How Women Manage Recurrent Urinary Tract Infections: An Analysis of Postings on a Popular Web Forum

Andrew Flower; Felicity L Bishop; George Lewith


BMC Fam Pract. 2014;15(162) 

In This Article


In the UK urinary tract infections (UTIs) are the commonest bacterial infection presented by women in primary care[1] with approximately 40–50% of women experiencing one lifetime episode.[2] Recurrent urinary tract infections (RUTIs) are defined as three episodes of UTIs in the previous 12 months.[3] Between 20–30% of women who have one episode will have a further episode and around 25% of these will develop RUTI.[4] RUTIs can reduce quality of life and increase healthcare costs associated with outpatient visits, diagnostic tests and prescriptions.

Antibiotic prophylaxis can prevent RUTIs[5] but is commonly associated with unpleasant side effects such as oral and vaginal candidiasis and gastrointestinal disturbances, and occasionally more severe side effects. Once prophylaxis is discontinued, even after extended periods 50–60% of women will become re-infected within 3 months.[6,7] In addition antibiotic overuse and the subsequent development of bacterial resistance is a growing problem[8] that increasingly affects management.

Although uncomplicated UTIs are considered a mild, self-limiting condition, qualitative research suggests that UTIs can seriously impact women's quality of life.[9–11] Malterud and Baerheim[10] explored the symptomatic experiences of 94 Norwegian women with UTIs and reported an 'unexpected finding' of accompanying systemic symptoms including tiredness, inability to concentrate, and irritability. These systemic symptoms and the disruption they caused were also noted in qualitative interviews with 21 women in the UK experiencing acute UTIs.[9] The Norwegian study (10) also found that women used vivid language to describe their symptoms (such as "like peeing barbed wire") that was more richly metaphorical and nuanced than the medical terminology of dysuria, urgency and frequency. Rink[12] found a similar disparity between the language used by UK GPs and 113 women with UTIs when describing risk factors for contracting an infection (for example GPs cited female anatomy as a prime risk factor for UTIs whilst this was not mentioned by any of the women involved in the study) and noted that this could have clinical implications. To our knowledge, there has been no qualitative study focussing specifically on the experiences of women with RUTIs and the impact that recurrent infection has on their lives.

In order to address this gap, a qualitative study was conducted that analysed naturalistic data available from an Internet forum dedicated to supporting women with cystitis. The selected web forum was hosted by The Cystitis and Overactive Bladder Foundation (COBF),[13] a support charity for people with bladder problems in the UK with 5,994 online members and an open access web-based message board forum with postings on 7,870 topics. This site is by far and away the largest and busiest UK online support community for women with bladder related problems and as such provides the greatest opportunity for a diverse range of experiences, perceptions and management strategies of women suffering from RUTIs.