What are the benefits of using i-GP to treat your cystitis?

i-GP is extremely patient centred, and this is at the heart of our beliefs. We always have your best interests and wellbeing in mind. It is designed and delivered by highly experienced and compassionate GP's, who also work in the NHS, and can appreciate the difficulties many people face in accessing good quality health care promptly.

Convenient

• i-GP is always available and ready when you are on your phone, tablet or computer. It is healthcare on your terms.

• There is no cost or time involved in traveling to a clinic for minor ailments and common conditions. You do not need to take time off from work. As experienced doctors, we appreciate the value of your time.

• Avoid long waiting times in crowded surgery waiting rooms, with other people who are ill. There is not a video consultation involved, which can be daunting for some people.

Safe

• It has been designed to work alongside the regular care you receive from your GP. It is not a replacement service for care provided by your own GP.
• If we feel you are better being treated elsewhere, we advise you of this and why completely free of charge. We constantly filter all your responses to ensure you are treated safely. Your safety is our priority.
• We understand the limitations of the online/virtual platform, so we only work within these limits. 

Fast

• If we do treat you, then you can choose your pharmacy for the collection of your treatment, and often you can pick up the medication in as little as an hour. This means that there is no delay in your treatment.

Affordable

• There is no subscription. You can access the service when you feel you need it, without being tied down.
• It is considerably cheaper than most other online doctor services; you only need to compare the costs of other services. 

There are certain symptoms that may be present with a urine infection that suggest you should see a doctor for a physical assessment. These can also represent a complicated UTI which usually requires further investigation.

You are advised to see a doctor as soon as possible for a physical assessment under the following circumstances:

If your symptoms are worsening 

Most episodes of cystitis will settle well either on their own or with antibiotics. However, if you develop any of the following symptoms, then it is important to seek medical advice straight away:

• If you develop a high fever (high temperature) which can cause shivers.

• If the pain becomes more severe or if you develop pain in your loin (the area at the sides of the lower back).

• If you feel increasingly unwell (this may include nausea and vomiting).

These symptoms could indicate a kidney infection (pyelonephritis). Most people who have cystitis, however, do not develop a kidney infection.

If your symptoms are not improving

If your symptoms do not settle with the prescribed antibiotic within two days, then you are advised to see your doctor for an assessment. ^2,10 This may mean that your bladder infection is caused by a bacteria that is resistant to that antibiotic, or an alternative diagnosis may be possible. You may require a urine test and a different antibiotic.²

In an emergency call 999 for immediate help for life-threatening conditions.

During working hours you can contact your GP surgery for help or call NHS 111. Alternatively, the following links can help you find Urgent Care Centres or Out of Hours care near you:

England 

Website: NHS Choices or telephone NHS 111

Wales

Website: NHS Direct Wales or telephone NHS Direct Wales on 0845 46 47 or the new 111 Wales Service for Swansea Neath Bridgend & Carmarthen

Scotland

Website: NHS Inform  or call NHS 111

Northern Ireland

Website: Health and Social Care

The contact telephone numbers for out of hours GP services in your area can be found here: NI Direct Government Services

Most urine infections are due to bacteria that come from your bowel such as E.coli. Some bacteria lie around your back passage after you pass a stool. These bacteria can sometimes spread to your urethra (the tube from the bladder that passes out urine) and into your bladder. Since women have shorter urethral tubes than men, the bacteria can pass into the bladder urine more easily, so it is considerably more common in females.

Certain factors can increase a woman’s chances of developing urine infections. This includes:

• being sexually active
• using a spermicide with contraception
• pregnancy
• being postmenopausal
• diabetes
• having a suppressed immune system
• having a condition affecting the urinary tract (kidneys, ureters, bladder or urethra)

The diagnosis of a bladder infection is made on the basis of your symptoms. Urine tests are not routinely required for uncomplicated female bladder infections.⁷

A recurrent urinary tract infection is defined as having three or more episodes of cystitis within a year. 

Some women will develop recurrent episodes of UTI’s and this affects about 1 in 5 of those women who have experienced a bladder infection. Factors that can increase a woman chances of developing recurrent infections include pregnancy, being sexually active, having diabetes, or being postmenopausal. 

There are certain things you can do that may help reduce the chances of recurrent bouts of cystitis.

• Avoid dehydration- aim to drink about 1.5 to 2 litres (6 glasses a day).
• Choice of underwear- try not to wear tight fitting trousers around the groin, and opt for cotton underwear.
• Don’t hold your urine- empty your bladder when you feel the need to go and try to drain it completely.
• Wipe your bottom from front to back to avoid bacteria from the anus spreading to the urethral opening ( the tube through which you pass urine) at the front.
• Avoid using products around the vaginal area- such as in the bath or shower, or afterwards.

• Sexual activity- try to pass urine before and after sex, as sexual activity can cause bacteria from the skin to enter the urethral tube through friction. If cystitis is usually brought about by sex, then consider washing the genital areas before sexual activity.
• Alternative treatments- there is conflicting evidence on the use of cranberry tablets or juice to prevent cystitis. A Cochrane review of studies did not show any evidence to indicate a reduction in episodes of cystitis. ^8. However, natural alternatives are a personal choice.

Visit our Wellness Philosophy Journal for a further article on How to help yourself: Recurrent Cystitis

Please fully read the Patient Information Leaflet that comes with the medication before starting treatment.

This will contain more comprehensive information. 

How to take Nitrofurantoin

It should be taken at meal times with food or milk, to help avoid stomach upset and to help improve absorption. 

Remember to finish the course as prescribed.

Nitrofurantoin may darken the colour of your urine. This is nothing to worry about. 

Driving and Using Machines

Nitrofurantoin may cause dizziness and drowsiness. If you are affected by this, then you should not drive or operate machinery until the symptoms settle.

Allergic Reactions

All medications can cause allergic reactions, however, serious allergic reactions are rare. 

Please note that i-GP DOES NOT TREAT Medical Emergencies. 

If you develop any sudden onset of the following then you must STOP the medication and seek urgent medical advice (from your GP, Out of Hours Service, Urgent care centre or NHS 111) or call an ambulance if the symptoms are severe:-

• Wheeze
• Difficulty in Breathing
• Swelling of the eyelids, face or lips
• A rash particularly if affecting your entire body

Possible Side Effects

All medications have the potential to cause side effects, but not everyone experiences them. Most of the possible side effects to Nitrofurantoin are mild and usually disappear once you stop taking them. 

Please fully read the Patient Information Leaflet that comes with the medication before starting treatment. 

This will contain more comprehensive information. 

Driving and Using Machines

There is no evidence to suggest that Trimethoprim Tablets affect the ability to drive or operate machinery.

Allergic Reactions

All medications can cause allergic reactions, however, serious allergic reactions are rare.

Please note that i-GP DOES NOT TREAT Medical Emergencies. 

If you develop any sudden onset of the following then you must STOP the medication and seek urgent medical advice immediately (from your GP, Out of Hours Service, Urgent care centre, NHS 111) or call an ambulance if the symptoms are severe:-

• Wheeze
• Difficulty in Breathing
• Swelling of the eyelids, face or lips
• A rash particularly if affecting your entire body
• Chest pain
• Fainting or collapse

Possible Side Effects

All medications have the potential to cause side effects, but not everyone experiences them. Most of the possible side effects to Trimethoprim are mild and usually disappear once you stop taking them.

Please read the patient information leaflet with your medication for the full list of potential side effects.

The common ones are listed below.

Antibiotics should be used responsibly and only when really necessary. Overuse and misuse of antibiotics can lead to antibiotic resistance. This is where the antibiotic becomes less effective at treating certain types of bacterial infection, so they do not work when needed. 

Antibiotics should be taken as prescribed, and it is important to complete the full course, this can reduce the chance of the bacteria developing an immunity to that antibiotic. It is important not to share antibiotics, and always take unused medication to your local pharmacy for disposal.

1. NICE (National Institute for Health and Clinical Excellence) Clinical Knowledge Summaries: cks.nice.org.uk
2. Scottish Intercollegiate Guidelines Network guideline Management of suspected bacterial        urinary tract infection in adults [SIGN, 2012]
3. BNF (The British National Formulary 2016)
4. British Infection Association (2013)
5. There is evidence from four trials that trimethoprim and nitrofurantoin are equally effective in treating UTIs. 
   1. (Sander et al, 1981: Journal of International Medical Research ( (3) 181-185
   2. (Iravani et al, 1982: Reviews of Infectious Diseases (2), 378-387.
   3. (Lightstone et al, 1988: British Journal of Clinical Practice42(7), 283-288.
   4. Spencer et al, 1994: Journal of Antimicrobial Chemotherapy33(Suppl A), 121-129.
6. Cochrane Database of Systematic Reviews 2010, Issue 10. Art. No.: CD00718
7. BMJ Online 5 February 2010
8. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10:CD001321.
9. Health Protection Agency, British Infection Association. Management of infection guidance for primary care for consultation & local adaptation. London, HPA, 2013.
10. Car J. Urinary tract infections in women: diagnosis and management in primary care. BMJ 2006;332:94-7
11. Electronic Medicines Compendium www.medicines.org.uk/emc