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[CLKD]

There has been a theory in recent years that we shouldn't be washing poultry/game as the small sprays from running water may spread to all serfaces.  [sp]. We have ignored that as we wipe down sufficiently after preparation.  I am phobic about wiping down as well as keeping utensils used for raw meat/poultry apart from any others in that area.  Many years ago MinL offered to wash up which I rejected.  Next morning I came down to find it all 'done' whilst I had been in the bath  .  Because she had the habit of washing everything together with n o separation I had to do it all again!!!!  It's a good job that she didn't say anything or I would have erupted.  DH got it in the ear too because he hadn't noticed that she wasn't in the lounge with him.

There, that's off my chest.  Perhaps Ann B, speak to a urologist or a pharmacist to find out what the current view might be? 

[Ann B]

There has been a theory in recent years that we shouldn't be washing poultry/game as the small sprays from running water may spread to all serfaces. [sp]. We have ignored that as we wipe down sufficiently after preparation.  I am phobic about wiping down as well as keeping utensils used for raw meat/poultry apart from any others in that area.  Many years ago MinL offered to wash up which I rejected.  Next morning I came down to find it all 'done' whilst I had been in the bath  .  Because she had the habit of washing everything together with n o separation I had to do it all again!!!!  It's a good job that she didn't say anything or I would have erupted.  DH got it in the ear too because he hadn't noticed that she wasn't in the lounge with him.

There, that's off my chest.  Perhaps Ann B, speak to a urologist or a pharmacist to find out what the current view might be?

I agree regarding the advice not to wash chicken.  I also avoid washing in my prep, in order to minimise contamination.

Eating chicken in restaurants concerns me.  Whilst on holiday recently and in two different restaurants, I had to return chicken to the kitchen because it was pink and uncooked in the centre.  Of course, they then overcooked it!

The advice I had from a urologist was to avoid having alkaline urine.  Yet there is conflicting information online.  The previous link I posted from the company that produces and sells d mannose as an alternative treatment for urinary issues, is to create an alkaline environment.

I prefer to avoid antibiotics where possible due to the development of AB resistance etc, and look to more natural treatments like probiotics and d mannose etc. 

It is not that I have a significant issue with UTIs.  I had 'possibly' one last year and this year.  I say 'possibly' because the bacterial count in the first one was very low and in the second it was classed as insignificant.  What was really high was the leucocyte level.  It could therefore be classified more as leucocyturia or possibly sterile pyuria, ie white pus cells in the urine.

Unfortunately, there is limited research and knowledge concerning sterile pyuria although it is apparently fairly prevalent in mature women, particularly those in a care home environment.  From my experience and knowledge, the gp and specialist' response is to treat it with antibiotics even in the absence of insignificant bacteria.  This can lead to AB resistance and more serious virtually untreatable UTIs, often without resolution of the pyuria. The other approach is to treat with permanent low-dose antibiotics which can lead to the same result.  Anecdotally, I can speak of two mature ladies I know who experienced this treatment, and it was not a good outcome for them healthwise.

Dr Rubin who I think is a urologist is on a mission and has seminars to educate her fellow urologists on how to treat mature women with vaginal oestrogen in order to avoid UTIs etc, and in fact prolong their life.

From my own reading and deduction on the matter, I think my leucocyturia is due to V.A.  I anticipate that I may/will need to have vaginal oestrogen to deal with it.  However, apart from dyspareunia, I am really comfortable and have always been irritation and pain-free vaginally, without any creams or gels.  I read of ladies on this site who are taking vaginal oestrogen and still trying to achieve a level of vaginal comfort.  I am therefore concerned about possibly irrevocably upsetting my current vaginal balance via the application of vaginal oestrogen.  There is also the additional matter of being a BC survivor and having had high oestrogen sensitivity (+8) in the breast tumour.

Perhaps a high leucocyte level is the body's natural defence mechanism for V.A. just like a fever for infection, or inflammation for injury etc.  Perhaps we have to live with it.

The foregoing is why I explore natural alternatives, and possibly diet as a way forward.

[Kathleen]

Hello again ladies.

I just wanted to add that my experience of vaginal atrophy has also been minimal which may also explain my lack of UTIs so far.

I am using a one mcg sachet of Sandrena gel daily and half a 200mcgm Cyclogest pessary on alternate nights. I don't use any topical Oestrogen creams or moisturisers. I have noticed that VA symptoms appear when I use less than one sachet and when I came off HRT altogether a few years ago I developed the classic symptoms of itching and burning.

I assume that any dryness and lack of lubrication would make UTIs more likely or harder to resolve. I know of someone who has frequent infections and even had a three month course of low dose ABs but she still had another UTI after that. Her GP then suggested that this was just something that she would have to manage in the future.

Perhaps a more plant based diet helps by reducing exposure to e coli from any animal source although I realise that lots of fibre can be a problem for some people.

Wishing you all well ladies.

K.

[Wrensong]

Ann

What do you think about whether urine p.h. should be more towards the alkaline or acid end of the spectrum in order to inhibit UTI bacteria, and how this could and maybe should be contolled by a possibly more alkaline or acid food-oriented diet?

I don't know what to think, Ann.  For years pre-menopause I took either unsweetened, pure cranberry juice diluted with water or cranberry tablets, both alongside probiotics, at that time all thought to acidify urine & promote a healthy urinary tract.  But as you know, these days opinion on the value of cranberries for UTI prevention differs & it's not among the natural measures my v good gynae recommends, though D-Mannose is.  The use of probiotics & fermented foods is also contentious for interstitial cystitis which I was diagnosed with 15+ years ago.  I do wonder whether the presence of a significant leukocyte count in urine samples with a negative pathogen culture could in some of us perhaps reflect the body's over-reaction to probiotics, especially in those with autoimmune tendencies.  What do you think?

I've long been aware of the thinking around alkaline v acid fostering foods for reducing systemic inflammation & though not vegetarian, our diet consists of a lot of veg, both cooked & raw, a good variety of fresh fruit, quite a bit of fish, both white & oily, wholegrain complex carbs, nuts & seeds & doesn't contain much meat.  I've been wheat-free for some years on gastroenterologist advice.  We do eat dairy, eggs & chicken, half a skinned breast each, 4 times a week & I've recently been advised to include some red meat to improve iron levels, but usually have only one portion a week at most.  I find meat increasingly hard to digest with age & tbh would prefer to go back to the predominantly vegetarian diet we followed prior to perimenopause wrecking my blood sugar stability, when I suddenly found I needed protein from fish & meat to help manage it.   I'm also underweight & have lost considerable muscle as menopause has progressed so I'm mindful of protein requirement from that aspect too.  We do eat beans & pulses, but like you I have to limit the amount, as with brassicas, because I find these hard to digest & at more than one portion a day they give me too much digestive discomfort. 

Like many women on here I'm very interested in nutrition & have amassed a large number of books & in latter years bookmarked links  on the subject, researching for IBS, migraine, interstitial cystitis, blood sugar management, cardiovascular health, breast health, menopause management & more!  I find the IC diet too restrictive to adhere to religiously but I do exclude those foods & drinks that seem most problematic for me & I'm more stringent when need be during flare-ups.

I can't be without HRT for GSM management & have run into probs when required to stop it for some weeks for surgery.  There are many articles attesting to its efficacy in promoting an environment beneficial to GU health, but I completely understand the dilemma you face in deciding how best to manage your situation.
Wx

[CLKD]

With regards cranberry juice there is no Peer-reviewed research.

[Wrensong]

Ann, I suspect there's nothing new to you in this link & extract but it may be of interest to others.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6629580/

The Etiology and Management of Recurrent Urinary Tract Infections in Postmenopausal Women

"Postmenopausal estrogen levels are associated with lower levels of Lactobacillus and higher pH in the urogenital niche.53,54 Restoring the urobiome to its protective state and avoiding dysbioses are key in preventing rUTI. Alterations to the protective state of the urobiome can also be caused by certain behaviors and hygienic practices. Smokers have decreased vaginal lactobacilli;55 vaginal moisturizers, personal lubricants, douches, and spermicides suppress the growth of Lactobacillus in vitro.56–58 Vaginal estrogen replacement reduces UTI risk, a beneficial effect not seen with oral estrogen.59 Within the first 12 weeks of use, Lactobacillus is restored and there is an associated recovery of the host defenses.24

D-Mannose, an over-the-counter monosaccharide sugar, acts in decreasing bacterial adherence to the bladder mucosa; it is nearly as effective as daily nitrofurantoin 50 mg daily and superior to placebo in preventing UTI over 6 months in women with rUTI.60"

[Ann B]

Thanks, Wrensong.

Yes, I have read those two references.  They are pertinent.

We all have our individualised issues and are trying our best to manage and deal with them, to stay as healthy, mobile, and vital as we can, going forward.  Dr Rubin puts it even more strongly and considers oestrogen replacement as literally a matter of life and death in post-menopausal mature women

Unfortunately, our problems are often not dealt with appropriately or adequately by the medical professionals. It is an NHS in decline and can be a postcode lottery.  We are fortunate if we find an NHS gp or specialist who is knowledgeable and invested in us as individuals and our specific post menopause issues.  These can go unresolved, hence the posts seeking advice and help on this menopause site. 

These individual issues have a degree of complexity, which in the absence of satisfactory resolution, as laypeople we are trying to understand and deal with as best we can.  Hence the search for and sharing of anecdotal information, on this forum.

Diet is obviously important as are some of the alternative treatments.  Through discussion and analysis as best we can, we hope that what some have found beneficial, we will too.

The pharmaceutical industry has a great deal of involvement in medical training and the NHS generally.  To deal with a problem, all medics immediately reach for the BNF to prescribe treatment.  They are schooled in that approach.  In the UK unlike the USA, the medics are in even more of a straightjacket because they are not permitted to prescribe off-label even for a pharmaceutical product.  As an example, my gp in her 50s had never heard of d-mannose, so there was no basis for discussion or consideration of that alternative, in my treatment.  With the urologist, it was either a long-term low-dose antibiotic or Hiprex.  Neither of these is palatable given the known side effects.  The pharmaceutical industry is not interested in low-cost non-profitable treatment, so unfortunately potentially beneficial alternatives lack the research and development.  We are therefore left looking for and discussing possible alternatives and strategies here.

From my reading, I am almost certain that I have leucocyturia or sterile pyuria.  From time to time, this gives all the very uncomfortable symptoms of UTI but is not a de facto bacterial UTI.  It is difficult to discuss this appropriately with any gp at my surgery.  They use prescribed UTI protocols as a basis for discussion and treatment, and tend not to want to veer from this script.

From reading, and formulating responses on M.M. I believe I have arrived at a conclusion and potentail solution to my problem.  It is now a question of if, and when, I take the next step.

Thanks to all for your comments and input.

Ann x

[Sage 🍃]

Ann, I suppose leucocyturia or sterile pyuria are linked to vaginal atrophy and not UTIs?

[CLKD]

Sage you are correct which is why treatment is so important .

[Ann B]

Ann, I suppose leucocyturia or sterile pyuria are linked to vaginal atrophy and not UTIs?

Hi Sage

That is the conclusion I have come to in my case.

Quote: "In older women, decreased oestrogenisation of the vulva, vagina and bladder can lead to a degree of inflammation, making sterile pyuria a relatively common finding. In this situation, treatment of women with symptomatic atrophic vaginitis with topical oestrogen therapy can lead to resolution of sterile pyuria".

However, there are two considerations.  Even with an insignificant level of bacteriuria but high leucocyturia, antibiotics seem to have a temporary effect of reducing the leucocytes.  I assume even though there is virtually no bacteria the AB must have an anti-inflammatory effect, although I don't believe the doctors give it for that purpose.  IMO they treat it inappropriately as a UTI.  Secondly, in the above scenario you can stiil experience all the UTI symptoms with very little or no bacteria.

I find that the response of the gp in this situation and if you have symptoms is to still simply chuck ABs at the problem.  If the symptoms go away they are prepared to ignore ongoing high leucocyturia.

I think leucocyturia is prevalent in at least 20% of mature post-menopausal women.  If they are asymptomatic they will never know, unless they personally dipstick, or have their urine checked.

If they present with repeated symptoms in the absence of significant or any bacteria they may/will be put on permanent low-dose ABs.  This is mistreatment IMO.  It leads to AB resistance and further problems down the line.

I believe it is a neglected issue, particularly in primary care.

The following references may be of general interest:

https://pavilionhealthtoday.com/fm/assessment-of-sterile-pyuria-in-primary-care/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549703/#:~:text=Additionally%2C%20sterile%20pyuria%20can%20be,a%20UTI%20%5BChan%20et%20al.

Ann