Antibiotics aren’t the only cure for bladder infections
MY friend has suffered from repeated urinary tract infections for years and is now terrified she’ll run out of antibiotics to treat them. She was recently prescribed one that she was first given several years ago because the others are no longer effective.
Her problem arose after a reaction to an anaesthetic for breast cancer surgery led to her ‘waterworks’ closing down. She had to catheterise herself every two hours for a very long time. Is there another treatment that might help?
Aurinary tract infection (uTi) is an umbrella term for a bacterial infection that occurs anywhere in the urinary tract; from the kidneys to the bladder to the ureters (the tubes connecting the bladder to the kidneys) or the urethra (the tube that carries urine out of the body).
Symptoms include a sudden urge to go to the loo and pain when urinating.
The term cystitis, sometimes used to describe a uTi, is actually an infection specifically in the bladder, and causes symptoms such as a burning sensation on urination, increased frequency, urgency — even incontinence — and blood in the urine.
These symptoms can come on suddenly, prove excruciating and, in some patients, occur frequently.
The accepted preventative treatment is a low dose antibiotic, usually trimethoprim or nitrofurantoin — a strategy known as antibiotic prophylaxis. numerous studies have confirmed this reduces recurrences by more than 90 per cent.
This prophylaxis should not be started until an analysis of a urine sample, taken at least a week after treatment for a previous infection, shows no trace of infection. This is not always possible, either because both doctor and patient cannot be bothered, or because of logistics — for instance, the patient can’t get to an appointment.
When prophylaxis is recommended, it is prescribed for six months (or sometimes one or two years). But in many women, the recurrent infections begin again after the course ceases.
understandably, your friend does not wish to use antibiotics, but there may be other options. ReSearCHerS
recently identified three significant factors that co-exist with, and possibly contribute to, uTis in post- menopausal women (i’m assuming your friend is post-menopausal).
in a study involving 150 such women with recurrent uTis, 41 per cent had urinary incontinence, 19 per cent had a prolapsed bladder and in almost a third an ultrasound scan showed they had residual urine after emptying the bladder.
By comparison, in a group of 50 women without a history of recurrent infections, a much smaller proportion had these problems.
your friend may have some or all of these issues. They should be diagnosed and treated by a urogynaecologist — her GP could refer her. Treating these may help prevent future infections. i have two further suggestions. First is the use of topical oestrogen: this can help restore the normal bacte-rial balance of the vagina, which can be altered by the menopause. restoring friendly protective microbes has been proven to greatly reduce the incidence of uTis in post-menopausal women.
The hormone can be applied either as a pessary each night, or as a cream inserted with an applicator into the vagina.
However, your friend will need to consult the oncology team who treated her for breast cancer, as if her tumour was hormone-dependent (fed by oestrogen), she may be warned against this.
The second strategy is a urinary antiseptic. This involves taking a daily tablet of methenamine hip-purate (Hiprex), which helps make the urine acidic, converting the drug into formaldehyde to kill the bacteria that can cause a uTi.
it does not cause significant side- effects and anecdotal evidence suggests it is helpful.
your friend must discuss this possible treatment with her GP. I’VE been taking one tablespoon of cod liver oil daily for a number of years, but recently I noticed that the label states it should not be consumed if you are also taking bendroflumethiazide for raised blood pressure.
I take 10mg of this daily (my blood pressure is now around 130/77), but I am loathe to stop taking the cod liver oil as I credit it with keeping my arthritis in reasonable check. J. H. Jones, Carmarthen. Cod liver oil has been consumed for its various health benefits since time immemorial — we have evidence that the ancient Vikings developed sophisticated techniques to extract the oil by steaming the fish liver.
it is known to lower levels of trig-lycerides, harmful fats in the blood — the omega 3s in cod liver oil reduce triglyceride production in the liver by competing for the enzymes involved in the process.
The oil also lowers blood pressure in some people, although how it does this is unknown. and it’s said to be helpful in limiting the severity of kidney disease caused by type 2 diabetes — again, the omega 3s are almost certainly involved here.
recent research in norway has shown that cod liver oil also halts or even reverses the breakdown of cartilage. However, there is little evidence that it is of any value in reducing the pain of osteoarthritis, though judging from your experience it is effective in some people, possibly by having an anti-inflammatory effect. For
an answer to your question i have searched for details of an interaction between cod liver oil and bendroflumethiazide, but found none, so the caution expressed on the labelling of your supply seems unexplained — though i do have a theory.
Bendroflumethiazide is a diuretic, i.e. a drug that gets rid of excess fluid, and is used as a first-line treatment for patients with raised blood pressure.
The drug is well-tolerated and has few contraindications.
But if your blood pressure is also lowered by the cod liver oil, the combination could — in theory — result in a large drop in blood pressure, for example, when rising from a seated position.
This could cause you to feel light-headed and even result in a fall. and this might explain the label warning.
However, if the combination has not disagreed with you so far, i see no reason not to continue to take the supplement. WRITE TO DR SCURR
TO CONTACT Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co. uk — including contact details. Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.