Narrator 0:00
The information provided in this podcast is not a substitute for medical advice or treatment. If you’re concerned about your health in any way, we encourage you to consult your GP.

Hannah Paterson 0:12
People don't like talking about it, but incontinence can affect anyone. You may have a friend or relative who lives with it every day, or maybe you're worried about your own incontinence. Incontinence Talks is here to make us all feel more confident about continence, hosted by former Olympian Rower and Coloplast Ambassador Pete Reed. Today, Pete continues his conversation with Dr. Carmel Curtis around the risks of urinary tract infections and how to minimise the chances of getting one as an ISC user.

Pete Reed 0:42
I want to bring it back to, a little bit back to catheterisation and I know you're a microbiologist and not a catheter expert. I'm now something of a catheter expert in my own world, but I wanted to ask you about what are the causes of UTIs for intimate and self-catheter users, seeing as we're talking about incontinence. So, the process that I do and many, many, thousands of others do around the UK, we're putting something inside. What, what's happening there?

Dr Carmel Curtis 1:09
So, when I mentioned earlier that you are covered in bacteria, that is through for your urethra, which is the pipe that goes from the outside into your bladder. So when you insert a catheter, there is a risk that you'll move some of those bacteria into your bladder. So, that's the first thing to say. Okay. The second thing is, if your technique is not as good as it should be, you can damage your urethra or your bladder and introduce bacteria.

Pete Reed 1:36
Talk to me about technique.

Dr Carmel Curtis 1:37
So, yes.

Pete Reed 1:37
So, a lot of technique for my old rowing days.

Dr Carmel Curtis 1:40
No, but I think it's about being taught the right technique right from the outset. I think if you have the right technique, if you don't contaminate the catheter as it goes into the bladder, you can prevent quite a few UTIs in ISC users. It's a technique that someone should train you how to do to to minimize that risk. And from my perspective, I think ISC is overall a lower risk than people might think, but I think in my experience, often ISC users experience occasionally a UTI right at the beginning of their journey because they're still learning how to do it. They're trying to get their technique right. That doesn't mean they deserve that UTI. It just means it takes a little bit more practice right at the start. And I think when you talk to experienced ISC users and you're one, I'm sure you're much better at doing it now than you were when you started and you're much clearer on hygiene, on the right technique, position. So, I think those are the key things from certainly from microbiologist perspective because you want to minimise the amount of bacteria you bring into the bladder.

Pete Reed 2:49
Yeah, pushing things into an exit pipe is never going to be healthy and having something in there as well. There's a little micro traumas going on, whether that's in the urethra, past the sphincter, or into the bladder which is quite a delicate lining. I've never seen one and touched one. I've seen one from afar, but it looks like it's I'm sure you've run your hand over some, like it looks smooth or it should be smooth inside.

Dr Carmel Curtis 3:13
Yeah, so it should be intact and not inflamed. And it should look, I suppose, from a medical perspective, you put a little scope, a little camera in there in a healthy bladder, up through the urethra, into the bladder. It looks healthy. You should see something that's quite, shouldn't be read or irritated or inflamed or you shouldn't really see blood. So that's a really key, healthy component to a healthy looking bladder.

Pete Reed 3:38
Where's the blood coming from? Because we mentioned earlier with the dips, it can have bits of blood, so is that blood from a traumatised bladder lining?

Dr Carmel Curtis 3:46
It can be. It can also be due to other things, but commonly it's probably a little bit of trauma in ISC uses very typically. Sometimes bacterial infections can cause some blood to be produced in the wall of the bladder, and that often happens with very acute, very sudden cystitis or bladder inflammation caused by bacteria. So you often see it in that scenario.

Pete Reed 4:11
So a phrase that came onto my radar as the urology nurses were explaining this process was the concept of urethral flushing, which is the process of the pee coming out to the bladder, down the urethra to flush it out. And some people who catheterise are encouraged to try and pee, so there is some urethral flushing going on, which, so the bacteria is coming out and having a wash effectively before they catheterise. For me, that doesn't happen. It can't happen. So I just use a catheter and everything is going up. And with self catheter users, there's no urethral flush at all. It's lubricated plastic with all the tech in the world going in and then coming out. So it's plastic on skin, on urethra.

Dr Carmel Curtis 5:00
Correct. So that voiding or flushing is, you're describing it, pushes all the bacteria that's in your urethral out, as you said, into the toilet. So that's like nature's way of keeping you clean to use that word. And of course, when you put a catheter in, that is not happening. In fact, the opposite is happening, depending on your technique, you’re in a sense, pushing them in the wrong way.

Pete Reed 5:24
So technique, when you were describing that process and the learning process, you didn't know that you were describing my journey through self catheterisation. So I was very lucky with my urology nurse that came to see me. And another nurse from Coloplast came to see me in hospital to talk me through this process and the importance of hygiene. I'm going to caveat this point in a second. But making sure that you've got clean hands, that you don't touch the product that goes inside you, that you hold your urethra open in a suitable way, even the position of your body. So you're doing minimum damage to a potentially twisted urethra in men, especially because it's longer. In fact, you said three to four centimetres. How long for a male? But it goes a long way inside the body as well. It's got a few loops to do. But we're talking more like 20 to 23 centimetres. So that's a long way to go in a lot of twists and you don't want to be putting something, you don’t want to be contorting your body during the process. So there's an awful lot to learn. And I remember quite early on getting a UTI and the caveat I mentioned earlier was I think it's important to remind people who are starting off their journey with catheters that there's a learning process. Getting a UTI doesn't mean that you're either rubbish at this or you're a dirty person

Dr Carmel Curtis 6:51
or that you can never get better at it. I think people, I don't know if you felt this pete, but do people feel like, oh god, that UTI was awful? I'm never doing this again.

Pete Reed 6:58
Yes, very much so. So something else in my life as well. I'm not a big drinker, but I don't mind sharing this story. The first time when I went out and had and saw friends, this is post injury and had a couple of pints and then had another pint. By the time you've had, I mean, within reasonable drinking, I remember catheterising, but the more you drink, the less dexterous you are and thinking to myself, this is a lot harder than when you're sober and finally peeing and then within a day or two having UTI symptoms and looking back thinking I was probably way off with my hygiene there. This is all learning. No, no, it's real. It's like a learning process and it's real life, so the process and the procedure does matter and I think in part that's what matters generally in society, having a bit of understanding, having some clean facilities, having a little bit of extra time and not being rushed, for the user being more confident and using products that work for them because catheterisation, your practices does have an impact on whether or not they send their pee off to you.

Dr Carmel Curtis 8:05
Absolutely. And then the other thing just to, that can also happen is, you don't drain enough. If you're not, if you're not, if you've had a couple of pints, you may be not thinking, I need to empty this bladder completely, perhaps you're a bit more impatient, you don't get all the urine out and then you end up with this little volume left behind. And there is some evidence that that residual volume might cause you to be more prone to UTIs.

Pete Reed 8:32
Can you explain why that's important? So let's say the bladder is not fully empty. I imagine, with healthy people, it's fully empties every time, is that correct? So why would 30 mil or 40 mil left in their residual pee, why would that be a problem for you as a scientist?

Dr Carmel Curtis 8:52
Well, I think the issue is we don't exactly know what volume is the critical volume, which is a problem in itself. We don't know whether leaving 30 is better or worse than leaving 100. We assume that we leave 100 or 150 mils. We might cause a problem. And the reason is, for the most part, urine is warm. It's exactly the right temperature for bacteria to grow. It sits all in one place. It's sort of static there. So the bacteria really like that environment and are more likely to multiply. Warm and wet. Warm and wet. And it's exactly the right temperature, so I think, generally speaking, leaving urine behind in the bladder is more likely to make you, well, definitely makes you more vulnerable to UTI.

Pete Reed 9:37
And as a user, it's very difficult to know if you're previously, because I've used a few different catheter products in my time now, settled on something that's working for me, I've spoken about it in the previous episode, but I'll mention it again. It's called Luja. It’s by Coloplast. I'm not here to sell it. But it's radically changed my life. I was about to say habits with catheterisation. But in all aspects, it's been brilliant for me. Previously, when I was catheterising, it would be quite difficult to know if I was fully emptying because of the mechanics of the way the older catheters work where the holes are. It meant that I would have this flow of pee coming out when I needed to go. At some point, it would sort of flutter and stop. And then the urology nurse has coached us to do something called repositioning, which is a little bit of a twist in a shuffle of the catheter so that if there are any pockets of urine still left in the bladder that they would come out as well, but I can't feel when there's more to come out. So at some point, you need to just finish the medical process and off you go. And I can't feel if there's anything left. I was really proud of myself recently. It's very, very rare to get any feedback on whether or not you fully emptied. But part of spinal cord injury life is you occasionally go to hospital to have a renal scans of various sorts. And I went to hospital very recently. And a sonographer was looking at my bladder. They were actually looking for stones and any anomalies and scan the kidneys to look for little abscessing things. So for that process, you need to have a full bladder. So I timed those things right. And then she asked if I could go away and empty my bladder and come back for a re-scan, which I went away and did with this product, Luja, and she was shocked that she couldn't find my bladder afterwards. It was completely empty. And she'd never seen that before. I was kind of partly proud of myself. And it's, previously, it was about technique. Now it's just about the product that I use. My bladder was fully empty. That's the first time I've ever had immediate reassurance that that process is working. And she was so taken aback with nothing, no urine and to find that I showed her the product and said, can you, can you just show this to some of your peers? And I think this is why I'm not, I'm not particularly adept at the process. So Carmel, how do people get access to a microbiologist?

Dr Carmel Curtis 12:01
Well, generally speaking, they don't. The microbiologist sits within, usually within the hospital setting, supporting other health care providers, like general practitioners, urologists, urology nurses, specialist nurses in MS, or Parkinson's, or dementia, through the laboratory process. And then through that process, they give specialist advice to these other health care providers about unique cases.

Pete Reed 12:27
So that might go to a urology consultant, maybe, in your area, and then you're behind the scenes doing the science to support their work?

Dr Carmel Curtis 12:35
Yeah, and we often have multi-disciplinary team meetings together where we discuss complicated patients or complicated cases. So it's a, it's a network really of healthcare professionals working together to support patients. And the microbiologist is very much part of that.

Pete Reed 12:50
It's important to remind people that it's a team effort. So it's not us versus doctor or us versus microbiologist, we're all working together and we're all supporting each other to try and get the best outcome for the end user. And ultimately to reduce the risks and treat acute infections when they arise. We're lucky to have you. I mean really lucky that you're on the podcast talking about this stuff and we've met a few times now. So this access is amazing and this conversation is important as well, it's access to the science behind a lot of the content that's going to come later on in this series of discussions as well. So thank you very much. I just want to talk quickly about what can patients who self-catherise due to minimise risk of UTIs, just in a nutshell.

Dr Carmel Curtis 13:37
So I think the first most important thing is hygiene. So have they been taught the right technique with good hygiene practices to minimise the risk of introducing bacteria into their bladders? I think the second thing they can do if they're using the right catheter, they have the right technique is to empty their bladder to the best of their ability because as we've said earlier, having fewer bacteria in your bladder reduces your risk of a UTI. So for me those would be two of the most important things that a person can do for themselves.

Pete Reed 14:10
Can I add to that as well? From a user experience, I'm not going to tell people what product to use. I would just say make sure that you know that there are different products out there and that your body is your own. It's unique, your conditions are your own. You need to catheterise for your own reasons and that there are products out there from different companies that will, you'll find that something works for you. Please don't make the mistake of thinking that your very experienced and brilliant urology nurse that came to educate you showed you every single example and there's nobody out there doing reviews like they would do of the latest phone or tablet or computer or car to show you everything that's out there. You need to do a little bit of the work and know that there are products and maybe try a few things and it's probably worth a discussion with your GP about finding something that works and not thinking either this is normal or this is good enough I can live with it. I can live with antibiotics twice a year because you might not have to for example.

Dr Carmel Curtis 15:13
And I think patients themselves or users themselves will know what works for them so some people listening might think well if I don't think two litres of water a day I typically get a UTI people will have also worked out for themselves the things that help them avoid UTI's like hydration maybe like some of the other non antibiotic preventative things that people take things like cranberry extract or de-manose or some of your listeners may be using these various different products. So I think know your own body, know how you it's like for you saying earlier about how do I know when I get a UTI people will know. So the more you know yourself then the better I think your outcomes will be.

Pete Reed 15:54
And you mentioned de-manose and these are products that you can buy from a Holland & Barrat or Amazon or any healthcare providers but because we've got you here, is it is it's a real thing should I be regularly taking cranberry capsules.

Dr Carmel Curtis 16:11
So I think this remains a difficult area to be certain about is what I would say there is some emerging evidence that certain, some of these non antibiotic preventative things like de-manose or cranberry extract or hyperex and things like that might do good in some patients. My advice would be to have a chat to your GP and run through whether or not they think it's suitable for you. I think the emergence of this area is is of interest and I would add probiotics in there, people wondering if certain kinds of probiotics might help them. I think this is still quite an emerging area. I would say to users that if it works for you I would keep doing it but I think there's not clear evidence at the moment that all of these products work the same way in every individual. So something that might work for you might not work for someone else.

Pete Reed 17:03
So some advice I've got actually for everyone out there going starting their either catheterisation journey or if they feel like they're presenting more and more with UTIs. I kept maybe this is the athlete in me but I kept a very very thorough diary of initially when I was first injured I kept a diary of every single time I peed, catheterised. Yeah. So I can look back and I did this for three years. So five or six times a day, a little mark in my online diary of just a 15 minute block and I could see how much I peed the quantity and just made a note of the colour from like 1 to 10 of my own made-up spectrum and it was so useful as I was starting to learn my new body and although there's a science, you're a scientist you'll hear there's an art tool of this stuff as well and learning and learning yourself. So I kept a very very thorough urine diary daily and then on top of that it helped me keep a UTI diary as well, which was it was so powerful for the doctors as well for GPs to have a look out to to see what trends are and it made me realise in the first instance when in 2022-21, 22, 23 there were patches of those times where I was having re-occurring UTIs and if I hadn't been keeping a diary I wouldn't have noticed the pattern. Those have almost entirely cleared up since changing products by the way which I think is the reason I really want to get across to people that there are other products available that fully drain and are less traumatic. Before we finish and we've been this such a rich conversation so valuable to me personally so I know it will be to lots of the listeners as well. I didn't want to not raise this one even though it's pretty difficult for me. It's about life-expectancy of people who cathetarise or people who have re-occurring UTIs because apart from my wheelchair and obvious complexities I feel very healthy. I feel very mobile and independent I've got purpose and fulfilment in life and it's only when I've got a UTI that I deviate from that mindset and I can't see any other reason why I should be thinking my life expectancy should be affected by spinal cord injury but I am worried about UTIs, should I be?

Dr Carmel Curtis 19:27
I would say generally no. Great. So let me just qualify this a little bit. Generally speaking most people get a UTI, who end up on the appropriate antibiotic do very well. What does it mean to get recurrent UTIs as an example? Well it's more of a quality of life issue I would say than anything else. Clearly you can become more vulnerable to getting things like kidney stones, you can be vulnerable to the effects of having a lot of antibiotics, so all the antibiotic complications. But unless you end up in a scenario where you have life threatening sepsis from your UTI and that of course does happen thankfully most patients end up on hospital and often do do very well on the appropriate antibiotic. But I think in terms of lifetime expectancy there's no evidence to suggest that people who get a lot of UTIs are more likely to have a shorter life expectancy than anyone else. I think the key thing is recognising when you're very unwell and seeking help immediately and not lying at home, sweating, worrying about bothering the health service. If you think you have a severe urinary tract infection or something for you doesn't feel right is to seek help because we are very lucky to still have a very good range of antibiotics that we can treat people with. So I think overall I would say the future is brighter you know in terms of life expectancy than you might think.

Pete Reed 20:57
That's wonderful to hear and leads me into the last piece of the conversation and it's going give me hope I'm sure but I really want to hear from you about scientific innovations for the treatment of UTIs. What's next?

Dr Carmel Curtis 21:12
So I think there are a number of things coming towards us. I would like to personally as a microbiology see better testing, quicker for patients. They shouldn't have to wait two or three days to get a result. So I'd love to see some, what's called point of care testing. So the testing is closer to the patient or perhaps they could even do some of the testing themselves. I'd really like to see the further development of what we were speaking about earlier. The non antibiotic prophylaxis. What is that going to look like? Probiotics or you know the other agents we discuss like cranberry and all of that? I think new things will come through. I don't think we're there yet. I think the other innovations aside from antibiotic development is vaccine development. So actually we already have some vaccines on the market against E. Coli UTIs which is a very particular bug. But I would like to see that world expand because I think vaccines may be the way forward. I don't think we're there yet. I think more work to be done, but there will definitely be people listening today who are taking vaccines against E. Coli for the UTIs and will be having a very good response.

Pete Reed 22:19
So that's great to hear. So I thought vaccines for viruses and antibiotics for bacteria, but that's not the case.

Dr Carmel Curtis 22:26
No, not at all. So we have lots of vaccines for bacteria also. But we are looking at companies are looking at very specific vaccines, targeting E. Coli, that cause UTIs, hoping also to expand into other bugs, other bacteria that cause UTIs. So I think that is an area of interest and I'm hoping that will be an innovation we'll see in the coming years.

Pete Reed 22:48
Are there any charities that you want to mention that are doing great work with funding research? Are there any pieces of signposting that you want to do for listeners before we wrap up?

Dr Carmel Curtis 23:01
I don't know that there are specific UTI charities. I think there are charities where people in particular have neurological disorders who have an interest in helping their sort of, I suppose, patients who have MS or Parkinsonism or spinal cord injury who are interested in helping move that research along. I don't think we've got as far as I'm aware a single charity that's just focusing on this. It has definitely, though, moved up the agenda, I think not that long ago, the Longitude Prize, which is a very big UK science prize, went to urinary tract infection diagnostics. So I think that for me was the first time I had really seen anyone move it up to the point where it was, it was available for a national prize. So I think plenty of room in that space for people to do more, I would say.

Pete Reed 23:49
Carmel, thank you so much for being so available to us for sharing your perspective from the microbiology world, for giving us your time. I know you're extraordinarily busy and for coming across to the studio to chat to us about these things. Not many people have the access. You've been really clear as well about the advice that you've to give to people who have a UTI and for those people who catarise, it's been wonderful to hear, and especially that last piece I was kind of smiling, I was a little bit nervous about asking and I'm sure a lot of people will be relieved who are listening. Thank you for your time. It's been an absolute pleasure talking to you.

Dr Carmel Curtis 24:27
Thanks, Pete, it's been a pleasure. Thank you.

Narrator 24:29
On our next episode, Pete is joined by ISC users and Coloplast ambassadors Samantha Cole and Dani Logan to share their experiences of ISC. There are lots of amazing charities that can provide focus support depending on your particular needs, as well as lots of information at coloplast.co.uk. Thank you for listening to Incontinence Talks. And remember to consult your GP if you have any worries about your own continence.