The focus group discussions also reported concern with the medical system and limited research efforts to investigate new non-antibiotic management strategies. Participants voiced frustration and resentment toward their medical providers for throwing antibiotics at them without presenting alternative options for treatment and prevention, and for not understanding their experience. In addition, many women described seeking advice from herbalists and acupuncture practitioners, as well as from peers in online forums and chatrooms.

Non-Antibiotic Management Strategies and Prevention

Although studies show that antibiotics are often the most effective treatment option for urinary tract infections, research also shows that up to 40% of bladder infections can be cleared with non-prescription steps that can include increased water intake and pain relief medications such as ibuprofen. Taking these steps when UTI symptoms initially develop and urine test results are pending can be important for avoiding unnecessary antibiotics and ensuring that appropriate antibiotics are prescribed when needed. Among steps women can take to avoid a urinary tract infection are drinking water, taking cranberry supplements or a low-dose antibiotic after sexual intercourse, and using vaginal estrogen for those who are postmenopausal.

Importance of Education and Seeking Evaluation by a Specialist

While over-the-counter treatments are preferred by many, the lead author of the study, Victoria Scott, MD, recommends seeing a doctor if a fever develops or symptoms persist beyond a day, as antibiotic therapy can be crucial for some infections to ensure they don't spread from the bladder to the kidneys. Scott emphasizes that antibiotics are amazing drugs and in certain settings are lifesaving, but it's also important for women to be educated regarding all their options. Those who experience recurrent urinary tract infections should seek evaluation by a specialist. Some women will benefit from undergoing a kidney ultrasound or a cystoscopy, which uses a small camera that can be inserted into the urethra to give a view of the urethra and bladder to rule out anatomic abnormalities.

Empowering Patients and More Research Needed

Some healthcare providers might not think that a single episode of a urinary tract infection could have a significant impact on a patient's life. But when UTIs recur, often without warning, they can have a negative impact on social life, work, families, and relationships. The study recommended that physicians modify management strategies to address women's concerns and to devote more research to improving non-antibiotic options for prevention and treatment of recurrent urinary tract infections, as well as management strategies that better empower patients.

Journal Information: Victoria C. S. Scott et al, Fear and Frustration among Women with Recurrent Urinary Tract Infections: Findings from Patient Focus Groups, Journal of Urology (2021). DOI: 10.1097/JU.0000000000001843