Anyone who has ever had a urinary tract infection (UTI) – also sometimes called cystitis or a bladder infection) – can probably agree that there is nothing more disruptive or irritating than the sudden onset of symptoms that always seem to start at the most inconvenient times. The burning with urination and urinary urgency beginning hours before a much-anticipated weekend getaway with your partner, on the first day of vacation in a strange town, as you head to the airport for a long flight, or prior to an important job interview.
Women are 14 times more likely to get a UTI than men, and half of all women will experience a UTI at some point in their lifetime (Sabih & Leslie).
UTIs are inconvenient, uncomfortable, and extremely common. The good news is that there are well established ways to get quick relief, treat infections effectively, and prevent recurrence.
What are the symptoms of a UTI?
- An intense, persistent urge to urinate
- Burning sensation when urinating
- Frequent urination, urinating small amounts of urine
- Urine that appears cloudy
- Urine that appears pink or red
- Strong, foul smelling urine
- Pelvic pain, pain in the lower abdomen above the pubic bone
UTIs are one of the most common types of infections, accounting for nearly 50 million visits to a health care provider each year. They are also the most common reason that antibiotics are prescribed to otherwise healthy women(Gupta et al). While antibiotics are often needed to treat an acute UTI, frequent or inappropriate use of antibiotics can result in a disruption of normal vaginal flora, creating a vicious cycle of both vaginal and urinary tract infections.
But why does VAGINAL flora affect my chances of getting a BLADDER infection?
Most UTIs are caused by common bacteria and pathogens from the gastrointestinal tract that make their way through the urethra and up to the bladder. The first step in the development of an infection is bacterial colonization of the vagina and the urethra. Because of this, the vaginal environment plays a very important role in UTI prevention.
Under normal conditions, the vaginal microbiome is dominated by a bacteria called lactobacillus. Lactobacilli processes glycogen (sugar). A by-product of this reaction is lactic acid which results in an acidic vaginal environment which limits colonization of infection-causing bacteria (Amabebe & Anumba). Any disruption to the normal lactobacilli-rich vaginal microbiome and pH can increase a woman’s risk of getting an infection. Hormonal changes associated with pregnancy, menopause, and contraceptives, as well as sexual activity, antibiotic use, douching, and use of harsh soaps and detergents can all affect the delicate balance of the vaginal ecosystem, ultimately increasing the risk of UTI.
What can I do to prevent a UTI?
- Stay hydrated – Dilute urine makes it difficult for bacteria to colonize in the bladder
- Urinate after sexual activity
- Don’t hold urine for extended periods of time
- Avoid douching or using harsh soaps or detergents
- Have good bowel habits – Address frequent constipation or diarrhea
- Aim for a vaginal pH of 4-5
What products or supplements can help prevent a UTI?
Some studies have shown that the active ingredient in cranberry (A-type proanthocyanidins or PACs) can block bacteria from adhering to the bladder wall. There is not uniform agreement, however, about the usefulness and/or the optimal way to dose cranberry products. The bottom line is that the cranberry juice cocktail found in your grocery store is unlikely to prevent or treat a UTI. If you want to go the cranberry route – be sure to stick with 100% pure cranberry juice from a health food store or a cranberry supplement from a reputable source.
Studies have demonstrated that a reduction in the ratio of protective Lactobacillus of the correct species in the vaginal can be associated with an increased risk of UTI. Lactobacillus vaginal suppositories can improve vaginal colonization of the normal flora and optimize the ideal vaginal pH, however many commonly sold suppositories are actually the incorrect strain and may be far less or completely ineffective (Wasrysluk et al). Purchase lactobacillus.
D-Mannose is a simple sugar that interferes with the ability of certain bacteria to adhere to the bladder wall, thereby reducing the risk of infection, and in some cases, may be used as treatment for urinary symptoms, either alone or in combination with other therapies. It can help prevent infections caused by some of the most common urinary pathogens including Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, and Enterobacter cloacae. D-mannose can be taken daily, after sexual activity, or with onset of UTI symptoms. (Nunzio et al)
Estrogen is a critical hormone for optimal vaginal function. It is responsible for stimulating the proliferation of healthy vaginal bacteria and promoting an optimal (acidic) vaginal environment. Vaginal estrogen normally declines in a variety of situations including menopause, for several months after a pregnancy (post-partum), and in association with the use of certain hormonal contraceptives. Peri or Post-menopausal women with a history of recurrent UTIs often get significant benefit by using a topical vaginal estrogen cream applied to the vagina regularly. With appropriate vaginal application, only extremely small amounts of hormone are absorbed systemically and thus, vaginal estrogen is generally considered safe for most women. Of course, patients should always discuss their individual concerns, health risks, and family history prior to considering any type of hormone replacement. Vaginal estrogen comes in many forms including creams, glycerin suppositories, and ring suppositories. Each of these options has different efficacy and benefits and your provider should customize the treatment approach based on your priorities. An additional benefit of vaginal estrogen can be improved vaginal symptoms and sexual function associated with genitourinary syndrome of menopause. (Wawrsluk).
Boric acid is a weak, topical, bacteriostatic agent that can contribute to an acidic vaginal pH, helping to prevent pathogenic bacteria and fungi from colonizing in the vagina. Boric acid is typically administered as a 600mg vaginal suppository and can be used twice per week to maintain pH (Prutting & Cerveny). Studies have demonstrated that boric acid can be used as a preventative therapy for chronic bacterial vaginosis, recurrent UTIs, and chronic vaginal yeast infections.
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If you suffer from UTIs more than three times in a 12-month period, or more than twice in a 6 month period, you may need to consider adding a preventative regimen. Depending on the frequency and severity of symptoms, further evaluation with kidney and bladder imaging or cystoscopy, as well as antibiotic prophylaxis may be considered.
Contact Snippa if you have acute UTI symptoms or are interested in solutions for recurrent UTIs.
Written by Kathleen Mackey, CRNP and Dr. Mara Holton – founders of Snippa, a web-based telehealth company focusing on improving quality of life for women dealing with bothersome conditions including UTIs, Overactive Bladder, Incontinence, and Female Sexual Dysfunction. As active women and mothers themselves, Mara and Kathleen empathize with the burden these conditions cause and are passionate about empowering and educating women to take control of their symptoms and improve their quality of life. hellosnippa.com offers expert consultation with licensed specialty medical providers and a full range of products to treat these conditions.
Amabebe, E., & Anumba, D. (2018). The Vaginal Microenvironment: The Physiologic Role of Lactobacilli. Frontiers in medicine, 5, 181. https://doi.org/10.3389/fmed.2018.00181
Beerepoot, M., & Geerlings, S. (2016, April 16). Non-Antibiotic prophylaxis for urinary tract infections. Pathogens (Basel, Switzerland). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931387/.
Chen, X., Lu, Y., Chen, T., & Li, R. (1AD, January 1). The female vaginal microbiome in health and bacterial vaginosis. Frontiers. https://www.frontiersin.org/articles/10.3389/fcimb.2021.631972/full.
De Nunzio, C., Bartoletti, R., Tubaro, A., Simonato, A., & Ficarra, V. (2021). Role of D-Mannose in the Prevention of Recurrent Uncomplicated Cystitis: State of the Art and Future Perspectives. Antibiotics (Basel, Switzerland), 10(4), 373. https://doi.org/10.3390/antibiotics10040373
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Infection Control Today. (2020, November 14). Cranberry capsules more effective than juice for utis. Infection Control Today. https://www.infectioncontroltoday.com/view/cranberry-capsules-more-effective-juice-utis.
Kranjcec, B., Papes, D., & Altarac, S. (2014). D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World Journal of Urology 32, 79-84. https://doi.org/10.1007/s00345-013-1091-6
Liska, D. A. J., Kern, H. J., & Maki, K. C. (2016, May 16). Cranberries and urinary tract infections: How can the same evidence lead to conflicting advice? Advances in nutrition (Bethesda, Md.). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863270/.
Meers, P. D., & Chow, C. K. (n.d.). Bacteriostatic and bactericidal actions of boric acid against bacteria and fungi commonly found in urine. Europe pmc. https://europepmc.org/article/PMC/PMC502502.
Miller, E. A., Beasley, D. A. E., Dunn, R. R., & Archie, E. A. (2016, December 8). Lactobacilli dominance and Vaginal pH: Why is the Human VAGINAL MICROBIOME Unique? Frontiers in microbiology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5143676/.
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Wawrysiuk, S., Naber, K., Rechberger, T., & Miotla, P. (n.d.). Prevention and treatment of uncomplicated lower urinary tract infections in the era of increasing antimicrobial resistance—non-antibiotic approaches: a systemic review. Europe pmc. https://europepmc.org/article/PMC/PMC6759629.