Episode Transcript
Speaker 1 00:00:07 Welcome to the Irish Pharmacy podcast. This podcast is brought to you by Total Health and Haven Pharmacies. There are 127 of our independently owned pharmacies located all over Ireland so that we can bring trusted local care to you in your community. And now on the go with this podcast, my name is Sheena Mitchell. I'm a pharmacist from Milltown Total Health Pharmacy. In each episode, I'll be chatting with one of my pharmacist colleagues from the Total Health and Haven Pharmacies where they will blow your mind with all of the amazing information that they have. We aim to bring you reliable and useful health information that you can listen to conveniently at a time that suits you. This week I'm speaking to Michelle Concannon. Michelle owns two pharmacies in Athlon, one in the middle of town, and one on the Mahan Road. Michelle is a really experienced colleague and I was delighted to be able to have the opportunity to talk to her all about urine tract infections.
Speaker 1 00:01:11 Michelle does a fantastic job at explaining how and why urine retract infections occur, and more importantly gives us loads of tips on how to help prevent them or treat them. This episode is suitable for any age group from young women all the way up to the very elderly. We talk about all the different kinds of things that can make urine tract infections flare up. We talk about the impact of sex on urinary tract infections and also pregnancy, the menopause and beyond. Michelle is a complete wealth of knowledge and I hope you enjoy this episode as much as I enjoyed recording it. Hi Michelle and welcome to the podcast. So season one, episode one. How exciting.
Speaker 2 00:01:55 <laugh>, how are you? Sheena, are you just nice
Speaker 1 00:01:58 To see you. Delighted to be here. Are you?
Speaker 2 00:02:01 I'm so excited Tina.
Speaker 1 00:02:03 I know. Look, you get to pharmacy nerd up as much as you like now for the next little while in
Speaker 2 00:02:08 My element.
Speaker 1 00:02:09 Yeah, tell us a little bit about your pharmacies.
Speaker 2 00:02:12 I'm in a loan. I have two pharmacies, con canyons, total health pharmacies. I've been here for 24 years this August. So I started off with one pharmacy and I was going to be in that loan for three years and then met somebody. I got married and built a house and had kids and <laugh> four years later I'm here with two pharmacies. So, uh, love that loan. It's great. People are lovely. It's been really good to me and I'm lucky cuz I like my job.
Speaker 1 00:02:38 I think a lot of community pharmacies, the staff and them love their jobs because you're so embedded in the community. Like
Speaker 2 00:02:46 You play such, such an important
Speaker 1 00:02:47 Role. Yeah,
Speaker 2 00:02:48 Absolutely. And I have five kids swell and they play a lot of sports with the the GA rugby local schools. So the tentacles start to spread out <laugh> and you get deeper and deeper, you know, so it's great. It's really good cause I couldn't have seen that happening when I was a young single girl. So I, it's been really good and I really love it. Very central too for airports and that sort of thing if you want to go traveling and That's brilliant.
Speaker 1 00:03:13 It's a good night.
Speaker 2 00:03:13 She wasn't down any time Sheila for a night out. Yeah,
Speaker 1 00:03:16 I'm like I've heard of the famous Sean's bar <laugh>.
Speaker 2 00:03:20 Yeah, fantastic. Rick Crack there on St. Patrick's Day as sweet was brilliant. So yeah, it's great town. Great town.
Speaker 1 00:03:27 Good. Today you're here to chat to me all about the very glamorous subject of urinary tract infections. We know these are something that affect so many men and women. So if you wouldn't mind if you can talk us through kind of the symptoms and basically how these occur and why
Speaker 2 00:03:45 About 50% women will get one infection in their life. So it's the kind of, it's three words that can send a shiver down a lot of women's spine. What is the urine tract? Where is it? So it's basically from where the urine exits the body up to the kidneys. So it was up through a tube called the urethra into the bladder and then up through two tubes to the kidney. So that's the urine tract. And in women, because the anatomy, there's a shorter distance between where the urine exits and the bladder. So that's why we get a lot more infections because there's bacteria intermingling sort of from around the back area to the front and they can travel quite easily up the little tube to the female bladder. And that's why we get more infections. It's basic anatomy. So men have a longer tube so it's very unusual for men to get kidney infections.
Speaker 2 00:04:36 So I'd say up to 50 to 60% women will get one. You know, a lot of us will be familiar but that leaves about 40% women that don't, you know, which is just lucky for them really. So what are the symptoms of urine at tract infections? There is burning stinging soreness. There's increased frequency you're getting up during the night to go and then not able to void, not able to empty the bladder when you go and then a ferocious stinging, sometimes you can get a pain just above the pubic bone and then when it gets a little bit more complicated you can get fever shakes, pain in the lower back, it actually get muscle pain besides your body and the legs as well. That's for the more complicated one. But generally they're uncomplicated so they would be the burning, the stinging, that's the main symptoms I think Sheena or urgency and discomfort, they're mainly caused by a bacteria called e coli, which is one that's that's in your bowel basically and it's traveling in where it shouldn't be.
Speaker 1 00:05:29 Okay. What really do patients tend to do in terms of their journey? I know obviously being a pharmacist as well, a lot of people will come straight in and just want maybe symptom relief, but what's the approach for diagnosis of a urinary tract infection in general?
Speaker 2 00:05:49 I suppose like everything else, when you're dealing with somebody at the counter in the pharmacy, you kind of tend to try and get a bigger picture. So if, if somebody who's a young girl start over 18 or under 18 as well, 60 to 18 and they present with symptoms like that, they're unlikely to have other complications. They're young, they're healthy, they're unlikely to have diabetes or they don't tend to be obese, they're, you know, you have to rule out pregnancy as well or immuno compromisation. But if you have a younger woman who has those kind of symptoms, you can tease it out and you can work out what treatment might be suitable or whether she needs to be referred. A lot of the time it'll be related to sexual intercourse. So you could have a very discreet chat with her about that as well, just to see would that have been the cause of it?
Speaker 2 00:06:32 So you can start with something like csip purin or cyst control, which have um, SAS in which changed the pH in the urine to make it a, a hostile environment would say further bacteria. So they could start with that, you could chat to them about that there. There's a cyst control fort product now available which has the cysto purin ingredients but has another product called ds, which seems to be really good at treating and preventing UTIs that they could take should they see something as starting up again a few weeks later cause there's a 50% chance of recurrence in six months of the uti. I, you could have a, as I say, a very discreet chat about things like voiding after intercourse, hygiene would be really important around sexual intercourse would be very important. This would be for that particular age group, but not just, it would also be for women older than that as well. But you also have to take in factors as women get older, different factors become important. So you'd form a picture around the patient and and the information that they're giving you.
Speaker 1 00:07:30 And when you say voiding after in intercourse, just to clarify for people you mean go for a P basically? Yeah,
Speaker 2 00:07:37 Go for a good pee. A good pee, yeah. Afterward
Speaker 1 00:07:40 And in terms of <laugh> just need to spell it out for me. So, and absolutely <laugh> in terms of hygiene, simple things like maybe making sure that people are wiping from front to back to try and avoid very important, yeah, the introduction of any e coli, as you said, everything that's so important. Tools down there. Yeah. Yeah. And in terms of like washes or douches, what's your advice on those kind of products?
Speaker 2 00:08:06 For most people that don't get UTIs, you know there's a variety of wash and douches that they can use with fragrances and stuff and it won't bother them too much. But ideally for any woman they should avoid fragrance products to clean with. They should avoid douches completely. It changes the pH in the vagina. It can damage some of the natural microbiome, the natural bacteria that live there that protects the area when that balance is not right basically then other bacteria can come in that cause the problem. So if women can avoid anything with fragrance, there's a lots of products out there that are available now without fragrance. The yes range y e s is called, they have no fragrance, they're natural, they're completely organic and they're good to use in the vagina area. So they'd be very good for hygiene. And also as you say, the front back thing would be very important if you are prone to infection U T i lower U T i infections after sex, it would be important to wash beforehand and that would just be a simple thing that could be done as well as having a big pee afterwards.
Speaker 2 00:09:10 And dehydration is another big thing. If you keep yourself, you know, adequately hydrated so that there's nice urine volume all the time coming outta the bladder, basically washing out the bad stuff. So the more volume you have in the bladder, the more chance you have to keeping everything clean. I heard on one of the things I was listening to the last few days that the solution to pollution is dilution. Basically load up the bladder and keep it full and empty now the whole area and that will keep everything flushed out and clean.
Speaker 1 00:09:39 That's very good advice. And do you know what, yeah we have enough reasons that we should be drinking water between our skincare and everything that anyone suffering from this. It's definitely worth putting the effort in in that case. Okay.
Speaker 2 00:09:54 Absolutely. Yeah, just remembering.
Speaker 1 00:09:56 And just to finish off on the kind of younger woman first, because it does get a bit more complicated as people get older. So I know you were saying they're the kind of straightforward cases, who would be best to go straight to the doctor maybe. So obviously you described there some of the more serious symptoms. So people with bad fever, do they need to go directly to the doctor or can they try to manage at home themselves first?
Speaker 2 00:10:22 If somebody has a temperature shivery has lower back pain pains and ache in their muscles, I would tend to say your best to go to the doctor. Yeah. People are finding it hard. We tend to get through to the surgeries now, which is not the fault of the gps. So they might say, well I'll just try this first. If they have those symptoms that I just mentioned, I would say look, you're going to end up bringing the doctor anyway tomorrow. Yeah. Or the next day now they could take the saches because they will make the area more hostile so they will manage it maybe a little bit while they're waiting for the call back. Yeah. With the DEOs and the cys CYS or the CS control that has the Ds in it, they could, but generally if it's moved on to temperature rigors, which is shaking and pains and a lower abdominal pain are feeling like you need to empty and then when you go to empty it's not happening and back pain and muscle pain, it really is time to check in with the doctor. Yeah, yeah.
Speaker 1 00:11:13 You're
Speaker 2 00:11:13 Feeling staged, they're
Speaker 1 00:11:15 Feeling and they're feeling very unwell.
Speaker 2 00:11:16 Feeling sick. Yeah, feeling very sick. Yeah.
Speaker 1 00:11:20 Okay. Okay. And then the other group you mentioned there was potentially people who are immunocompromised that might have, I suppose, other risk factors that an infection could become more serious
Speaker 2 00:11:31 Exactly. Very quickly. Could deteriorate very quickly. Yeah. Pregnancy as well as another one to very careful with and they are more common in pregnancy than not. So definitely a referral would be needed there. You need to go to the doctor and the doctor will decide then now you can get antibiotics in pregnancy. There's certain antibiotics that are fine in pregnancy. So I would, it wouldn't be something I'd be, you know, worried about if you're going and you're worried about being put on antibiotic, don't be worried cuz a UTI can become something else in pregnancy. So it's very important to go to the doctor straightaway
Speaker 1 00:11:59 To act promptly. Okay. On that Vena thought of antibiotics, I know a lot of people have read a lot in the media and everywhere that you know, antibiotic resistance is becoming a serious problem and is a real tre down the road for that young person. Obviously they're trying to manage it at home and in most cases that will work, it will pass without them having to need an antibiotic. But if they do get to the point where they've had to go to the doctor, their symptoms aren't resolving, do they need to feel bad or worried about the fact they're using an antibiotic or is it just at that case a good idea?
Speaker 2 00:12:35 I think it's a good idea without a doubt. Antibiotic resistance is becoming a huge issue and probably there's more antibiotic prescribing for UTIs than is strictly necessary because a lot of them would resolve. But for example, there was statistics there about younger girls will say that get UTIs that they'll have if untreated, they'll have 6.1 days of symptoms, 1.2 days of missing class or work and not 0.4 days in bed. So for example, if you're having a UTI and you don't go to the doctor when you need to, you probably risk all of those days that you'll be sick for an antibiotic would've sped up the recovery from the infection. And this would be particularly for women get recurrent infections. So some women are more prone to them. Like we say, if you get one, you're 50% more likely to get one in another six months, you'll know yourself, your symptoms.
Speaker 2 00:13:26 Women will know their bodies and they'll know their symptoms and they'll know that if they start the antibiotic within two days probably it'll clear up a awful lot quicker, it'll be less sick, they won't be off work or school as much. So in that case it will work an awful lot better to get on the antibiotic early. But I certainly wouldn't be ever concerned if a doctor suggests going an an an antibiotic. I wouldn't be concerned about taking the antibiotic. Certainly if you've tried all the other things as well yourself because you have been uh, reticent about having the antibiotic, it's time to go on it if they haven't worked.
Speaker 1 00:13:55 Yeah, okay. And there you mentioned recurring infection. So I suppose that maybe brings us on to the journey through age for women where, you know, you've been a young woman and you've gone through your pregnancies or whatever and you, you get to the other side and you maybe enter the cap compari, menopausal, menopausal stage. What happens then in terms of urine tract infection frequency?
Speaker 2 00:14:21 So you might have got through all stages if you were lucky without having any kidney infections and then all of a sudden in your mid forties, late forties, early fifties, you start to get symptoms. You go to the toilet more often. Not necessarily burning, but just a frequency and an urge to go. And it can happen during the night. You may not have the symptoms of U T I, but it's definitely something to watch out for because at that stage the anatomy basically in the pelvic area starts to change. So tissue gets thinner, there's prolapse, the bladder can drop forward and if it drops forward, it's not going to empties well. There's going to be a little bit of reserve left behind, stagnant sitting there, the bladder isn't working efficiently. So there's a little bit left over all the time and that can get infected.
Speaker 2 00:15:06 So that's one thing is the anatomy changing. Another thing is that the estrogen level is dropping and when that happens, the flora changes in the, in the whole vaginal area, the pelvic floor drops. The pelvic floor is the kind of the muscle basket that holds up all of your pelvic organs like your bladder, your vagina, your uterus. When the pelvic floor starts to drop, the bladder drops again not emptying as efficiently. And when the floor changes, again that is a protective mechanism for protecting against UTIs and that changes again with perimenopausal menopause. So while that's a terrible picture to paint, I just
Speaker 1 00:15:42 Women in their words, fairly horrifying as a woman who just turned 40. Yeah, thanks. I know
Speaker 2 00:15:49 I, I don't mean to frighten you. Okay. But it's just, it's just something, it's really good to know to look out for it <laugh>. So if you're saying, God, I got up last night to go to the toilet twice, what's that about? It's just good to know and to have the information and watch out. So drink loads, keep your bladder full so that even if it's not emptying out very efficiently, there's lots of volume moving through it all the time. Drink a little bit less at nighttime, but topical estrogen, so vaginal pessaries of estrogen that you pop in have been shown to work really well in the prevention of UTIs in that age group. Okay. So you just pop in the estrogen pessary, it loads up estrogen in the area, lift up your pelvic floor, pops it back up again. Bladder energies more efficiently and you're less likely to get the UTIs. So there is solutions to it. You're giving hope
Speaker 1 00:16:36 <laugh>. Yeah. Yes. And they're a prescription item at the moment.
Speaker 2 00:16:41 Here they are. Yeah, in the u in the uk now they're over the counter, which is, yeah. Fantastic. And maybe the case here,
Speaker 1 00:16:47 Because I think, yeah, the whole thing with that is that access to these kind of medicines is so important and obviously all these decisions are made on a kind of benefit versus risk, but because it's local and so small, an amount of estrogen is actually absorbed. There is no risk for stroke or blood clots or you know, cancer, heart disease, all these things we were afraid
Speaker 2 00:17:12 Of whatsoever.
Speaker 1 00:17:13 And that just shows how confident they are in the UK that the risk is so negligible. Absolutely.
Speaker 2 00:17:19 And yeah, and, and almost all oncologists will prescribe it for their breast cancer patients quite readily now after the first two weeks of use, when you use it every night, the vaginal walls pickens up in those two weeks. So after it's thickened up after two weeks, there is little or no absorption outta the vagina area, which means it's really safe to use if you've had breast cancer, of course it's up to you to discuss this with your healthcare provider and decide amongst yourselves what you'd like to do. But most oncologists will now prescribe it for breast cancer patients or even ones that have familial breast cancer and are very aware of say their mom or their aunt or somebody and are worried about introducing any estrogen into their body.
Speaker 1 00:17:59 And it's really interesting because I think a lot of women in, you know, the kind of 40 to 50 age group might think that look, well I'm too young for H R T, so what do I do? So it's important that they, they know this is available because the scenes you were painting there are horrifying.
Speaker 2 00:18:17 Well now I've, that's just to give information. That's all really. I know it's not like your pelvic floor is going to drop out on floor's,
Speaker 1 00:18:24 Bring my wheel arrow with me everywhere just in case <laugh>. It's
Speaker 2 00:18:29 Just subtle changes you're going to be watching out for and then you're gonna get right in there and fix it all up before anything
Speaker 1 00:18:34 Happens. It's little cured sort it. And does that then have an impact on symptoms that may have arisen as a result of all this? Like <laugh> things like incontinence, like does incontinence start to become a problem at this stage and then obviously
Speaker 2 00:18:50 Well I think that can be a problem now pregnancy much earlier.
Speaker 1 00:18:54 Yes, yes. Yeah.
Speaker 2 00:18:55 Yeah. You'll find four women in their thirties have had a baby, their first baby even. Yeah. And then they'll be back to their jogging after their first baby and the next thing they're having to wear pads when they're jogging and it's very nice and
Speaker 1 00:19:07 That's the important thing that women have put up with that and have kind of just accepted that we all just get a little bit leaky cause our bodies go through so more and
Speaker 2 00:19:17 You mentioned the TV is just full of ads for pads as well and Yeah, you know, really education would be so much better to, and this would also prevent your tract infection. If people focused a bit more on, we'll say maybe a pelvic floor physio doing exercises, your pelvic floor exercises with Pilates, they would all help in the prevention of UTIs. If you get your pelvic floor lifted up a little bit, it'll mean everything you'll be working more efficiently. Your bladder, particularly a pelvic floor physio for women is fantastic actually. They're really great. They're specific to that area. Like for example in France, after you have a baby, every single woman sees a perfect floor physio for six months.
Speaker 1 00:19:52 It's like why don't we push that here? It's so important
Speaker 2 00:19:54 Because overall it would reduce the cost to the taxpayer for example, of all the visits to the doctor, the visits to the hospital, visits to urology. If we, it's simple as that just lifted up all the muscles in the perfect floor area. Now I'm great for talking, I know, but I don't find the time too much myself to get down and do the exercise that I should be doing.
Speaker 1 00:20:12 If you did, it would change the quality of your life. So you know, it's, it's absolutely
Speaker 2 00:20:17 Big. You would yeah, like we don't have to be stuffed in 12 pads in to ourselves before we go for a walk or run all the time if we tried to prevent it. Yeah.
Speaker 1 00:20:26 And the other side of that is about the urinary tract infections. Like it's not advised to be wearing damn pads all the time anyway. Like that's another risk. Exactly for infection. Yeah,
Speaker 2 00:20:37 That's part of the hygiene picture again. Yeah, so they're very much interlinked. The incontinence and the recurrent UTIs, you know, they're very linked coming back just to the women who are a little bit older and even they don't have to be that much older. But if you have recurring kidney infections, so two in six months or three in a year or more, you can get put on a maintenance dose of antibiotics. So one a day, which is really good for reducing the risk of infection. Now a lot of women don't want to be on for too long, so it would be reviewed after six months, but once you've been infection free for six months, you actually have a period then where you're less likely to have them as well. So you could take a break. Yeah. For women will say who are younger or older women who find that they have more kidney infections for UTIs after having sex, you can take an antibiotic at night and take another antibiotic in the morning that's been used now post sexual intercourse. Yeah, dose of antibiotic at night and in the morning. And it's proving very effective at reducing the STIs for all age groups where it has been linked to intercourse.
Speaker 1 00:21:36 And we are seeing those prescriptions coming in now kind of pre and post-coital and it's great. Like this is all progress and proactivity that has been lacking in this area. So it's important for people to know maybe to discuss that kind of thing with the doctor if they think that their UTIs are coming straight after having sex or you know, a day or two later. Yeah. In terms of other complications that can happen or as you get older, do risk factors increase more again once you managed to navigate the the menopausal stage and if you've managed to keep your pelvic floor upright, is there more risks after that?
Speaker 2 00:22:16 You know, it's say in nursing homes than that catheterization would be a big thing. Wait a minute
Speaker 1 00:22:22 Now Michelle, we're not going straight from menopausal today. Okay,
Speaker 2 00:22:25 We'll go straight to nursing
Speaker 1 00:22:26 Home.
Speaker 2 00:22:26 Okay.
Speaker 1 00:22:27 Can we have a few GU years in the middle?
Speaker 2 00:22:29 No, there'd be, there'd be 50 years between what we discussed there and the nursing home <laugh>. But some people we say would be catheterized post-surgically or whatever for a little while. Yeah, when they're younger. And because that is a big part of UTIs would be catheterization that actually has its own subsection we say. And the other thing as well, which is really important is when you're giving samples it's, it's important to do a midstream because when you first pee you'll get some of the bacteria and protein and stuff from the genital area would be in the urine to start. So it's very important to do a midstream sample if you are dropping a sample in so you get the best result. And it's very possible too that the doctor would start you an antibiotic before that sample is checked and then change you midway through that antibiotic because the result has come back. I forgot to mention that earlier on the midstream cycle sample is really important. Yeah, yeah. If you're bringing a sample to the doctor, even though sometimes it's hard to get that stream straight <laugh> a little bit older,
Speaker 1 00:23:26 There'll be a lot of hand washing going on <laugh> afterwards be fine. No, because you know what, that's the thing I know like doing pregnancy tests over the years, you're like, oh god, you know, you're there trying to coordinate it <laugh>, but look another joy of being a woman. <laugh>, I think we've covered an awful lot there in terms of additional things that you can do, like you spoke there obviously about the probiotics. What kind of probiotics would you recommend for people who are suffering from recurrent urine tract infections?
Speaker 2 00:24:02 There's the Bio Pro is a specific probiotic for people, recurrent UTIs. The selection of probiotics has come on so much in the last 10 years and five years. And is the probiotic pessary,
Speaker 1 00:24:17 That's a very
Speaker 2 00:24:18 Interesting one. Oh it is. Yeah. It's so it, they're newly available. They won't be everywhere at the moment, but it has been shown to reduce the frequency of UTIs as well. So you pop in the pessary into the vagina and where the flora for whatever reason, sometimes it can be antibiotic use from say multiple respiratory infections over Christmas just gone by. It's changed your flora all over your body, which includes your vaginal flora, you pop it into the vagina melts, it sorts out your flora inside and it comes out a little bit. So sorts out the outside as well, which can help to reduce the incidence of the urine tract infections. And again, this would all go hand in hand with the hygiene, hydration, voiding after sex, the sometimes the antibiotic afterwards and in the morning. So they can all kind of compliment each other on work hand in hand.
Speaker 1 00:25:04 And a lot of people will be curious maybe about the role of cranberry juice, drinking cartons of cranberry juice. Is that something you'd recommend?
Speaker 2 00:25:14 Yeah, it's still, there's kind of a question mark over it. I certainly wouldn't not recommend it if somebody would like to try it. It's certainly can't do any harm. I think it's something like four grams of cranberry though, that are required. So you know, the purest form of cranberry that you can find. If it's a pure organic cranberry drink rather than something that's diluted down, it might be the best option. Again, it's down to the, the pH of the area in the bladder and you know, making it a more hostile environment for the bugs to grow and you don't want them to travel up then through the uh, ureters into the kidney where that becomes a whole other ballgame then of a higher urine tract infection, which causes the problems with the temperature and the mela, the tiredness and the malaise, sickness muscle pain. So if you can try and manage it further down and stop at traveling up anything that would help. Even trying the cranberry, you know, it certainly wouldn't be the first line I'd go for, but that's this control fort now. I really like that product that has the cranberry in it as well as the DNOs. I think that's a really good product.
Speaker 1 00:26:15 Michelle, thank you so much for all of your information. You're a complete wealth of knowledge and you could go on a TV show with this as your specialist subject <laugh>. I'm not sure anyone would watch it, but you know. Yeah,
Speaker 2 00:26:28 I know. Well maybe women 45 plus might be interested, you know, <laugh> in the solutions rather than the description
Speaker 1 00:26:35 <laugh>. Yeah, exactly. No, that was absolutely brilliant. So thank you so much and special thanks for you actually because you are our first Total health pharmacist on the podcast. Yay. Yeah, so fantastic. We'll have more of your Total Health and Haven colleagues coming onto the podcast over the next few months and I'm very excited to see and learn so much more from them. So thank you so much, Michelle. Well, I learned a lot as well. It's very interesting. Yeah, it's great. If you enjoyed the first episode of the Irish Pharmacy podcast, please remember to subscribe and review. We have so many interesting topics coming up over the next few months. Everything from insomnia to stress, to skincare, and even how to access free contraception. Thank you so, so much for listening and we'll talk to you again soon.
