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Treatments – UTI

Treatment always requires conservative measures, followed by one or more of the other options.

Conservative measures

Most of us do not drink enough fluid. Those with recurrent UTIs should consume 2-3 litres of fluid throughout the day. The type of fluid is not important but you are aiming to produce around 2 litres of urine.

Erratic bowels and, in particular, constipation are associated with an increase in UTIs. Therefore increasing dietary fibre along with a good fluid intake will be useful.

Over the counter remedies

Cranberry is the best known. The research evidence is conflicted but some patients find it helpful. It is best consumed in tablet form as the amount of cranberry in juice is variable. In theory it prevents the bacteria sticking to the bladder wall and therefore combined with a good fluid intake allows bacteria to be flushed from the bladder.

D-mannose is a natural complex sugar. It appears to bind bacteria together preventing an infection establishing and, again, with a good fluid intake should allow the bacteria to be flushed from the bladder.

HRT & vaginal oestrogen

Post menopause the vaginal mucosa changes with a drop in oestrogen. This can cause discomfort with sexual intercourse, but also results in a change in the normal ‘friendly bacteria’. This can be part of the reason for an increase in UTIs. Hormone replacement therapy by tablet, patch or vaginal pessary can be helpful.

Prophylactic antibiotics

These are used sparingly as we are always concerned that overuse of antibiotics encourages resistant strains of bacteria which are more difficult to treat when a patient is unwell.

Occasionally sporadic antibiotic doses can be used for women with an obvious trigger such as sexual intercourse. More commonly antibiotics can be taken for 6 – 12 weeks at a low daily dose. If infection is prevented during this time, then the bladder’s natural ability to repel infection is returned and hopefully fewer course are required in the future. This measure must be combined with other tactics such as an increased fluid intake.

Bladder installations

The bladder’s natural repellent lining or GAG layer can be disrupted by recurrent infections. Occasionally, chemicals can be instilled via a temporary catheter to encourage the lining to repair. Initially this is a treatment weekly for 6 weeks but it can require ongoing maintenance treatments.


There has been extensive research in this area and progress has been mixed. Uromune does appear to be useful for some patients.


This is not commonly required for women. Occasionally the urethra (water pipe) is narrow and requires dilating.

Men with UTIs secondary to poor bladder emptying may benefit form surgery to the prostate such as TURP or similar. The details are in the benign prostate section