Medications for urogynaecological conditions

This section covers:

  • Impact of medications on quality of life
  • Finding the right approach with medicines
  • Difficulties accessing medications
  • Concerns about the interactions and side effects of medicines

In this section we use the terms:

Pelvic organ prolapse (prolapse) is a condition in which pelvic organs, like the bladder and uterus (sometimes called the womb), move down or slip out of place and may bulge into the vagina.

Urinary incontinence is the unintentional loss of wee/urine. There are other bladder symptoms that do not involve incontinence, such as needing to urinate a lot, getting up at night a lot for a wee, or difficulties emptying the bladder.

UTIs (Urinary Tract Infections) are when bacteria infect the system that stores urine (such as the bladder). There are other types of conditions that can involve bladder irritation and pain, such as interstitial cystitis (also called bladder pain syndrome).

Medications – such as painkillers, bladder anti-spasmodics (drugs that relax the bladder and prevent spasms), and antibiotics – can be used to help manage urogynaecological conditions. You can read more about dietary changes and supplements, including D-Mannose, in the section on management through lifestyle changes.

Dr. Sharon Dixon, a GP, describes the main medications available for the management of urge incontinence and the importance of considering the risks and benefits with your healthcare provider.

Impact of medications on quality of life

For some people we talked to with urinary and bladder symptoms, medications had been a ‘lifeline’ that greatly improved their quality of life. When medications worked well, it allowed the person to do more of the activities that their symptoms had made difficult.

Alice found oxybutynin, a medication for overactive bladder, made a “big difference” as it led to better sleep and overall quality of life.

Phyllis’s urinary tract infection (UTI) symptoms improved after starting on a long-term antibiotic. Since taking a long term course of antibiotics, Elizabeth now feels “fantastic”. Leah, who has chronic UTI, has found taking painkillers has given her a bit more of her life back. Vicky had bladder symptoms, including tingling, and eventually found had a “lightbulb” moment when she read on social media that it could be related to menopause. Using oestrogen pessaries and creams made a huge difference for her.

Clare asked her GP about going on hormonal replacement therapy to see if her urinary infections were related to menopause. She feels “life has gone back to normal” since starting the treatment.

While finding effective medications could be life-changing, this often didn’t solve women’s problems completely, as they could still face future problems with supply issues, effectiveness, and knock-on health effects of the medication.

Cynthia struggled to feel like her usual active self when taking a lot of medications.

Some felt they had to ‘fight’ for antibiotic treatment. Jane and others had help from their partners or wider family to pick up their prescriptions from pharmacies. Mehar felt that she had needed to “spend my life in hospitals” trying to sort out her care and treatment. However others disliked taking pills and saw their medicines as a source of frustration or burden, not relief.

Georgina was frustrated by the amount of medications she needed to take and that there was no foreseeable end to taking them.

Finding the right approach with medicines

For the people we spoke to, finding the right medication or combinations was often a long and ongoing process. In some cases, there was not a clear end point where urogynaecological symptoms were fully managed. Finding the right medications often fitted into a broader ‘journey’ of learning to manage symptoms in the best way possible. Megan reflected that, “there’s not a right or wrong way of treatment, it’s just trial and error really and seeing what works best for you”.

The process of finding suitable medications could be drawn out and difficult. Healthcare professionals sometimes seemed to know little about the condition or complication (such as injury from mesh surgery) making it difficult to trust that they would offer the right treatment. Phoebe felt that her doctor was dismissing her as “neurotic” when he implied that prolapses weren’t painful and that she shouldn’t be taking pain medication.

At times, Leah and Vicky felt that a prescription was being used instead of finding the root cause. Vicky found this “so frustrating” and worried that her medications were “more of a sticking plaster than treating the cause”. Mehar and Laura felt frustrated that their medications were only targeted at specific symptoms or conditions, rather than at their overall medical needs.

Laura had a difficult time finding the right medications. She thinks she probably has a “long way to go” in finding the right approach but feels much better than before.

At times, people felt their doctors gave prescriptions too willingly and without much thought about the harms. Elizabeth suggested, “all they [doctors] want to do is give you antidepressants; that’s not what I need”.

Katy felt like her doctors would just “throw painkillers” at her regardless of the side effects.

Sue X had been taking medication for urinary urgency for many years. She doesn’t know what would happen if she stopped. Amy wasn’t sure that her medication was working, so she requested other options. Holly, Clare, and Anna decided to do their own research through support groups and NHS webpages. Jan felt unsure why she had been prescribed certain medications and didn’t feel like her doctors explained enough.

Hope wondered why oestrogen cream hadn’t been brought up as an option earlier.

Antibiotics can be used to treat UTIs in different ways: as a prophylactic (or preventative, to stop a person developing an episode of UTI), a short course (for an episode of UTI), or on a longer-term basis (for embedded or chronic UTI). For those with recurrent, embedded or chronic UTI, finding the right course of treatment could be especially difficult. A three-day course of nitrofurantoin was often the first option. For Elizabeth and others, this was often unsuccessful in treating the symptoms, meaning they ended up taking a three-day course of different antibiotics again and again. Anna described this as a “whack-mole” approach, where she felt that more infections would keep popping up again because the first wasn’t treated fully.

Some people were offered or requested antibiotics on a prophylactic (preventative) basis. This meant taking antibiotics after a potential trigger, like having sex. For Jane and Phyllis, this approach helped to prevent new UTIs from developing, which Phyllis said, “gave me a life”. This approach worked for Leah for a while, but stopped being effective after a few years and she thinks it led to her having an embedded UTI. Melanie had been prescribed a six-month course of preventative antibiotics by her private urogynaecologist but it was expensive. Her NHS GP agreed to prescribe a lower dose of preventative antibiotics.

Leah thinks that using antibiotics to prevent the chance of getting a UTI for so long may have been a “mistake”.

Others were given a supply of self-start antibiotics which they could use as soon as they felt early signs of a UTI beginning. Rebecca found that having a supply of self-start antibiotics allowed her to “actually get on with my life”. For Rowan, it’s been “a relief” to go on holiday abroad and not worry about having a UTI because she takes self-start antibiotics with her.

Difficulties of accessing medications

Getting medications from a GP or pharmacist could be stressful and frustrating for some. When Anna asked for help from a pharmacist, she was told they can only deal with one-off (rather than ongoing problems with) UTIs.

Chasing up medications could be particularly unpleasant during flare ups of UTIs. Jane typically considers herself good at advocating for herself, but has found that: “when you’re completely vulnerable laying on the bathroom floor, incontinent, in agony, you cannot argue for yourself”. Having to wait to collect a prescription could mean a longer time with these symptoms and disruption in everyday life.

Using antibiotics in high dosages or for extended periods of time can lead to antibiotic resistance, which occurs when bacteria adapt and are no longer responsive to antibiotics. Because of this, some women said that accessing antibiotics felt like an “uphill battle” of trying to overcome doctor’s concerns about antibiotic over-use. Anna, Kerry, and Rowan had found it increasingly difficult to get antibiotics for their UTIs and felt that doctors were “gatekeeping” to stop antibiotics being used too often. Rebecca felt that her GP had become a “dispensing machine” for antibiotics which made for a “tricky relationship”. Anna felt “guilty” about needing to call her doctor so often, and noted that “I can just tell that some people would have a hard time having to constantly ring the doctor to get antibiotics”.

Elizabeth struggled to get access to antibiotics when her dipstick tests didn’t show signs of infection.

For those on long-term, prophylactic, or high-dose antibiotics, having prescriptions cut off was a significant source of anxiety. Holly found that controlling chronic UTI required “dogged persistence”, when missing even a day of antibiotics potentially sending you “back to square one”.

Gwen’s GP flagged up concerns that she had been on antibiotics for too long.

Access to strong prescription painkillers could also be difficult for women. Susan encountered problems when her pharmacist lowered her dosage without warning, which resulted in withdrawal symptoms.

Getting hold of medications could be especially difficult while on holiday, which caused some people to avoid travelling or to bring back-up prescriptions with them. Sarah opted to stow away a prescribed supply so she could be certain she would have it if she needed it.

Supply issues were a concern for Alice, who had to stop taking oxybutynin because it was unavailable in the UK at one point. She found this experience “more stressful than the condition itself”. After experiencing delays or resistance from their NHS doctors, Laura chose to pay for medication privately and Kerry bought some from a pharmacy.

Concerns about the interactions and side effects of medicines

There were also concerns about potential problems from taking medication long-term and what it might do to their bodies.

Rowan worried about the impact of long-term antibiotics on her immune system, especially as she got older. Others worried about their gut health. Laura worries about what she will do about UTI medication if she has a baby in the future. However, for Phyllis, Leah, and others with chronic UTI, life without antibiotics was seen as “just not viable”. Though she knew antimicrobial resistance is important, Leah didn’t think it was right that patients with UTI should be a “sacrificial lamb” and their infections left untreated.

Helen takes high dose antibiotics prescribed by a specialist NHS unit. She hopes to come off antibiotics at some point, but worries about her quality of life.

The side effects of medications could be disruptive and, at times, worse than the urogynaecological symptoms being treated. Side effects described by the people we talked to included nausea, brain fog, and an upset stomach. Leah worried about weight gain as a side effect and the impact on her mental health. Liz worried that inserting oestrogen pessaries and cream could damage her vagina.

Leah worried about amitriptyline’s side effects like weight gain, but found that her body balanced out after being on it for a while.

Taking strong painkillers could be hard on the body. Several women had problems with side effects or drug interactions. Medication left some feeling “dazed”. Jackie, who has severe pain after mesh surgery, has tried a variety of pain medications, including amitriptyline, morphine, and codeine, but hasn’t found anything that helps. She struggles with dizziness as a side effect of her medications, which leaves her feeling like “a sickly zombie in pain”. Pain medication had also caused constipation for Georgina and others who then had to take other medications, like laxatives, to counteract it.

Susan and others worried about what would happen if they ever stopped taking painkillers or if their prescriptions were cut off. Susan and Fran, who were mesh injured, were concerned that they were taking too many painkillers or on too high dosage. Fran preferred staying on a low dose to avoid being “doped up”. Katy found painkillers ineffective because of the side effects she experienced and says, “every now and again I’ll have a couple of glasses of wine just to self-medicate”.

Susan felt ill after being prescribed a “cocktail” of multiple painkillers at once.

Some women like Leah and Melanie were concerned and frustrated about pain medication masking their symptoms without fixing the actual problem, especially when it felt like pain medication was being used as an excuse to not look for the root issue. Long-term issues like kidney problems or pain medications losing their effectiveness were a concern.

You can read more in this section about experiences of decision-making for treatments.