For Thirty-Four Years I Told Women With Recurring UTIs To Try Harder. I Want To Apologise.
My name is Margaret Ellis. I am a retired nurse, and I spent thirty-four years on urology and geriatric wards.
If you have had three, or six, or twenty infections in the last few years, I already know how this went for you. You went in. You gave the sample. Somebody kind but hurried wrote you a prescription, and somewhere in that appointment — maybe not in words — it was made clear that this was, in some small way, something you had brought on yourself.
I was one of the people who made that clear. Not cruelly. I thought I was helping. That is the part I would like to put right.
Here is what I used to say, almost word for word, to a woman who came back for the third time:
- Wipe front to back.
- Go to the toilet straight afterwards, every time.
- Cotton underwear. Nothing tight.
- Drink more water. More than that.
- Try the cranberry — it will not hurt.
- Change your soap. And your laundry powder, just in case.
You did all of it. I know you did, because every woman I said it to did all of it, came back anyway, and apologised to me on the way in.
Six weeks. Eight if she was lucky. Then the same sentence at the desk: “I think it’s back.” And the same small, awful apology, as though she had been caught out at something.
Nobody should have to apologise for their own bladder. She was doing everything right. The advice was simply aimed at the wrong thing.
Here is what none of us were looking at.
The wall of your bladder is not a passive bag. It is a working surface, and it is your first defence — a healthy lining sheds constantly, which leaves bacteria nothing to hold on to. They are flushed out before they can establish.
Over years, ordinary urine leaves mineral and acid sediment on that surface. It builds a molecule at a time, it causes no pain while it does, and there is no routine test that looks for it. What it does is give bacteria somewhere to sit — a rough, sheltered surface to hold on to while the antibiotic moves through the urine above them.
That is why the course works and the infection comes back. The prescription clears your urine. It was never designed to touch the surface they are living on. Three days later your sample is clean. Five weeks later the same population is back, from the same place it never left.
It is not a failure of hygiene. It is not bad luck, and it is not in your head. It is a surface nobody checked.
I would like to tell you I worked this out on the ward. I did not.
I worked it out at seventy-one, out of the uniform, reading the things I never had time to read across thirty-four years of shifts — and being able, for the first time, to say what I thought without a specialist looking over my shoulder.
I teach a small group of nurses now, at a lab called Bayside. Part of what I signed up for was permission to say this out loud. It is the first thing on my list.
If you are going to be angry about this, please be angry at the advice and not at yourself. You followed it. It was good-faith advice aimed at the wrong surface, given by people — including me — who had ten minutes and a full waiting room.
You have not been failing at this. You have been treating the water and leaving the wall.