Managing a chronic UTI flare

Flares not only affect the body physically but emotionally too especially if they arrive suddenly after a period of feeling better.

Unfortunately flares are common and can happen at any time including when you are taking medication to manage a chronic or recurrent UTI. Some people flare after eating certain foods, after drinking alcohol, after sex or during periods of stress. Flares can also happen when there seems to be no trigger. This can be down to the cyclical shedding by the body of the the bladder lining which can release infected cells into the urine setting up a sudden flare.

What is a UTI flare?

A flare is an increase or return of your lower urinary tract symptoms. So that could be pain, frequency, blood in the urine, lower back and abdominal pain, fever, tiredness and nausea. You could also notice a change in mood making you more irritable, emotional or distressed.

It is usually caused by bacteria from within the biofilm or intracellular infection in the cells of the bladder wall releasing into the urine and in the right circumstances, significantly increasing symptoms.  The immune system sensing an upsurge in bacteria, dilate the blood vessels in your bladder wall and increase the blood flow to the infected area triggering an inflammatory response so that white blood cells and other antibodies can begin to eradicate the bacteria. This response causes the nerve endings in the bladder wall to activate causing symptoms of pain, frequency and urgency. The pain can often radiate out beyond the bladder itself into the vagina, pelvic floor, abdomen and legs.

What can trigger a UTI flare?

• Not on medication
• Having had sex
• Eating or drinking something that is a personal trigger
• Extreme stress – which can cause the immune system to lower
• Dormant bacteria awakening in the bladder wall cells and releasing into the urine
• Periods of travel especially flying
• The bladder lining naturally shedding and releasing bacteria from the shed cells
• Whilst taking antibiotics or antimicrobials early in treatment due to the bacterial reaction
• the hormonal effects of the menstrual cycle, perimenopause or menopause.

Managing your UTI flare

Always consult your doctor or consultant when you have a flare to ensure you have the right treatment to support you. Tell them what has happened and explain all your symptoms so they have a clear history. A urine analysis may be necessary.

Flares are common, but try to remember it will pass. It might take a few days or weeks but it will pass. Try to reframe it in your mind: “whilst I am currently flaring, I know that I have come through previous flares and will come through this one as well”.  If you need more support, read our guide to stopping chronic illness taking over written by Dr Kate Middleton, herself someone who experienced a chronic UTI and is now fully well.

Things you can try at home to help with a UTI flare

• A teaspoon of baking soda or bicarbonate of soda in a glass of water 2-3 times a day can reduce the acidity in your urine and reduce some pain. This is much cheaper than over the counter sachets. If you’re on a low sodium diet look for alternatives such as Potassium Citrate.
• An ice pack between the legs placed on the vulval region will numb and distract the nerves causing your pain. However make sure you wrap it in a towel or tea towel rather than applying directly against the skin to avoid irritating delicate vulval skin.
• Avoid heat pads between the legs as this extra heat could encourage vulval conditions to become irritated.
• Take pain relief and/or an antihistamine to calm the nerves in your bladder aggravated by the immune system response to the bacterial upsurge.
• Azo – a urinary painkiller – can help. Azo is available on prescription or over the counter in America or via Amazon elsewhere.  It contains the active ingredient Phenazopyridine Hydrochloride.
• If you can, go to bed or lie down. Pop a cushion or pillow under your knees to take the pressure off your pelvic area.
• Wear unrestrictive clothes to avoid pressure on your lower abdomen and pelvic area.
• Eat and drink a very bland IC style diet until the flare settles.
• Try to relax, take lots of deep breaths and use gentle visualisation, mindfulness or meditation techniques.

If things don’t get better

Contact your doctor or consultant again. If you have blood in your urine, a high fever, an increase or decrease in blood pressure, experience pain radiating to other areas than the pelvic region, become confused or dizzy or start vomiting seek urgent medical help. Take any prescribed medications with you to show the emergency doctors.