Ask the doctor: Cystitis

Dr Max Pemberton 28 June 2020

Our resident doctor, Dr Max Pemberton, answers a reader question about a nagging problem

Q: I have been struggling with cystitis for over a year. My urine samples show white cells and I’ve been prescribed antibiotics four times in 12 months, but somehow the symptoms always return. I’ve given up tea and coffee and drink lots of water and cranberry juice, but I have no idea what more I could be doing. —Julie, 49

A: I’m sure a lot of readers can sympathise—urinary tract infections can be very unpleasant. While UTIs are painful, for most people they are short-lived. It’s unclear how they’re contracted, but according to the NHS “most cases occur when bacteria that live harmlessly in the bowel or on the skin get into the bladder through the urethra (the tube that carries urine out of your body)”. A course of antibiotics is usually all it takes to knock them on the head. However, some people are blighted by recurrent infections which can really impact their lives.

One of the pioneers in this area was Professor James Malone-Lee. You mentioned white cells in your urine, which is an indication of infection. The next step is usually to take a urine sample and grow the bacteria in a laboratory to find out what type it is. However, Malone-Lee found that this isn’t very reliable for chronic UTIs as it fails to detect bacteria buried deep in the lining of the bladder. He and those who follow his approach champion high-dose, long-term antibiotic treatment with patients closely monitored in a specialist clinic.

One study of 624 women treated over ten years at a specialist LUTS (lower urinary tract symptoms) clinic showed that they got better, only one had a serious side effect and there were no incidences of antibiotic resistance. If this does seem to be a recurrent pattern for you, I do think you need to ask for a referral to one of these specialist clinics.

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