To ask for advice on UTIs?

[seriouslynonames]

This might be long, sorry!

I have not, as far as I am aware, been a regular sufferer of UTIs in the past.

However, since having a vaginal hysterectomy and front/back wall repairs in early summer, I have had a few issues.

About a week or so after surgery I had burning, frequency, but of a temp etc. Dipstick from pharmacy said leucocytes but didn't show nitrites. Given 3 days nitrofurantoin. Symptoms improved but about 10 days later I felt similar symptoms, minus the temp. Dropped off sample at GP, negative on dipstick, got a text saying no action. Symptoms continued so this time spoke to a (different) GP who said will send a sample to lab. Lab confirmed group B strep in urine (at infection rather than contamination levels) so given 5 days amoxicillin. Seemed largely better.

Have had frequency and urge incontinence on and off since. Can be fine for a few days then a day where it feels not quite right again. No burning or temp so decided it must be down to post-surgery issues (there seem to be a lot of potential complications that can arise post hysterectomy etc).

Saw pelvic floor physio early Oct. She said get it dipped in case infection. Dipstick at home negative. So left it. About 10 days later had sudden urge incontinence and burning pain and urine has visible blood. Called out of hours (was weekend). Whilst awaiting call back had a couple of normal wees. Very confusing. Dipstick at out of hours GP showed leucocytes but not clear on nitrites so he said if I can wait to Monday send sample off at GP then take nitrofurantoin 3 days. Did this. Symptoms improved but not completely gone. Took about 2 weeks to finally hear back from GP who said, again, group B strep shown in lab. 7 days amoxicillin this time.

Symptoms are still there - intermittent. Mostly frequency and urge incontinence. Not really burning. Sometimes seems fine, sometimes not.

GP called to check (pre arranged) to see whether things settled. I said not really any change so he's now saying take Methenamine for 3 weeks and see if things settle. As a preventative rather than treatment. He assumes the antibiotics have treated but that the ongoing issues are irritation or something.

But I am not that keen on 3 weeks of this stuff as antibiotics have messed with my digestive system and don't want this stuff to mess with it more. And it sounds like it produces formaldehyde or something like that, which has made me hesitate!

I am peri, already on evorel 100 patches. I have some blissel gel but given all the UTI issues have been reluctant to be putting things in around that general area. But I gather local estrogen can sometimes help UTI type symptoms.

I have also heard of people using D-Mannose. A type of sugar that can help. I also read that you should reduce sugar in your diet to help with UTIs, seems conflicting!

I have already heard about specific probiotics for vaginal flora that might help.

I have read things that tell me to do any or all of the above, and other things that say the opposite.

So I am not quite sure of best next steps really. Not yet been offered a camera (the blood in urine slightly concerning me as not the first time I have had this on a dipstick - though once was during a period when I gave sample pre-hysterectomy! And once was after surgery so might both have been contamination) but if this methenamine doesn't help he will refer me I think.

Any advice from those with experience of repeated or tricky to shift UTIs, or this with UTI like symptoms after antibiotic treatment?

Should I start with blissel, then if no change try Methenamine, and after that D-Mannose? Should I keep the urine acidic for the methenamine to work better or keep it alkaline (can't remember where I read this - but it was completely contradictory advice). It's a minefield!

Thank you for any advice!

Bump!
Any advice welcome, thank you!

Vaginal oestrogen. HRT on its own doesn't always cut it. The vaginal stuff is like a miracle.

Sounds like you might need more estrogen, perhaps a higher strength patch + local cream/pessary?

Are you seeing a doctor with menopause as their specialism? I would imagine that’s essential here, after the hysterectomy?

I was going to say Ovesse for genitourinary symptoms of menopause, but you have to be 50.

First reply, I am a lurker but I saw your post and could not respond. I am similar to you, currently antibiotic resistant to some of them now as I have used them so much.

Currently on Vaginal Estrogen pessary and it is very good (tried the gel but did not get on with it). I have only had 2 UTI's in nearly two years, going previously from one every 2-3 months this is amazing.

I also take D-mannose and I did the Zoe diet for a while cutting out sugar, I eat a lot of foods that are gut friendly that try to build up all the lovely friendly bacteria. I use YES moisturizer for that area to stop that weird feeling you get sometimes and that works as well. If I see an increase I would also look at the probiotics for this, the one I am interested in were the ones that were on the Zoe podcast, formulated and tested especially for this problem. They are expensive though!

Also mine tend to happen if I have a heavy few days of sex with my husband. I am super cautious about him washing before hand, me peeing after sex and also not using any toys in that area as that was also triggering them.

Hopefully you will find something to help as its a vicious circle taking antibiotics and getting another UTI :-(

https://cutic.co.uk/what-is-chronic-uti/

Have a look at the website above, there are also helpful support groups on fb.

I am under urology for a chronic /embedded UTI. It’s horrid being on antibiotics so long, but I eventually kicked a 6 month infection with taking cephalexin everyday for 2 months at least, and Methenamine.

Can you ask for a urology referral? There are specialist clinics in this but only 1 NHS think.
It depends if you get a urologist who knows about this condition and can explore all treatments. Standard UTI testing is very blunt and doesn’t show embedded infections often.

i hope you get somewhere, it’s a miserable condition to have and you feel like you’re going mad, is it still there, is the area just inflamed etc.

Yes l suffered many years after loads of gynecological / bladder problems.
My bladder never grew past me being 10 years old.
Very urge incontinence.
I now have a prolapse and waiting surgery .
I had total abdominal hysterectomy age 30 years ago ( im 67). Estrogen cream really does help.
Twice a week.
Helps with thining vaginal tissue too.
Plus my vaginal dermatitis.
Try it .. can't hurt you to try but might just be the thing that helps.
Good luck.🌺

Vaginal oestrogen is a game changer. Anything going on in the vagina - dryness, irritation etc will affect the bladder wall and hey presto return of symptoms and then infection. Get the pessaries and see if things improve.

Thanks all!

I have the blissel gel but I am not sure I get on well with gel, it seems to irritate (e.g. when gynaecologist used it to examine me). Will try again, or ask for the vaginal pessaries instead of it's no good. I haven't come across vaginal estrogen cream yet, will ask. @ItsFridayIminLoveJS what's the name of the cream you use?

Should I try the vaginal estrogen plus the methenamine at the same time? And the D mannose? Or one thing at a time?

I will look into the Zoe recommendation for probiotics. Good ones so seem to be so expensive!

Will also look at the website you linked @sweetpeaorchestra, thank you

Will also look at the Yes moisturiser @goldiepop, thank you!

@Figs788 I do see (on zoom) a private menopause GP about 2-3 times a year. She writes to my GP and he prescribes what she asks. I am due to have a (very expensive 😵) appointment with her in the next month or so and will ask her about all this stuff. She's a bit gung ho with HRT, seems to think it can solve all my problems (it definitely can't!). So she would definitely up my patch but I am already on 100 and when I tried to go beyond that I got bad breast pain/lumpiness, so not that keen.
Thanks again all!

Look up Dr Amir Khan on Instagram
He says the same about estrogen. See my photos. He's done a video on UTIs and estrogen.. him from the telly.

Possibly if you feel she’s gung-ho about the HRT it might be worth a different opinion from a different menopause specialist? If you find you don’t have complete faith in her, another voice might be helpful at this stage?

My understanding is that it’s becoming more common to prescribe higher than 100 mg estrogen these days. And that some symptoms can worsen after the increase in estrogen initially, but then calm down as your body adjusts?

I hear you when you say it’s all so expensive, it’s very frustrating and feels like yet another tax on being a woman. But it’s where we are, and you are very important, and very worth every penny you spend on this. Solidarity with everything you’re going thorough! X

It so is. It’s changed my life x

I have had what seems to be urge incontinence since my hysterectomy, never had it before I now can’t trust my bladder as it will just leak or go all at once. Sometimes I get some pain also but it goes again. I used to suffer with utis terribly sounds simple but I went off having baths as much (yes I shower lol) an realised I was getting them 99% less. Xx

Have they taken swabs?

I recently had a problem with UTI symptoms reoccurring after antibiotics so my GP decided to take swabs along side the urine samples and it came back as being bacterial vaginosis. I didn’t have the classic unpleasant discharge but I had burning when passing urine.

Thanks @CoolPlayer interesting to know you have also had urge incontinence since surgery. I don't have baths anyway, only showers, so definitely not that.

Thanks @CosySeason I haven't had swabs taken, I was wondering if I should ask that. Particularly as I was positive as a group B strep carrier when tested late in second pregnancy and that's the bacteria that have been found in urine samples sent to lab.

I feel like I am wasting GP appointments with all this but I want to get to the bottom of it.
Thanks again all

So painful op isnt it. I was around a month getting over my uti it lingered and lingered. Friend swears by D mannose and high dose cranberry tabs. I tried the cranberry they quite good. My antib took time to work.

You’re definitely not wasting their time.