UTIs

Carly OsmanPerfect. So, Kath, before we dive into what I think is going to be a really interesting conversation about something that affects so many women, tell me a little bit about yourself.

KatherineYes. So firstly, thank you for having having me on, Carly. It's a real pleasure. So I am Catherine Church. I'm a femtech and digital strategy consultant. So what that means is I help female founders working in health tech to navigate the healthcare systems in the yeah UK, which are hugely, hugely complex. So acting as that conduit between them and the market that they're trying to get into. So this could be market entry strategy, could be product fit, it could be determining and helping with business cases, etc. And I also advocate and advise the government on the use of digital in women's health services. So that bit of a bridge between those two things. And my background was I was in corporate IT, decided banking was a no longer worthy of my attentions, moved into the and NHS in a senior leadership role in digital, just as COVID hit. So I had the best and the worst time. So some of the scariest times ever, but also the time that showed that the NHS is capable of moving at pace. And when the obstacles are moved out of the way, then we can do absolutely incredible things in digital and healthcare. And what left what what was I was left with is my passion for women's health. So that brought me to where I am now.

Carly OsmanSo where did the focus for UTIs come from?

KatherineYes, well, I didn't think there was anything that could still make me angry in in women's health. And then last summer, I got a UTI pillage. And it was personal experience that, a personal experience of bound bouncing around primary care, not really knowing what to do in my early 50s. So thinking that I was pretty well equipped in terms of of of knowledge around UTIs and and how to go about getting treated. And finding that my experience was of opaque, was obtuse, that it took about four months to get what could have been and for most people it should be for most women should be a really simple, a really simple infection cleared up. And that got me curious as to how my experience could have been so bad. Was I the only person was I the only woman who was going through this really infuriating experience? And of course, the answer was no. i think anybody listening to this podcast either will have had an UTI or will have a woman in their circle who's had a UTI and they will find that that my story is is is very, very typical. And then of course, having worked in the NHS and worked with founders and innovators, I thought there's going to be a better way of doing this. So I started doing some research, started reaching out to the healthcare system, started reaching out to innovators and just thought, hang on we have the opportunity to do a lot, lot better. And just yesterday, I hosted an amazing workshop with representatives from retail pharmacy, from digital pharmacies, from pharmaceutical companies, full start, both women's health and and more generic with the and NHS leaders and with innovators. And we've defined two areas where we think we can genuinely, genuinely do things really differently and change the outcome for many, many women without without radically changing the pathway, using what we've got and doing it in a bit a bit of a better way, in a more joined up way.

Carly OsmanAmazing. Are you able to share what those are

KatherineYeah, yeah, our broad areas are diagnostics. So we'll come on to how UTIs are commonly treated at the moment. But at the moment, the guidelines say that we prescribe wherever you you turn up with a UTI, whether you go to your GP or whether you go to a pharmacy, you'll get prescribed a broad spectrum antibiotic blindly. So essentially, the clinician who's prescribing for you is going to prescribe something that works for maybe two thirds of women, but may not work for you. So we don't they don't actually know which pathogen is causing your infection. And for a third of the women who get UTIs, The antibiotic that's prescribed just simply does not work for them. So actually, if we equip clinicians with the ability to know which microbe they're dealing with, which infection they're dealing with, and giving them the opportunity to do that precision prescribing at that earlier stage, that could make an enormous difference.

Carly OsmanThank you.

KatherineSo that's one of the first areas we want to trial. And the second area is around education, awareness and prevention. So women who have had, in fact, all women should be much better educated around UTIs, what the cause is, how we can manage them, where to go, what to expect when you reach out for help. But in particular, the 50% of women who will get a UTI in their lifetime, they will get another one. So once you've had it once, it's quite likely that you will have it, that you will get another one. And there are a ton of things that we can do to manage our own bladder health, to think about prophylactics and to think about equipping ourselves in the best possible ways to reduce the the likelihood of that recurrence. And that's another thing that we want to do. And both of these areas need to bring together retail pharmacy, pharmacy first, primary care in the form of GPs, so our local doctors, education and innovators. And luckily, we had all of those people in the room, like there with this one thing of how do we design something practical that we can test and see if we can make a difference without needing to radically change the whole system. And so we came out of that workshop yesterday, really quite excited about the possibilities.

Carly OsmanOh, that sounds absolutely brilliant. And on this topic of education, a lot of people probably will have heard the term UTI. There will be some people who experienced it. But what is it actually? Is it the same as cys cystitis? Is that a UTI or is that something completely different?

KatherineYeah. So, so same, same, same cystitis, the honeymoon, disease. so urine retract infection, it is an infection. it is when bacteria enter, a woman in, some men do suffer from UTIs about 10% of men will get a UTI, in, in, in their lifetimes. but it's when bacteria enter the urethra, in women and, and those bacteria can then, take hold in, in the urinary tract and cause infections, which can be extremely, extremely severe if left untreated. The actual cause, the reason why women get UTIs and why some women get UTIs so much more severely than other women and why some women risk respond to certain and antibiotics better than others is is not known. So there are said there are some some broad explanations, but if we went down to what exactly causes a UTI, Why do some women suffer so much worse than others? Then we don't actually know the reasons for that. And that's another thing that that needs to be investigated with with a lot more rigor, because it is a huge number of women, 50% of women in their lifetimes will get an infection of the urinary tract.

Carly OsmanAnd this isn't just a bit of uncomfort peeing, is it? it's There are a lot more severe symptoms that show up in many women. Can you talk to me a little bit more about what those are?

KatherineYeah, yeah, absolutely. So so so the the the the common symptoms, the symptoms that impact on the vast majority of women are that burning desire to pee. So you've got that discomfort and tingling. You've got that then that burning desire to to pee. When you try and go to the loo, urine doesn't pass. Or when you pass or or when you can wee, it feels like you're weeing acid. And I can see from your face, Carly, that's... That's the face of a woman who's had a who's had a UTI.

KatherineAlso a dragging kind of low sensation of pain, general feeling of unease and and and being unwell. And just your entire body is preoccupied with this burning sensation. So it really does feel as though there's something quite wrong, doesn't it? If left untreated or if treated with incorrect antibiotics, then that infection can spread further up the the urethra and in the urinary tract and the urinary system. And you can end up with kidney disease. So that's happened to me, especially in my 20s, a number of times is that I didn't get to treat the UTI properly. at that initial stage and then that turned into and became a kidney a kidney infection, which is, of course, a and lot more serious. And then depending, again, this can then also, if less left and untreated, can then turn into, in a as a significant minority of cases, this can turn into, if untreated, into urosepsis. So this is a form of sepsis which develops from an untreated urinary tract infection, and that is extremely serious. All cases of sepsis are serious, but with urosepsis, you're looking at a 20% to 40% mortality rate. And in fact, in terms of hospital addict admissions and cases of sepsis full stop, in one in three cases of sepsis in women, there there is a UTI that it's involved at. at some point during the development of that disease. So UTIs can be deadly. They can absolutely kill women. I don't want to be super alarmist, but there there there are there is there is a very strong link between sepsis and UTI. The other thing to say is that that is the case for younger women, in older women, especially women suffering with dementia, then there is the symptoms of UTIs are different. So UTIs in much older women will present as confusion, will present as aggression, will present as dizziness, as as as faintness. And of course, that can then very easily be mistaken for dementia. So quite often, and the onset is very rapid, so quite often older women living on their own who are not quite so well hydrated can develop UTIs and those UTIs can be mistaken for dementia, which of course then when you've got that risk of developing urosepsis, especially in in older women who may be a whose immunity may be compromised, and this is really serious indeed.

Carly OsmanThis is terrifying. And kind of when we also think about the scale of the number of women who suffer from this. So you shared a fact with me before that and every year about 7 million people or women are given antibiotics to treat a yeah UTI. And I'm guessing that not everyone will go for the, med then I suppose, a prescribed route. A lot of them will buy off the kind of shelf solutions as well. So we're talking about millions and millions and millions of women who are living with pain of something that could potentially be life-threatening. But yet, there isn't the support. We're not talking about it. I've never, ever had an open conversation, apart from with you, Kath, about UTIs with anybody. Why i is that?

KatherineYeah. Yeah. Yeah. I mean, it is, it's, it's, it's an area that, that it is an area that, that if you present to your GP and and most women will at some point end up at their GP or in A&E or a walk-in center or, or a pharmacy, because it just doesn't, it doesn't go away. It's not one of those things that goes away and you just think, oh, well, maybe I'm just making, you know, i'm maybe I'm overreacting. but, but in terms of why we don't have these conversations, It's women. It tends to be older women. So the link between menopause. So the genetic, sorry, can we do that again? Just, okay.

Carly OsmanBut

KatherineSo why don't we talk about it? So it's women. So number one. it's it's it's older women. So there is an extremely long extremely strong link between more frequent UTIs and and menopause. So the genitourinary symptoms of of menopause are becoming to becoming much, much more understood. but So women, it's older women, and then it's urine. So you've got a triple kind of like yuck from everybody, including women ourselves. I think you'll find that if you call it cystitis and call it the honeymoon, syndrome, then younger women may be talking about it a lot more. I remember when I got cystitis in my 20s, then I wasn't, it was, it was cystitis, it didn't have that level of shame. It seems to be now that it's linked to, you know, linked to me, maybe in my my age, that that there's maybe there's an ick factor about older women having sex and talking about sex. But there's certainly, there's there's certainly that women, older women, you're in But the fact is that that women, and we're we're not talking about it ourselves, we're suffering in silence. i I haven't found any data on the actual numbers of days off that women take. because of of UTI specifically, as opposed to women's health conditions more generally. But I'm going to guess that it's pretty high, and especially in in menopausal in menopausal women, because you are so much more likely to get a UTI as you know as as you get into perimenopause and menopause. So, you know, we're taking time off work, we're suffering, we're suffering in in silence quite a lot. And we're not talking to each other about it, which seems fairly crazy, doesn't it But the second you say UTI, same as as you and I, when we had this conversation, then it just unlocks the room. And then all of a sudden, everybody's talking about it.

Carly OsmanYeah so with that in mind and you say you mentioned perimenopausal menopausal women are more inclined to get it what is there anything preventative we can do

KatherineYes, there absolutely is. There absolutely is. And I'm not going to position myself as any kind of clinician because I'm not. So I'm just going to talk about my personal experience. There is there is a, and I would encourage every woman to go and talk to her GP about, about this. There is a, an incredible, one there's there's an undeniable link between reducing levels of, of, of estrogen and, and the vaginal tissue, so the the tissue in the vagina. As we lose oestrogen in the vagina, the skin becomes thinner and the skin becomes drier. And as the skin becomes thinner and drier, then it's it's easier to get those tiny tears and friction that that you will get either during sexual intercourse or the skin is is drier and thinner. And that makes it much more receptive. to those bacteria, which can then be transferred into, into, into the the urinary tract. Let's just do that bit again. So, so the thinning of of the, the, the membranes in the vagina can make it much more likely that you will you will get the bacteria breaching and then that can be transferred or transferred into into the urinary tract so the thing that was an absolute lifesaver for me and when you meet other women who are on vaginal oestrogen they they will all say the same thing you get this huge beaming smile of, oh my God, vaginal estrogen has been absolutely incredible. And it has been a real lifesaver. So it has genuinely changed my comfort. It's changed comfort levels. It's changed hydration. And it's just essentially made my life so much better.

Carly OsmanOkay.

KatherineAnd since I've been on vaginal estrogen, I haven't had a UTI. I've So for me, I'm going I'm going to claim this as as you know, I'm going to say this is my experience. It's shared by a lot of women. But I would say genuinely, genuinely, if you're getting more UTIs now and and you're in that perimenopausal age, then I would seriously encourage you to go and and and talk to your GP or to a clinician or there's online services for UTIs, both Boots and Pharmacy to you. I've got some really good online services. So talk to somebody who knows what they're talking about and investigate that link and see if HRT is the right thing for you. Or if you are on HRT and you're not taking vaginal oestrogen, then go and talk to somebody and seriously, seriously consider it.

Carly OsmanI think this is really interesting and and when we spoke before one of the things you mentioned was the changes in the but menopause industry and people are now more aware and more advocating for themselves because they're going hang on a second I've got all of these symptoms and Doctor, don't tell me I'm too young, young, I'm presenting. So therefore I'd like to talk about solutions to address this. Do you think we're on the same kind of trajectory with UTIs? Knowledge is power. And the more that we can i be aware of this, the more that we can go out and actually advocate for ourselves.

KatherineYeah, yeah, absolutely. Absolutely. We we need a Davina moment, don't we? We need we need we need a you know a real kind of like catalyst a catalyst for for for that kind of of change. And there are there are women who are who are advocating. Cherry Heaney is a UK presenter. She's a huge, huge advocate, a huge advocate and a flag there. And she's a a recurrent UTI sufferer. so So, yes, but we need more of that. We absolutely do. So I think there's there's a top down, there's that kind of like that lightning moment, you know, what what what Kate Muir and Davina did is is just essentially exploded menopause into all of our attention. And that's done some extraordinary things, hasn't it? We've got we've got free HRT, we've got HRT being available.

Carly OsmanOkay

KatherineI know it's still a postcode lottery, but but but widely talked about. We've got the ability to pay six times as much for bar of chocolate if it will cure our menopause than we would for exactly the same bar of chocolate aimed at someone else. So we have the opportunity to part with so much money to buy so many products to address the 52 or 60 or 80 or however many. at symptoms of menopause but what I haven't seen and and I would love to see is that one of the top symptoms we can all talk about hot flushes and not everybody gets hot flushes we can all mention hot flushes associate hot flushes and menopause but we're not associating UTIs and menopause and I think that's the next bit of the conversation that we need to bring to light.

Carly OsmanSo you mentioned that there are a number of different bacterias that can cause these UTIs. Why is it so important to know which one's which?

Carly OsmanAgain, this is a terrifying fact that again, shows that we have to address this problem head on now, because it's yes, for the individual suffering, but the knock on effect of what happens if we don't have antibiotics that work, because these are treating so many different other infections. So it's it's frankly, just blows my mind that this isn't a top priority that we've, that I suppose nationally we're focusing on.

KatherineYeah, yeah, yeah. Well, we've we've we've had just today, we've had the revised women's health strategy. And that strategy is is talking about linking the women's health strategy to the 10-year plan.

KatherineIt's talking about making the incredibly long waiting list for gynaecology a priority. It's talking about investing in community diagnostic centres, So that's a sent you know one center in the community outside of a hospital most of the time where you can come and get those diagnostics done really quickly and really effectively and really efficiently. We've also got the prescribing guidelines are being looked at. So NICE is looking at the prescribing guidelines around urinary tract infections. So actually, is this broad spectrum antibiotic for three days and not longer, is this the right thing to do? So so there is there is, I don't want to be all doom and gloom, that there is some focused attention on this.

Carly OsmanThank you.

KatherineI, are of course, not enough given the scale of the problem. And let's face it, the experience I had was less than 12 months ago. The women that I spoke to yesterday are still having these experiences today. So GPs are not well educated enough. Women are not well educated enough. The whole of the the system is not joined up enough. that That's a women's health problem. but But I like to be positive and, and you know, and and think like in the in in in menopause, with we're making some progress. It just isn't enough and it's not quick enough.

Carly OsmanAnd I do fundamentally believe in the ripple effect of one conversation can lead to something else that can lead to something else. And that's where change can happen grassroots up. So anyone listening who has, i suppose, whether it's a recurring UTI or just a singular UTI, and they're going to speak to their doctor, what should they say?

KatherineAnd Yes, they should say they should say, i want a cultured urine test. What what the standard response is, you'll get a dipstick. So they they almost like you're testing for diabetes. So very so different. But they'll say there is an infection present. And on the basis of that, they will prescribe you these broad spectrum antibiotics. if the If the surgery or yeah, if your GP does not offer to take a urine sample, send it off to a lab, get it tested so that they know what to prescribe for you, you should insist on that. that would be That would be my one single recommendation. And that's what would have made the difference for me. The thing to say with that is that it does take 48 hours. to get a lab test back. So there is there is that thing of of can you wait 48 hours? But on reflection for me, and i again, I'm going to claim this as my experience, given that it took nearly four months to get to the bottom, and numerous courses of antibiotics before I got the one that was actually right for me. Had I been given the option, I think I would have waited the 48 hours and I would have got the, I would have understood or my GP would have understood exactly what they were dealing with and prescribed me the right the right antibiotics at that point. So I think that that would be, and if you've got recurrent UTIs, then it really is it really is about getting to the right specialist service and understanding what you can do by way of prevention and bladder health. Because there is a tiny amount of help out there, but women have got to fight tooth and nail to get it. So if you're getting these infections over and over again, then you really need to be escalating that as much as you can and getting the right the right advice as soon as possible.

Carly OsmanAmazing, well thank you so much Kath.

KatherineOkay, brilliant. Well, thank you so much. Hopefully if even, you know, five women hear this and go and have conversations with five other the women, you have them with five other women, and we can save even a few hundred days of the horrendous pain of not feeling you can focus on anything because your bladder is just on fire, then we will have done a good thing, won't we?

Carly OsmanWe really will.

KatherineYes.