Why we need to improve care for women with urinary tract infections

Dr Cat Anderson is a GP in North Staffordshire specialising in women’s health and UTIs (urinary tract infections). She outlines how traditional testing can miss UTIs and urges healthcare practitioners to listen closely to patients when they say they have a problem.

Urinary tract infections (UTIs) can be common in women. Bacteria within our own bodies can travel and accumulate which can lead to a lower urinary tract infection which primarily affects your bladder (cystitis), whereas an upper urinary tract infections can include infections within your urethra (urethritis) and/or kidneys (kidney infection).

What are the symptoms of UTIs?

Symptoms of an acute UTI can include discomfort when passing urine, frequency of wanting to pass urine, lower abdominal pain, feeling unwell and even urinary incontinence. Chronic UTI can have symptoms of constant pelvic discomfort while with recurrent UTI, the patient can experience an acute infection frequently.

What is classified as recurrent and chronic UTIs?

An acute UTI disappears after appropriate treatment, whereas a recurrent UTI has a medical diagnosis of two UTIs within six months or three within 12 months. More research is needed around chronic UTIs and we have set up a working party to gain a formal medical definition.

How common are UTIs?

Approximately 50% of women will get a UTI in their lifetime. One in four women who have a UTI will go on to have what is classed as a recurrent UTI and for an estimated 3% of women, this will turn into a very persistent chronic UTI.1 symptoms, in those with no red flags and in which the cause of UTI can be determined; recognising dipstick and culture testing have their limitations. We know for example, a patient who has had a UTI in the past, will be very good at recognising the symptoms when they experience them again.

How are patients diagnosed?

Why is it hard for patients to get the right diagnosis?

Whilst new testing criteria is investigated1, it is acknowledged by most microbiologists that up to 40% of symptomatic patients will not be diagnosed by the current testing criteria. This is due, in part, to culture testing, relying on limited legacy data. This data is not always reflective of the present day patient. Additionally, another contributing issue is that bacteria can also burrow within the bladder wall, which means it is less likely to be picked up on standard testing methods.2

A US study by Michels et al 2015, showed that when women presented with symptoms, there was an underlying urinary tract infection in 90% of patients. This is why we urge patients to keep a note of their symptoms so that they can communicate them clearly to their doctor.3

What is the solution?

If NICE and the NHS agreed, GPs could ‘flag up’ patients known to have problems to undergo more detailed culture testing. With the current process, many patients miss out on treatment. So, although there are some limitations in current diagnostic methods, patients should be urged to discuss their symptoms with their doctor.

A charity recognises the power of patient voice and the impact of a ‘lived experience.’ They offer an advice line where patients can speak to speak to someone openly about bladder illness.

Bladder Health UK (BHUK) is a national patient support charity that has been communicating with bladder illness sufferers for over 25 years. We offer a wide range of resources to help educate and inform on various conditions; and we pride ourselves on our advice line.

Encouraging patients to talk about bladder concerns

Callers are listened to with empathy and understanding by experienced people, with both expert patients and clinical staff available five days a week. Sometimes, it will be the first time the caller has shared that they have a bladder condition. There are also regular callers who want to unburden themselves when their symptoms get too much for them to manage on their own.

An anonymous patient says: “If it wasn’t for Bladder Health UK, goodness knows where I would be now. I will be forever grateful to their staff who spent time talking to me and explaining the help available.”

Another shares: “The helpline is priceless – advice is practical, realistic and evidencebased. I rang the helpline in desperation because I was having a UTI up to twice a month…”

Find out more at bladderhealthuk. org

Page sponsored and approved by Viatris HIP-2023-0099 / June 2023

NICE (National Institute for Health and Care Excellence) has recently simplified the guidance to help healthcare professionals identify a UTI. Whereas the advice previously relied on dipstick and/or culture testing, NICE have now suggested changing the approach, and relying more heavily on patient

References 1. Cochrane review - Antibiotics for preventing recurrent urinary tract infection in non pregnant women. Xavier Albert, Isabel Huertas, Inmaculado Pereiro, José Sanfélix, Victoria Gosalbes, Carla Perrotta,July 2004 https://doi.org/10.1002/14651858.CD001209.pub2

2. https://bsac.org.uk/utis-what-are-the- burning-issues/

3. Michels TC, Sands JE. Dysuria: Evaluation and Differential Diagnosis in Adults. Am Fam Physician. 2015 Nov 1;92(9):778-86. PMID: 26554471

Helping people who can’t be heard on their own Admitting to a bladder problem is hard, and even if you do see a GP, diagnosis can be complicated and disheartening.

Marketing and Communications Manager Susannah Fraser has suffered from bladder issues for 20 years. She is now a passionate advocate and valued team member of the charity because it helped her when no one else understood. “You cannot underestimate the relief I felt when I found this organisation that knew exactly what I was going through and that there were others like me,” she says.

The charity has a wonderful community of people passionate about making things better for those who know what it is like to live with a debilitating and often isolating illness. They have strong, supportive relationships with relevant corporate and commercial organisations and access to NHS and government bodies.

WRITTEN BY Susannah

Comms and Media Manager, Bladder Health

WRITTEN BY Polly Weston Clinical Lead University Hospital of Morecambe Bay and Chair, ACA