UTI, soreness - are my bike riding days over?

[mutterphore]

I'm nearly 60 and post-menopausal for 5 years (luckily sailed through that process with no difficulties). Unfortunately, I've had my first UTI for the last 8 weeks+ with incredibly and unremitting soreness too and am on my third set of antibiotics.

As a regular bike-rider - usually around 80 miles a week - I can't even imagine the possibility now of getting back on my bike as the soreness is so awful, all the time. Will I ever cycle again? It's my main source of exercise and one of my greatest pleasures.

All the creams the GP has prescribed so far haven't worked and in fact I'm slightly worried they may have made things worse. I've tried Canestan Hydrocortisone (although I don't actually have any of the usual thrush symptoms - eg no itchiness and no discharge) which I think exacerbated the soreness, Replens - which definitely made it worse and Sylk, which sort of relieves it a tiny bit for a few seconds but doesn't go anywhere near relieving the soreness.

As I had no problems at all before all this, I'm reluctant to try topical HRT.

Wise women, can you suggest something for immediate relief from the soreness - ideally a safe, natural product, as I think all these creams have just made it worse?

Has anyone suffered similarly but then the UTI and the soreness gone away completely without further more drastic interventions. Finally, if there are any other post-menopausal cyclists on here, can you give me hope for future bike rides?

Sorry to hear you have it too. 💐

Sjorgens is one of the many autoimmune issues I have, alongside lupus (which often overlaps with sjorgens), Addisons, hypothyroidism, pituitary issues, painful bladder syndrome, asthma etc 😳😆 I’m a walking disaster…. If you have one autoimmune issue it’s fairly common to have others though.

With the sjorgens I am under an oral specialist for the dryness related to that - one of the first signs I had was recurrent oesophageal thrush and it got so bad I could barely swallow. So for that they have me on Daktarin gel nightly (which prevents thrush and the gel itself helps dryness), corsodyl mouthwash every morning (although it stains teeth, this can be removed by hygienist), and Fluconazole 150mg capsules once a month. If it’s really bad I can also use Flixonase nasal drops as a mouthwash mixed with water (steroid).

With the vaginal issues related to sjorgens - I have recurrent thrush so I have the canestan internal cream applicator 10% (as the pessaries won’t dissolve properly if you have sjorgens) once a month or more if it’s really bad, and canestan 2% external cream to use as needed. I use Ovestin cream 3 times a week and Replens on the days in between. When I first started to use the Replens I thought something was really wrong because I seemed to have a lot of white clumps coming out of me (!) but apparently that’s normal at first and then it stops - and it has. I use that externally as and when I need to as well. It really helps.

For my eyes - I have PF drops 0.4% prescribed to use as I need to.

Not sure if any of that helps! 🤷‍♀️💐

It’s a horrible thing to battle with. I think the HRT really helps with it all as well generally.

Xrays thank you for posting at such length and I am sorry to hear you have so many challenges. Most of my symptoms have been neurological until recently (hence the delay in diagnosis) which is a different set of challenges but now I have joint pain and dry eyes etc. (but getting away with 0.2% drops over the counter etc.). Good to hear that HRT is worth taking.

You’re welcome ❤️ there’s a very good Facebook group called Sjorgens support uk I think if you’re on there and fancy joining.

The joint pain is miserable… I take Tramadol for the pain when I need to (maybe once a day, I try not to take it) and amitriptyline 10mg at night has been really good, it helps me to sleep too as the joint pain was keeping me awake!

Sorry to hear of your neurological issues.

@mutterphore You might like to know that vaginal estrogen is not HRT.

It's 'topical estrogen'.

That's not classed as HRT.

You are still young in terms of post menopause years!

I am quite a bit older than you and have used HRT (and Ovestin) for over 12 years. I started on Ovestin 15 years ago and have used it ever since.

Like other posters here, I'd had symptoms for a long time, assumed it was thrush etc.

Remember that loss of estrogen in the bladder and vagina can do 2 things- make women more susceptible to infections, but also give symptoms that feel like an infection, but are caused by thinning of the bladder. It's now called 'Genito Urinary Syndrome'.

What a great topic for a Saturday night! :)

I'm back on this thread again as it's now 3 months and counting since I got a UTI. I'm still waiting for an appointment with a urologist and getting really fed up.

On the advice of my GP, I did try cycling one more time recently as my symptoms seemed a bit better. Bad idea! I feel I'm almost back where I started. Even going on long walks seems to make things worse. So I've now gone from cycling 80 miles a week, walking, wild water swimming and feeling fit and healthy to getting fatter and unfitter and very very frustrated. I can't do any of the hobbies I normally do, in case I get a UTI or exacerbate one I've already got. I can't drink coffee and I can't have a bath.

My GP meanwhile prescribed a stronger antibiotic but said only take it if I have a further infection. However, I don't know how to tell whether or not I've got an infection or just continuing inflammation or something else. So I'm reluctant to start a 4th course of antibiotics without knowing I need these.

Meanwhile, she also prescribed a medication for when women have 'urgency' symptoms without infection, called oxybutynin hydrochloride. I'm also reluctant to take this as, if I do have another infection, then it seems a bad idea to take a medication that stops you wanting to wee so much and flush out the infection - and it also has side effects like sedation and constipation.

I've never been someone to take any kind of medication, even things like paracetamol, unless really really needed and suddenly I've got all these medications, creams etc and still no solution to my problem. I'm sure all the topical creams made things worse. The GP hasn't suggested topical HRT and I think I'm supposed to wait and see the consultant urologist before anything further.

I suppose I'm just looking for positive messages of support at this point. I find it unbelievable that I've gone from never having had a UTI or any post menopausal problems at all, since my last period 6 years ago, to my whole quality of life massively and adversely impacted.

OP I'm so sorry to read your update, you have my sympathies.

When are you seeing the uro-gynae? Is it NHS or private? I saw one for prolapse at the end of last year and in my report he wrote 'largely asymptomatic' but actually I have tons of symptoms and it does impact me, so really go hard on the impact this has on your life.

Also and apols I haven't re-read the thread, but have you also seen a womens health physio? They usually work with uro-gynaes and have tons of useful info.

@Dogsgottabone , thanks for responding sympathetically. I don't know when I'll get the uro-gynae appointment. The GP was supposed to have referred me two weeks ago but I've heard nothing since and I was supposed to be referred for an ultrasound scan before then too but have also heard nothing about that appointment.

I've actually had to dip into my savings to see a private GP and get a private referral about this (don 't have health insurance) as it's impossible to see my NHS GP these days unless you're dying and I've not been to the NHS GP for over 5 years.

Thanks for the recommendation to emphasise impact on quality of normal life. That's very helpful.

The private GP didn't suggest anything about a women's health physio. I can't keep making appointments with the private GP just to check whether or not I've got an actual infection or it's just post-infection symptoms, as it's quite expensive each time and I need the money for the consultant appointment if and when it comes through.

I wish there was a home testing kit for UTIs as it looks very easy to do when the GP has done this with a dip-stick test. Then I could be more autonomous with at least monitoring what's going on.

I can sort of endure pain if I know it's not indicating anything that could lead to something worse like a kidney infection. It's the not knowing what's causing all of this or if even trying to exercise in any form, move around etc, is actually causing damage - eg infection. I've found that I can go for a long walk but the next day, symptoms get worse and the one cycling trip I tried really has set me back a lot with increased symptoms.

I can't recommend women's health physio enough. I saw one initially for urinary incontinence, she then picked up on the prolapse, sent a letter to my GP recommending ovestin (topical estrogen cream) and has been so supportive.

I can recommend mine if you are anywhere in the middle of England at the bottom..

Also there is a good podcast I've listened to called 'the pelvic service announcement' it's a couple of women's health physios in Texas and they are hilarious, you might get some useful info, otherwise I find them generally entertaining as they refer to their clients needing to ride horses or farm equipment!

Louise Newsome does some podcasts which talk about the urinary impact of meno too. You can see the subjects if you search through.

Its really shit that this is happening to you. My prolapse has mainly happened in the last 6 months and I feel stricken by it so I really do know what you are going through.

I think you can buy dip test strips at the chemist. Though dip testing isn't much use from what I have read - it often misses things.

So when the GP dip tested did something come up? (As I know they often prescribe antibiotics even when the test is clear).

Unclear if your urology referral is NHS or not, if it is you can check waiting times here:
www.myplannedcare.nhs.uk/
It's likely to be a long wait though.

I still think it's worth asking for topical oestro whilst waiting and given that you have been on a few antibiotics a probiotic that contains Lactobacillus rhamnosus GR-1 & Lactobacillus reuteri RC-14 is also worth considering. I take one by Nutrizing which is a bit cheaper than Optibac..

Not menopause related as I was in my thirties when this happened but I had to stop cycling for a while due to intense irritation/soreness. Swabs came back clear, various antifungal treatments didn't work. The thing that worked for me in the end was a week's course of Balance Activ for BV (even though BV had been ruled out by GP). It may well be that this won't help you but I can't see any harm in trying it.

I also bought a saddle with holes in it just at the points where my weight was putting pressure on the sore bits.

mutterphore I'm so sorry to hear that you are suffering still. I'm not a medic and obviously don't know your medical history, but from my own personal experience and that of other women replying on the thread who have benefitted from vaginal oestrogen (and as I mentioned upthread, since using it I have not had a UTI since), did your GP even mention this as a treatment? (Btw I can well believe they might not because despite numerous UTIs, it was not until I saw an older woman doctor that this was recommended.) Sending you all my sympathy.

Just joining in to second the change of saddle. Thinking about all the pressure that is put on that one "zone" of the body, when riding a bike, or a horse for that matter.
I stubbornly refused to change mine 9mountain bike, so easy to do and a good option) but in the end, did so - and also raised my handlebars (and the bit they are attached to - I forget what it's called; it can be extended at a bike shop....) to change where the pressure/weight is most.....
Apparently, a lot of professional lady cyclists suffer with incontinence, but it isn't widely talked about. And I'm sure they aren't carrying extra weight, in the way that we ordinary riders might be. I have certainly had more issues since putting weight on, ironically....
(And not lost any weight, despite sometimes 100 miles a week.)
I didn't know about all the HRT benefits (I did not have a single "typical" - obvious- menopause symptom), but am sure my GP (practice) will not help with something that might be preventative though.

Wow! Thanks so much for all this help! I don't feel so alone, although very frustrated that what I thought was simple fixable issue - and was told after 3 days of the initial antibiotics, I'd be back on my bike, it's now over three months and I'm no further forward.

@Nixer, the urology referral is also a private referral and I just figured that even private medics are very busy and overworked, so I've not heard anything back yet.

I think the private GP did 3 dip stick tests for infection and told me they were really accurate. The first and third dip stick tests were positive for infection. The second was clear. The third was sent off to a lab for culturing but came back negative, so the GP said I no longer had an infection and then prescribed the oxybutynin hydrochloride.

She also prescribed a mega dose anti-thrush tablet but as I've had no normal symptoms of thrush - no itching, no discharge - just the feeling of acid and barbed wire at the entrance to my ureter - I think I don't have thrush and was again worried about side effects of this huge antifungal meds.

@Dogsgottabone thanks for this recommendation for a women's health physio. I think I'll ask the consultant or GP about someone local to me as this sounds like a good option. The private GP is a lot younger than I am and is carefully going though all the NICE guidelines step by step with me but I do think I need a specialist at this point and preferably an older woman. The consultant is also a younger woman I think. These podcasts sound great! Thanks.

@ReallyShouldBeDoingSomethingElse that sounds very interesting about treating it as BV. Hadn't thought of that. I am planning to buy a bike saddle with a gap in the middle but when I tried to get a pressure point seat tests through a local bike physio, to see if they could recommend the best type of saddle to me that would fit my bike, they said they didn't provide that service.

I expect I'll have to invest in a few saddles and try them out but as I can't cycle at all anyway at present, it's a bit of a Catch 22 situation. I've got cycling trips and a main cycling holiday coming up - my one holiday of the year, in July - and am now having to think about cancelling everything. Very disheartening.

@LoveMyPiano is there a particular bike saddle you'd recommend? I know these are all very individual but I'm thinking something with a gigantic gap in the middle but lots of padding on the seat bones! I am very well endowed in the nether regions! I too find I don't lose any weight cycling but I feel so much better and stronger and I'm now actively putting weight on, which I can ill afford.

@Boiledeggandtoast , the GP muttered a few times about "there are topical HRT treatments but......" in a sort of off-putting way and it made me think this isn't an avenue to take. I suppose I'm holding out hope for the consultant urologist/gynae but don't even know whether she'll want to do loads of other expensive and invasive tests first. Gulp!

So I'm just sitting here drinking gallons of cranberry juice (making no difference as far as I can tell), eating active live yoghurts (ditto) and watching the next cycling day pass by (although I am actually in the middle of work anyway!).

OP.

Expensive tests - No. Uro-gynae always go with least invasive and most Conservative action. Will almost certainly recommend topical HRT, mine practically choked when he heard I wasn't already using it.

Re referral. If private, ring the consultants secretary. Book Appointment. Tell them GP has done a referral and the secretary will chase. All you do is turn up. I've had the same scenario with several consultants. Don't wait to be contacted, you'll be there ages. BTW you are lucky to have a female uro-gynae, they are all male and late middle aged near me. Not a fucking clue how it feels to run/workout/have sex with a prolapse.

Can you ring the GP and get them to prescribe some ovestin in the meantime? I got mine over the phone.

Can you ring the GP and get them to prescribe some ovestin in the meantime? I got mine over the phone.

I would second this (ovestin or Vagifem which is what I use). You could always try it while you're waiting for your referral to come through; I can't imagine it would do any harm and, at least, will hopefully give you some relief.

@Dogsgottabone , you gave me courage and I managed to track down the private secretary of the consultant and emailed her. She speedily responded but only to say they've not even received a referral letter and can't offer me an appointment until they do. So I've yet again emailed the private GP and asked her to send the consultant the referral letter and a copy to me as well. I already had to pay extra for the referral letter so hope she gets time to do it soon, though imagine she's snowed under with work.

Yes, I'm lucky that this is a female consultant too and I'm hoping for a conservative approach. I'll definitely be discussing topical HRT with her.

@Boiledeggandtoast it's not possible to phone the GP but I've emailed and hopefully she'll respond soon.

Thanks for all this support. It really helps.

Yay! I'm so pleased for you!!

If it's a GP you've paid for then your expectations about turnaround time on the referral letter should be much higher. Snowed under with work isn't your concern. Your letter is!

The wonderful thing about going private is that you are entitled to expect a certain level of service, as opposed to being endlessly grateful for the NHS.

Keep us posted OP.

I know you are already drinking cranberry juice, but once the infection clears, you may want to try cranberry extract tablets. I have 2 relatives with recurring UTIs and this is what finally stopped it coming back (one of them at least is still taking them daily years later, just in case).

Well done mutterphore, I really hope you can get this sorted it out soon. Fingers crossed for you.

@mutterphore
I am no expert - but this one is the one I got from you know where....
(Can't upload at the moment, but here's the name)
OUXI bike seat, should come up in a Search on the site.

EASY to fit - just a lever - but (you probably know) height, and matching handlebars to alleviate pressure, might need a second pair of eyes, or bike "expert"
Ooh, it's now £13.99, I paid more than that!

I've not read every single post here @mutterphore but the gist of it seems to be you are having to jump through hoops to get vaginal estrogen.

I feel really angry for you.

It's very well known that VA can both cause UTIs (as the bacteria get hold more easily) but also VA can mimic the symptoms.

Your GP ought to have prescribed topical estrogen ages ago (if they haven't by now.)

It's also a real shame that you need a referral to see a specialist. Most of them now take self-referrals so no need to use the GP as a gatekeeper.

IME the best consultants are very happy to see anyone without a referral. It's sometimes the less experienced ones who insist on a GP letter. (Whole family has had private cover, surgery etc, for over 30 years.)

cranberry juice I notice someone mentioned this as a treatment or preventative. It's fallen out of favour now and research showed it did no good and because it's acidic it may even make things worse.

I've not read every post but if you are still waiting for vaginal estrogen have you not bought Gina over the counter?

Many apologies if I'm behind what's happened.

The GP hasn't suggested topical HRT and I think I'm supposed to wait and see the consultant urologist before anything further

Talk about using a sledgehammer to crack a nut.

@mutterphore Sorry but this is just ridiculous. Your GP needs to do some training. Honestly, I could scream at how she's treating (not treating) you.

Go and buy Gina at a pharmacy. Use it daily for 2 weeks then 2 x a week thereafter.

Stop the cranberry juice as it's acidic.

You've lost all these weeks when something very simple could be helping.
You don't need oxybutin which is for frequency and over active bladder- something totally different.

I may have posted this before, but here it is again.

www.newsonhealth.co.uk/wp-content/uploads/2021/07/Vaginal-Dryness-v21-02.pdf

Extract here....

What is vaginal dryness?

The hormone estrogen keeps your vagina healthy by acting as a natural lubricant. It also stimulates the cells in the
lining of your vagina to encourage the presence of ‘good’ bacteria that protects against infection.

As estrogen levels in your body decline during the perimenopause and menopause, the vagina, vulva, and urinary tract can suffer from a lack of estrogen. The tissue lining your vagina thins (known as vaginal atrophy or atrophic vaginitis) and becomes drier. Your bladder and the tube running from it (urethra) also thin and become weaker which can cause you to need the toilet more often and feel very desperate to go, without much notice.
As estrogen helps cells to fight off harmful bacteria, a lack of this hormone makes you prone to urinary tract
infections, such as cystitis.

Please either insist on the right treatment from your GP- print off the above from Dr Newson's website- or buy your own treatment from the pharmacy.

OP you can buy a pack of urine dipstick tests on Amazon. They are exactly the same as the GP uses. Also, you can buy topical oestrogen over the counter called Gina as a previous poster has said. At least give it a try. I think you will be amazed how much it helps. I can't belive your GP hasn't suggested it and sometimes you have to take matters into your own hands.

It is interesting you where told the dipsticks and cultures are accurate as they are notoriously inaccurate. The nhs website evens states they miss cases of infection. It sounds like you may have an embedded uti. Unfortunately there are few specialists that treat this. The quickest would be getting a private appointment with Prof malone-lees clinic or otherwise it would be gettinga urologist to refer you to Luts at the Whittiwhittingon as they are the only NHS clinic that treat chronic utis

Or just try vaginal estrogen first.

This is what her symptoms point to.