You wake up with that familiar urgency to go to the toilet and burning when you pee – and no matter how many times you go, that urgency doesn’t let up. You know exactly what it is: a urinary tract infection, or UTI.

UTIs are common, affecting half of all women at some point. They occur when bacteria enter the urinary tract, causing symptoms such as burning, urgency, frequent urination and lower abdominal pain.

Now many women can go straight to the pharmacy and get antibiotics without having to wait to see a doctor. This will mean faster treatment and fewer delays, as well as less pressure on general practice.

But this approach is designed for simple, or “uncomplicated”, infections in otherwise healthy people. It excludes men, those with recurrent UTIs (usually more than two UTIs in six months), pregnant women, and those with more complex cases or underlying kidney or urinary conditions.

So how does prescribing work for simple UTIs? And what might you need for more complicated infections?

What happens when you see a pharmacist for a UTI?

Pharmacists will ask a series of questions to check it’s safe to treat you, and if it is, they can provide a short course of antibiotics.

These services are limited to women because UTIs are less common in men and more likely to be complicated, often requiring further investigation.

The most common antibiotics used include nitrofurantoin and fosfomycin. These target the bacteria most often responsible, especially Escherichia coli, which causes around 75% of uncomplicated UTIs.

The antibiotics pharmacists give you without a GP prescription can help with straightforward UTIs, but not the ones that keep coming back.

If you have a fever, back pain, or feel unwell, the infection may have spread beyond the bladder – and the pharmacist won’t be able to prescribe to treat this type of infection.

If your symptoms keep coming back, or don’t improve, you need to see a GP.

Why some infections don’t go away

For most people, antibiotics clear the infection and symptoms settle within a few days.

But some bacteria are surprisingly good at surviving. Instead of staying in the urine, they can invade the cells lining the bladder. Here, they are harder to detect and harder to kill, effectively “hiding” from the antibiotics and the body’s immune system.

Other times, the antibiotic simply doesn’t work. This is known as antibiotic resistance. It means the bacteria have adapted in a way that makes the drug less effective.

There are also other factors that increase the risk of repeat infections. Hormonal changes, especially after menopause, can alter the urinary tract and make it easier for bacteria to grow. Sexual activity, certain contraceptives and incomplete bladder emptying can also play a role.

What are your options if it keeps coming back?

If infections keep coming back, a doctor may test your urine to identify the exact bacteria causing the infection. This helps guide treatment, rather than relying on best guess.

Treatment might include a longer course of antibiotics, or a low-dose antibiotic taken over a longer period to prevent recurrence.

For postmenopausal women, vaginal oestrogen can help restore the natural balance of the urinary tract and reduce infections.

Researchers are also exploring vaccines. One example, Uromune, targets common urinary bacteria and aims to train the immune system to respond more effectively.

Alongside medical treatment, simple strategies can help reduce the risk of a UTI: staying hydrated, urinating after sex, and avoiding harsh soaps or products that may irritate the area. These steps won’t eliminate the chance of getting a UTI, but they can make a small difference.

What happens if it’s not treated properly?

Most UTIs stay in the bladder. But sometimes bacteria travel upwards to the kidneys, resulting in a kidney infection. This is more serious. Symptoms can include fever, lower back or side pain and nausea. It often requires stronger treatment.

Repeated infections can damage kidney tissue over time, affecting how well the kidneys filter waste.

In rare cases, the infection can enter the bloodstream. This can lead to sepsis, a life-threatening condition in which the body’s response to infection damages its own organs.

While uncommon, this shows why ongoing symptoms should not be ignored.

What complicates UTI treatment?

People with recurring symptoms and chronic UTIs often need ongoing, coordinated care. This may involve a GP for ongoing management, urine testing and preventative treatment. Sometimes, you may need a referral to a urologist to investigate underlying causes. Coordinated care can be difficult to access, especially if doctors dismiss symptoms.

Testing is also a challenge. Standard urine tests don’t always pick up hidden infections, leaving some people without clear answers. On top of this, antibiotic resistance complicates treatment.

For people living with recurrent infections, this is not a minor inconvenience. It affects sleep, work, relationships and quality of life. The good news is that, with the right care, many people can get their symptoms under better control.

So if your symptoms don’t improve, or keep coming back, it’s important to see a doctor. And if you feel your concerns are dismissed, find another doctor who listens and takes your symptoms seriously.

You can also ask your doctor about further testing, such as a urine culture to identify the exact bacteria, whether a longer or preventive course of treatment is appropriate, and if referral to a specialist may be needed.

If you have fever, severe back or side pain, or feel very unwell, seek urgent medical care, as this may indicate a more serious infection.

Iris Lim, Assistant Professor in Biomedical Science, Bond University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

As a clinical psychologist, I often have clients say they are having trouble with thoughts “on a loop” in their head, which they find difficult to manage.

While rumination and overthinking are often considered the same thing, they are slightly different (though linked). Rumination is having thoughts on repeat in our minds. This can lead to overthinking – analysing those thoughts without finding solutions or solving the problem.

It’s like a vinyl record playing the same part of the song over and over. With a record, this is usually because of a scratch. Why we overthink is a little more complicated.

We’re on the lookout for threats

Our brains are hardwired to look for threats, to make a plan to address those threats and keep us safe. Those perceived threats may be based on past experiences, or may be the “what ifs” we imagine could happen in the future.

Our “what ifs” are usually negative outcomes. These are what we call “hot thoughts” – they bring up a lot of emotion (particularly sadness, worry or anger), which means we can easily get stuck on those thoughts and keep going over them.

However, because they are about things that have either already happened or might happen in the future (but are not happening now), we cannot fix the problem, so we keep going over the same thoughts.

Who overthinks?

Most people find themselves in situations at one time or another when they overthink.

Some people are more likely to ruminate. People who have had prior challenges or experienced trauma may have come to expect threats and look for them more than people who have not had adversities.

Deep thinkers, people who are prone to anxiety or low mood, and those who are sensitive or feel emotions deeply are also more likely to ruminate and overthink.

Also, when we are stressed, our emotions tend to be stronger and last longer, and our thoughts can be less accurate, which means we can get stuck on thoughts more than we would usually.

Being run down or physically unwell can also mean our thoughts are harder to tackle and manage.

Acknowledge your feelings

When thoughts go on repeat, it is helpful to use both emotion-focused and problem-focused strategies.

Being emotion-focused means figuring out how we feel about something and addressing those feelings. For example, we might feel regret, anger or sadness about something that has happened, or worry about something that might happen.

Acknowledging those emotions, using self-care techniques and accessing social support to talk about and manage your feelings will be helpful.

The second part is being problem-focused. Looking at what you would do differently (if the thoughts are about something from your past) and making a plan for dealing with future possibilities your thoughts are raising.

But it is difficult to plan for all eventualities, so this strategy has limited usefulness.

What is more helpful is to make a plan for one or two of the more likely possibilities and accept there may be things that happen you haven’t thought of.

Think about why these thoughts are showing up

Our feelings and experiences are information; it is important to ask what this information is telling you and why these thoughts are showing up now.

For example, university has just started again. Parents of high school leavers might be lying awake at night (which is when rumination and overthinking is common) worrying about their young person.

Knowing how you would respond to some more likely possibilities (such as they will need money, they might be lonely or homesick) might be helpful.

But overthinking is also a sign of a new stage in both your lives, and needing to accept less control over your child’s choices and lives, while wanting the best for them. Recognising this means you can also talk about those feelings with others.

Let the thoughts go

A useful way to manage rumination or overthinking is “change, accept, and let go”.

Challenge and change aspects of your thoughts where you can. For example, the chance that your young person will run out of money and have no food and starve (overthinking tends to lead to your brain coming up with catastrophic outcomes!) is not likely.

You could plan to check in with your child regularly about how they are coping financially and encourage them to access budgeting support from university services.

Your thoughts are just ideas. They are not necessarily true or accurate, but when we overthink and have them on repeat, they can start to feel true because they become familiar. Coming up with a more realistic thought can help stop the loop of the unhelpful thought.

Accepting your emotions and finding ways to manage those (good self-care, social support, communication with those close to you) will also be helpful. As will accepting that life inevitably involves a lack of complete control over outcomes and possibilities life may throw at us. What we do have control over is our reactions and behaviours.

Remember, you have a 100% success rate of getting through challenges up until this point. You might have wanted to do things differently (and can plan to do that) but nevertheless, you coped and got through.

So, the last part is letting go of the need to know exactly how things will turn out, and believing in your ability (and sometimes others’) to cope.

What else can you do?

A stressed out and tired brain will be more likely to overthink, leading to more stress and creating a cycle that can affect your wellbeing.

So it’s important to manage your stress levels by eating and sleeping well, moving your body, doing things you enjoy, seeing people you care about, and doing things that fuel your soul and spirit.

Distraction – with pleasurable activities and people who bring you joy – can also get your thoughts off repeat.

If you do find overthinking is affecting your life, and your levels of anxiety are rising or your mood is dropping (your sleep, appetite and enjoyment of life and people is being negatively affected), it might be time to talk to someone and get some strategies to manage.

When things become too difficult to manage yourself (or with the help of those close to you), a therapist can provide tools that have been proven to be helpful. Some helpful tools to manage worry and your thoughts can also be found here.

When you find yourself overthinking, think about why you are having “hot thoughts”, acknowledge your feelings and do some future-focused problem solving. But also accept life can be unpredictable and focus on having faith in your ability to cope.

Kirsty Ross, Associate Professor and Senior Clinical Psychologist, Massey University

This article is republished from The Conversation under a Creative Commons license. Read the original article.