What do women who suffer from recurrent UTIs believe could be causing them and how do they approach early pre-antibiotic management?

Problem

Recurrent UTI (rUTI) is common, disruptive to women's quality of life, and assocatied with antibiot use and resistance. However there has been limited work, particularly in the UK context, to understand women’s beliefs surrounding behavioural and non-behavioural causes of their recurrent UTI and how they try to avoid recurrence. There has also been limited exploration of women’s experiences and approaches to using early non-antibiotic treatments before seeking healthcare.

Approach

Semi-structured qualitative interviews were conducted with 34 participants recruited from the MERIT trial, evaluating the effectiveness of D-Mannose as prophylaxis for UTI. A flexible topic guide included questions about what the women believed could cause a UTI recurrence, how they tried to avoid recurrence, and how they approached early phases of management. Interviews were audio-recorded and transcribed and thematic analysis was facilitated by NVivo.

Findings

Women described a wide range of beliefs regarding causation, including non-modifiable factors such as age, and potentially modifiable behavioural factors such as stress, sex, diet and hydration. Other gynaecological or urinary tract conditions were commonly mentioned as being possibly related to recurrent UTIs, including ones that impacted cleanliness, such as incontinence. Some women had been unable to identify any factors which could be potentially causative. Early treatments included modifying diet and hydration. A range of opinions were offered about over the counter treatments and more home-made remedies, but no treatment was endorsed by a majority of participants. Information on possible causes and early treatments was frequently gained from informal discussions with friends and family, whereas clinical advice was highlighted by some as simplistic and unhelpful.

Consequences

There is an absence of clear evidence based guidance for women with recurrent UTI on early non antibiotic treatment options or on behaviour changes which could reduce the chance of recurrence. Better evidence and education could contribute to reducing the frequency of UTI and the need for antibiotics.