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My wife, who is 85, has suffered from urinary tract infections every few months for five years. Antibiotics don’t work. What can she do?
Dr Ellie Cannon replies: Recurrent urinary tract infections are miserable to live with, but there are now more options to tackle them.
The female bladder sits close to the vagina and rectum, which means bacteria can pass easily between them. After the menopause, women lose oestrogen – the hormone that keeps bladder tissue healthy and helps protect against infection. Vaginal oestrogen prescribed by a GP can reduce the frequency of these UTIs.
Constipation is another factor. When stool builds in the bowel, it can stop the bladder emptying fully, allowing bacteria to multiply in stagnant urine.
Pelvic organ prolapse – where the bladder or womb drops slightly out of position – can have the same effect. Both are common in older women and need to be ruled out.
Being well hydrated – aiming for a litre and a half of water a day – helps flush out bacteria from the bladder. Avoiding soaps or bath products that irritate the skin in intimate areas is also important.
Being well hydrated – aiming for a litre and a half of water a day – helps flush out bacteria from the bladder
A supplement – D-mannose – helps some women reduce recurrences, but results vary.
A nightly preventative antibiotic prescribed by a GP is another option. Where this is not suitable or effective, ask your GP about Hiprex – methenamine hippurate. It acts as an antiseptic to stop bacteria growing in the bladder.
Older women with recurrent UTIs should also have an ultrasound scan to check the ovaries and bladder. This is because these symptoms can, in rare occasions, be a sign of cancer.
I have been taking tramadol for knee pain for several months. My last prescription request was rejected and paracetamol doesn’t cut it. What are my options?
Over-the-counter ibuprofen and paracetamol can be combined effectively for better pain control – a pharmacist can advise on how to do this
Dr Ellie Cannon replies: Stopping tramadol without consultation or support is not acceptable practice, and the GP surgery should offer alternatives. Tramadol is an opioid – a strong painkiller in the same class as morphine – and is prescription-only as its use risks dependency and withdrawal, with GPs ever more cautious on long-term use.
However, the first thing to do is contact the surgery to request an urgent phone consultation. Many practices also employ a pharmacist who can advise on pain management and would be well placed to help. A sensible approach is to reduce the dose gradually – alternating it with paracetamol, or taking it only at certain times, such as at night, to let the body adjust.
Other prescription options include naproxen or similar anti-inflammatories, depending on other health conditions, or a weaker opioid such as codeine.
Over-the-counter ibuprofen and paracetamol can be combined effectively for better pain control – a pharmacist can advise on how to do this. Heat pads and cooling gels can also be used safely with tablets.
