How to finish the agony of UTIs WITHOUT antibiotics. These are the straightforward fixes docs do not let you know about – together with the 50p complement that is reworked lives

The millions of Britons who suffer from recurrent and painful urinary tract infections (UTIs) will know only too well how uncomfortable and frustrating they can be.

Mainly affecting women because of the unique layout of the female anatomy, the infections occur when harmful bacteria, often from the bowel, get into the urethra – the tube that carries urine out of the bladder.

This causes a burning or dagger-like sensation while urinating, lower abdominal pain and an urgent need to go to the bathroom, as well as a general feeling of being unwell.

But those affected by UTIs regularly may have an increased risk of deadly bladder cancer. A study published last week in The Lancet Primary Care journal that found older adults who suffered three UTIs within six months were over five times more likely to develop the disease.

One theory is that repeated infections trigger long-lasting inflammation in the bladder, prompting the body to repair the damage by producing new cells.

Over time, this increases the chance that dangerous mutations could form. That is significant because the infection is so common. Between ten and 20 per cent of women have at least one UTI every year – and for about six per cent, equivalent to about two million women, the infections are recurrent.

Dr Cat Anderson, a GP and ­specialist in UTIs, says: ‘UTIs can be absolutely devastating for women. They’re not just painful and disruptive, they can be life-altering and lead to loss of sexual function and even loss of employment due to the pervasive nature of these infections.’

The good news is that there are simple fixes that can help stop them from coming back.

Drink two litres of water a day

It’s the number one way to prevent UTIs – drinking at least two litres of water a day, or six to eight glasses, helps flush bacteria out of the urinary tract.

One 2018 trial found ‘strong evidence’ that women with a history of UTIs who then drank 1.5 litres more water a day had 50 per cent fewer repeat infections.

Helen Lake, specialist UTI nurse at charity The Urology Foundation, says: ‘If fluids aren’t moving through your urethra regularly, any bugs in the system are going to stay there.’

Urine should be a pale straw colour – dark orange means you’re dehydrated.

Always wipe from front to back

Most UTIs are caused by harmful bacteria from the bowel – most commonly E. coli – entering the urethra and travelling upwards to the bladder. The issue is driven by a design flaw in the female anatomy, as the urethra is close to the rectum – something that is not an issue in men.

But you can reduce the risk of bacteria reaching the urethra after going to the toilet by always wiping from front to back.

Ms Lake adds: ‘Go to the toilet when you need to go – don’t hold it in, which allows bacteria to linger. Also take your time to empty your bladder properly. Don’t rush it.’

Have a wee before and after sex

Up to 80 per cent of women prone to recurrent UTIs – defined as more than three in a year, or two in six months – may find sex is a trigger, studies show. That is because bacteria can be introduced during sex, and the movement itself can push bacteria in the lower part of the urethra upwards into the bladder.

But Dr Anderson says: ‘While a UTI isn’t a sexually transmitted disease, going to the toilet before and after sex to flush out bacteria is a good idea. Even if you don’t need to urinate beforehand, drink a glass of water and wait – you could avoid a painful infection.’

Avoid fragranced soaps… and G-strings

It is a myth that urinary tract infections are linked to poor hygiene, although the stigma still lingers today. But bacteria can linger on the skin despite it appearing clean, Dr Anderson says.

The key is to avoid too much moisture, which can trigger ­bacterial growth.

Keep the genital area clean and dry, she advises, and avoid ­fragranced soaps and gels. This is because these can lead to ­irritation and raises the risk of symptom flare-ups.

Change out of sweaty clothes or swimwear promptly, and regularly change incontinence or sanitary products to reduce exposure to bacteria. Opt for cotton underwear – and avoid tight clothing, thongs or G-strings.

‘G-strings and thongs are a bacterial superhighway,’ explains Dr Anderson. ‘They help convey the germs from the back passage forwards.’

Ditch prosecco and pile up leafy greens

Overhauling your diet could help protect against UTIs.

Sugary foods, including processed carbohydrates, fizzy drinks and alcohol, provide the perfect feeding ground for bacteria in the urinary tract, allowing them to multiply.

Dr Anderson says: ‘If you eat a really high-carb, high-sugar meal, your blood sugar levels will increase, which could cause sugar to spill over into the urine. That fuels UTIs. My busiest time as a UTI doctor is after Christmas and Easter.’

Alcohol and caffeine can also dehydrate and irritate the bladder, making it easier for bacteria to stick around.

Dr Anderson says her patients often report infections being ­triggered by white wine – and especially prosecco.

‘There’s no real evidence it impacts UTIs, but it’s certainly my patients’ experience,’ she adds.

Ms Lake recommends foods that are rich in flavonoids, which help reduce inflammation, boost the immune system and support bladder health.

These are found in berries, citrus fruits, apples, grapes, leafy green vegetables, tea and dark chocolate.

One Taiwanese study last year found that women following a ­vegetarian diet reduced their UTI risk by 16 per cent.

50p supplement could be ‘life-changing’

TV presenter Cherry Healey, who has spent her life in ‘agonising pain’ with UTIs, told the Daily Mail last month that since taking the supplement D-mannose she had not had an infection for nine months.

The sugar molecule, found naturally in certain fruits and ­vegetables, prevents E. coli from sticking to the bladder wall, and is recommended by the NHS to help prevent UTIs.

The evidence around it is mixed – one study found it was better than an antibiotic, while another was inconclusive.

But Dr Anderson says that few high-quality studies have been carried out. She adds: ‘Some patients find it’s a good enough prophylaxis [preventive treatment] that they don’t need to use Hiprex [an antiseptic] or ­antibiotics.

‘Unfortunately it’s not cheap, but it’s really worth investing in.’

D-mannose can be taken in tablet or powder form and costs roughly 50p a dose, but needs to be taken regularly throughout the day because it leaves the body when you urinate.

Ask for a seven-day course of antibiotics

Antibiotics nitrofurantoin and trimethoprim are routinely used to treat UTIs, but there is debate over how long they should be taken for.

Guidelines for GPs recommend just three days, due to concerns about bacteria developing resistance to the drugs.

However, many women find this is not long enough and the infection returns.

Dr Anderson says the guidance is based on low-quality evidence, and that further laboratory data and some small studies suggest a seven-day course may be more effective at preventing the ­infection from returning.

‘We’re not sure whether the ­problem of recurrent UTIs seems to be burgeoning because we’re better at recognising it or whether we’re fuelling it by only giving these three-day courses across the board,’ she says. ‘But at a meeting of the all-party parliamentary group on UTIs last week, this was discussed and everybody there was singing from the same hymn sheet and agreeing a seven-­day course could prevent UTIs more effectively.’

It’s worth asking your GP for a seven-day course, although they may not agree unless the guidelines change.

Antibiotics can also be ‘highly effective’ in the longer term for some people with recurring ­infections. This involves taking low doses every day for up to six months. Patients under specialist care may be able to take them for even longer.

Ms Lake says: ‘They do work brilliantly, but the infections can come back when you come off them. And the biggest worry is that you become resistant to them.’

Those prone to UTIs should ask their GP for a course of antibiotics to keep at home so symptoms can be treated straight away. 

Alternative to antibiotics

Patients can now choose to take a twice-a-day tablet called Hiprex instead of antibiotics, which studies show is just as effective at preventing further infections but without the risk of antimicrobial resistance.

Known as methenamine ­hippurate, it is an antiseptic that breaks down into formaldehyde in urine, killing bacteria and making the urinary tract less hospitable to infections.

It’s important that urine is acidic for it to work, so doctors may recommend taking a vitamin C supplement to boost its effectiveness.

One trial found 43 per cent of those taking the drug were free of UTIs after a year, compared with 54 per cent of those taking a low dose of antibiotics.

Dr Anderson says: ‘It’s a game-changer – it’s incredibly safe, and patients can now choose which option they’d prefer.

‘Unfortunately, there is still a postcode lottery when it comes to getting it prescribed because it’s still more expensive than ­antibiotics, but that has improved since a generic version became available.’

How oestrogen can help boost post-menopause

For women who have gone through the menopause, vaginal oestrogen – in the form of cream or pessaries – can help restore healthy bacteria and reduce UTI risk.

Dr Anderson says it improves the health of the cells in the vagina, making it harder for bacteria to stick to them.

‘It also helps promote the survival of healthy bacteria so they start naturally producing acids which lower the pH of the vagina and generally make the whole environment more hostile to bowel bacteria,’ she says.

‘The more acidic the environment, the better when it comes to UTIs.’

Vaginal oestrogen is also very safe to use, even for women who have had breast cancer driven by the hormone.

One standard oral tablet of HRT contains one milligram of oestrogen – but even the most potent vaginal oestrogen would have to be taken for a year to reach this level, Dr Anderson says.

A vaginal probiotic serum called P.Happi may help – although more evidence is needed.

The serum is applied externally to the vulva, labia and perineum and it uses live bacteria to target E. coli.

Vaccine could be the answer

A pineapple-flavoured oral spray vaccine called Uromune has been shown in trials to prevent UTIs for up to a decade.

The liquid contains four of the main bacteria linked to UTIs – E. coli, Klebsiella pneumoniae, Proteus vulgaris and Enterococcus faecalis.

The spray stimulates the immune system to generate a ­protective response against these bacteria, helping to stop infections in their tracks from the start.

It must be taken once a day for around three months.

Trials found that 64.7 per cent of patients had either not had a UTI at all within six months of taking the drug, or had only had one.

Ms Lake says: ‘It doesn’t work for everyone. Unfortunately, when it comes to UTIs, there is no one magic bullet.’

Dr Anderson says that when used in her clinic in patients with ‘fairly extreme’ chronic UTIs, the vaccine ‘didn’t live up to the expectations set by the data that has been released’.

‘I think we need more robust data in a high-quality clinical trial,’ she adds.

The vaccine costs £400 from private clinics for a three-month supply, and may need to be repeated if the effects wane.

How Helen solved her problem without antibiotics

Months of recurring UTIs left Helen Smith in agonising pain and going to the toilet every 20 minutes day and night.

When short courses of antibiotics failed to help, the 31-year-old from Birmingham, pictured left, started taking antiseptic Hiprex alongside a low daily dose of antibiotic ciprofloxacin. These caused a significant improvement, although she came off the antibiotics due to gastrointestinal symptoms.

Today she is still taking Hiprex – which she credits for her recovery – alongside vitamin C, D-mannose, NAC and the probiotic P.Happi.

‘Over the course of the past few years I’ve really got my quality of life back,’ she says.

‘I have occasional ‘off’ days – manageable flares – but they’re few and far between.’

Helen stays well hydrated and eats a mainly whole-food, plant‑based diet.

She also gave up caffeine and alcohol after realising they were triggers for infection, and swapped regular running for yoga and walking.

The truth about cranberry juice

Despite cranberry juice being widely recommended for UTIs, Dr Anderson says its effects are ‘over-hyped’, particularly for those prone to repeat infections.

The fruit contains beneficial proanthocyanidins – compounds that stop bacteria sticking to the bladder wall – but the juice dilutes these and so is unlikely to help.

A review of the evidence by the Cochrane research organisation found that a concentrated 36mg dose in a powder or tablet was the most effective way to take it. But the review concluded that it ‘probably worked’ only for some people.

‘It has a role, but won’t work for people with severe UTIs so they’d be better spending their money on something else,’ Dr Anderson adds.

Oregano oil, popular in Greece, might also help. She says: ‘I’ve had patients who’ve had problems with recurrent UTIs and we’ve got them off antibiotics by using oregano oil – it seems to work for some people.’

For tips to help prevent UTIs, visit theurologyfoundation.org