Navigating UTIs and Bladder Conditions with Helen Lake, Nurse Lead of The Urology Foundation’s UTI Information Service

1. Helen, you’ve recently launched the UTI Information Service and Helpline. Tell us a bit more about yourself and what inspired this initiative, and what makes it unique compared to existing support services?

I’ve worked as a registered nurse in urology for more than 30 years, starting out as a ward sister in the NHS before moving into specialist practice. I was very fortunate to have worked alongside the late Professor Pickard Consultant Urologist at The Freeman Hospital in Newcastle, and also more recently Professor Chris Harding who is doing such great work in UTI research.

Much of my work has been with people living with bladder problems such as overactive bladder or difficulty emptying properly. UTIs have always been a big part of that picture, and over the years I’ve developed a real interest in how we can not only treat them but prevent them—especially using approaches beyond antibiotics.

This isn’t just professional for me. I’ve seen the toll recurrent UTIs take on people I care about in my own family, so I know how exhausting, painful and disruptive they can be. When The Urology Foundation asked me to set up a dedicated UTI support service and helpline, I jumped at the chance. It’s a project that feels very close to my heart.

What makes the service different is that it’s personal and nurse-led, with a clear focus on UTIs and the impact they have on daily life. It’s a space where you can share your story, feel understood, and get practical guidance that’s tailored to you.

2. What are the most common misconceptions you encounter about UTIs—especially among patients experiencing recurrent infections?

 

“It must be because I’m not clean enough” Many people tell me they’re made to feel as though their UTIs are somehow their fault, as if it comes down to poor hygiene. That’s simply not true, but sadly it’s an assumption some encounter in healthcare, and it leaves people feeling blamed and dismissed.

 

“If the dipstick is negative, I can’t have an infection.”  Not true. Dipsticks often miss infections, particularly in older people, catheter users, or those with long-term symptoms.

 

“Cranberry juice will cure it.” It may help some people, but it’s not a cure-all—and shop-bought juice often isn’t strong enough to make a difference.

 

“Antibiotics are the only way forward.” They’re important when needed, but there are other options to look at too—like vaginal oestrogen, methenamine, or strategies around sex, hydration and bladder emptying.

 

“Pain or burning always means infection.” The classic symptoms of cystitis - burning when you wee, needing to go more often, and lower tummy discomfort — are usually caused by infection in the bladder. But not always. Sometimes you can have these symptoms even when no bacteria are found, because the bladder is irritated for other reasons such as tissue changes after menopause, prostatitis, or pelvic floor issues. It’s not always straightforward, which is why it’s important to be listened to and properly assessed.

 

"It’s just something I have to live with.” No one should feel they just have to put up with repeat infections. There are ways to reduce them, manage flare-ups, and find longer-term strategies that make a real difference. Support is out there, and you deserve to feel heard and helped.

3. Can you talk us through the difference between cystitis and other types of UTIs?

“UTI” is a catch-all term. Cystitis usually means a bladder infection, with symptoms like burning when you wee, going more often, and discomfort in your lower tummy. 

Other types of UTIs include:

• Kidney infection (pyelonephritis) fever, back or side pain, chills—this needs urgent medical attention.
• Prostatitis (in men) pelvic or rectal pain, difficulty passing urine, sometimes fever.
• Urethritis (the urine tube) burning or irritation, sometimes discharge.
• Catheter-associated UTI: in people with catheters, symptoms may be more general—cloudy or smelly urine, fever, confusion, or just feeling unwell.
• Asymptomatic bacteriuria - when bacteria are found in urine without symptoms. This isn’t the same as a UTI and usually doesn’t need treatment, except in pregnancy or before certain procedures. There is an awareness now that this collection of bacteria without symptoms is part of a healthy bladder biome.

4. How do you advise people who feel their symptoms are dismissed or not taken seriously by healthcare providers?

First, know you’re not alone. Many people tell me they’ve felt brushed off, and it can be really disheartening. What helps is going into your appointment feeling prepared.

• Keep a simple diary of your symptoms, possible triggers, and what you’ve already tried. Patterns can be really powerful.
• Be clear and specific. You could say something like  “I’ve had three infections in the past year. This affects my sleep, work, and quality of life. I’d like to discuss prevention and a longer-term plan.”
• Take someone with you if you find appointments stressful or hard to get your points across.
• Do your homework. NICE guidance says recurrent UTI is defined as 2 infections in 6 months or 3 in a year. It also recognises prevention options such as vaginal oestrogen after menopause, methenamine, and self-start or post-sex antibiotics. Knowing this means you can ask confidently about these choices.
• Remember you can ask for referral if things aren’t improving. NICE supports referral to a specialist (urology, urogynaecology) when infections keep coming back or aren’t responding to standard treatments.

5. How does UTI presentation and management differ between men and women?

Women are more likely to get UTIs because their urethra (the tube you wee through) is shorter, so bacteria can reach the bladder more easily. Hormonal changes, especially around menopause, also increase the risk. The “classic” symptoms are burning when you wee, going more often, urgency, and lower tummy discomfort — but in older women, it doesn’t always show up this way. Sometimes the signs are more general like feeling off balance or just feeling generally unwell. Confusion and agitation in both older men and women can be signs that a UTI are present.

For men, UTIs are less common but often more complicated. They may have burning or frequency like women, but they can also get pelvic or rectal pain, difficulty starting to wee, a weak flow, or feeling they can’t empty fully. Fever and feeling unwell can also be part of the picture. UTIs in men are often linked to bladder emptying problems. As men get older, the prostate tends to enlarge, which can trap urine and make infections more likely. The prostate itself can become infected (prostatitis) or make a bladder infection harder to clear, so men usually need longer antibiotic courses.

In both men and women in later life confusion and agitation are main signs of UTIs.

UTIs in children, during pregnancy, or with a catheter need closer attention and often specialist care.

6. What are some red flags that might mean you should get help quickly?

• Fever, chills, involuntary shaking, vomiting, or feeling very unwell
• Back or side pain
• Blood in your wee that doesn’t go away
• Blood in urine unrelated to UTI ( even just once)
• UTIs during pregnancy
• Ongoing symptoms even after treatment

7. Can lifestyle, hydration, or diet changes really make a difference?

Yes, often they do. Small, everyday habits matter - 

• Drink enough so your wee is a pale colour most days.
• Don’t hold on—go when you need to.
• Ensure your bladder is empty – wee, wait, wee again.
• Avoid constipation—it makes bladder emptying harder.
• If UTIs follow sex, try weeing afterwards, use lube, avoid spermicides, and see if condoms make a difference.
• After menopause, vaginal oestrogen can really help restore PH levels and prevent infections.
• Keep blood sugar steady if you have diabetes.
• Whole foods, fruit and veg, avoidance of processed foods can help innate immunity. Anti inflammatory foods such nuts and seeds, leafy greens, turmeric and ginger. Prebiotics such as garlic ( allicin) must be raw ( crushed) promising antimicrobial properties, asparagus, artichokes. Probiotics like live yoghurt, kefir and kimchi. Non adherent foods ( stops bacteria sticking to bladder wall) Cranberries, blueberries, peaches.

8. Are there any self‑care routines or over‑the‑counter options that are underrated?

For prevention:

• D‑mannose powder or tablets—worth trying for some take more than once per day as it is removed when you wee – say morning and evening for prevention – mixed evidence. Some evidence that during an infection increasing to 3-4 times per day over a few days can help.
• High‑strength cranberry tablets or powders – evidence low but helps some.
• Vitamin C 500-1g.Helps acidify the urine - Low evidence but can make a difference and especially when taking Methenamine.
• Probiotics for gut and vaginal health – Lactobacillus orally, vaginal probiotics are under research. Low evidence so far but promising.
• Vaginal and vulval moisturisers – helps reduce friction during intercourse ( and micro trauma) can also be used with vaginal oestrogen in menopause transition and post menopause
• Topical barrier gel which contains ‘good’ bacterial components to support the natural defences of the vulval and vaginal area. Under research shows promise.
• Avoid soap and highly perfumed body washes which may lead to irritation and cystitis like symptoms – use Inert soap free PH neutral cleansers or dermatological tested fragrance free creams around the vulval area -  wash gently and pat dry.

9. What’s your view on prophylactic antibiotics?

A low daily dose antibiotic has its place and is usually given for 3 to 6 months, sometimes up to a year if it’s really helping. But it should be reviewed, because once you stop the infections often come back. That’s why it’s important to also look at longer-term strategies and non-antibiotic options alongside.

There are also other ways antibiotics can be used preventively - some people only take a dose after sex if that’s their main trigger, while others are given a “rescue pack” to start quickly when symptoms strike ( handy for holidays) . Whatever the approach, it should always be reviewed regularly with your doctor, to make sure it’s still right for you and to keep antibiotic resistance in check.

The addition of Methenamine Hippurate ( Hiprex) to the NICE  guidelines has given people another option.( it was on the red list for a while) It’s a urinary ‘antiseptic’ that works by making the urine less friendly to bacteria. For many, it’s helped cut down infections without the risks that come with long-term antibiotics. It doesn’t work for everyone, but it’s a valuable alternative to anti biotics that gives people more choice in how their UTIs are managed.

10. How do you balance natural remedies with clinical treatment?

I think of it as a menu of options. You start with the basics and the things you can do yourself — hydration, healthy bladder habits, and looking after your general wellbeing, including nutrition. From there, you can explore supplements or natural remedies, but it’s important to do your research on the level of evidence and to give them a fair trial, usually at least six months, before deciding if they’re helping.

I always remind people: don’t feel guilty about taking antibiotics if you need them. Antibiotic resistance hasn’t come about because of people with genuine UTIs who’ve needed treatment. You are the expert on your body, and it’s about finding the right balance of approaches that works for you.

11. How can people advocate for themselves when UTIs are affecting their whole life?

This is very difficult and one I hear a lot. It’s especially hard as we tend not to see the same health care professional and we often have to start again each time. Keeping your own notes, a simple symptom diary, and a record of what has and hasn’t worked can be really powerful when you go to appointments. Be clear about what you want from the consultation for example, “I’d like to talk about prevention options” or “I’d like to discuss a referral.”  

Tell them it is affecting your quality of life, mental health and ability to work. Which is very often the case. 

12. What new developments give you hope?

Rapid tests, better understanding of “hidden” or embedded infections, and new options like vaccines or treatments that don’t rely on antibiotics. There’s also exciting work on the role of the vaginal microbiome and the interaction between the gut and the bladder biome.

13. What would you like to see change in the way UTIs are treated by the health system?

I’d like to see UTIs taken seriously, with the impact on people’s lives properly recognised.

They’re not “minor” problems — they can wreck sleep, sex, work, and confidence. We need quicker and more accurate diagnostics, a clearer treatment pathway that doesn’t leave people going in circles, and timely escalation to specialist care when things don’t improve.

Nurse-led clinics and consistent prevention strategies would make a huge difference too.

14. How can we support people who struggle to access care?

We need services that are easy to reach, welcoming, and inclusive—whether that’s for people in care homes, those with disabilities, people who are homeless, or those who feel overlooked by mainstream services. Training carers in catheter care and early warning signs is vital too. Our free telephone helpline and email service is there to support and signpost for patients, health care professionals and carers.

15. You’ve held many roles in urology—what’s kept you passionate about this work

I’ve seen, time and again, the enormous difference it makes to be available for people with intimate, often highly personal issues. The anxiety that comes with bladder issues and urology issues in general is real and sometimes overwhelming. My reward is breaking down the stigma, making those conversations easier, and helping people feel listened to, understood and reassured. Helping people find the solutions that work for them is an incredibly rewarding part of my work at The Urology Foundation.

16. What keeps you motivated when supporting people through such tough conditions?

Often hearing something simple like thank you for listening!

 

How can people get in touch with you?

You can call the UTI Helpline on 0808 801 1108 (UK Freephone)

Open every Tuesday and Thursday from 10am–12

Email: nurse@theurologyfoundation.org

Whether you’d like an empathetic listening ear, practical information, signposting, or helpful resources, we’re here for you. You can also get involved with our Patient and Public Involvement group, or even share your own UTI story to help raise awareness and shape future care and support for UTIs

Visit The Urology Foundation to download our resources.