A UTI is an infection of the urinary tract which consists of the kidneys and ureters (upper urinary tract) and the bladder and urethra (lower urinary tract) and is one of the most common infections around. With bladder infections being the most common with over half of all women experiencing a bladder infection at least once in their lifetime. (1)

UTI’s are called different names according to where the infection is:

• Cystitis – inflammation of the bladder 
• Urethritis – inflammation of the urethra (this is a tube from your bladder to the front of your vagina, whereby urine leaves the body).
• Pylon/nephritis – inflammation of the kidneys

 

A simple UTI is an infection in one place, a complicated UTI is one that has infections in multiple areas of the urinary tract or the person with the infection has other risk factors including being immunocompromised. 

 

Risk factors for getting an UTI include:

• Pregnant women
• Perimenopausal/Postmenopausal women
• Women in general (due to a shorter urethra)
• People who are immunocompromised
• People who have catheters
• Elderly 
• Hygiene practices
• Dysbiosis in the gut
• Family history (particularly mothers and sisters)

 

What causes UTIs?

The main cause of a urinary tract infection is from bacteria. In particular, a bacteria called Escherichia coli  (E.coli) which is believed to cause up to 95% of infections.  Other bacteria that may be causative include Staphylococcus saprophyticus, Proteus spp., Klebsiella spp. and Enterococcus spp. Rarely UTI’s can be caused by Candida spp. (2)

As a result the main treatment for UTI’s are antibiotics and painkillers. 

 

Typical symptoms include: 

• Burning, pain or discomfort when urinating
• Frequent urination
• Urgency to urinate
• Pain in the pubic area or low abdominal region
• Pain in the lower back
• Smelly, cloudy, or a change in colour to urine (not as common as more likely to be due to dehydration, diet or even kidney stones) (2-3)

 

You MUST go to a doctor if you experience the following (2-3):: 

1. If you are pregnant and experiencing UTI symptoms
2. If you have a diagnosed health condition that can affect immunity e.g. diabetes, cancer, autoimmune etc.
3. If you are elderly 
4. Fever
5. Severe or increasing pain
6. Blood in the urine
7. Vaginal bleeding (outside normal periods) or unusual discharge
8. Low blood pressure
9. Delirium or confusion
10. Increased heart rate and palpitations
11. Nausea or vomiting
12. Increased breathing rate
13. More than 3 UTI’s in 12 months or 2 in 6 months

 

General Tips to reduce likelihood of UTI’s occurring: 

1. Drinking enough water – dehydration can be a cause of UTI’s so the general recommendation is about 2.5L water/day.
2. Wiping from front to back after urinating or having a bowel motion
3. Treating constipation. Constipation can put pressure on the bladder or even obstruct the bladder leading to infection. Eating fibre rich foods is really important – try 2 kiwifruit in the evening, PHGG, psyllium husk etc. 
4. Treating diarrhoea/loose bowel motions. Can increase dehydration and also faecal contamination (poo going into the urethra). Its important to find out the cause of the diarrhoea which may be infection or food intolerance.  
5. Eating prebiotic, fibre rich and probiotic foods may help to reduce dysbiosis in the gut which can play a role in UTI’s – this basically means eat lots of plants (if you can tolerate them) and fermented foods. Reduce alcohol and the refined-sugar rich carbohydrates. 
6. Consider changing your contraception – the spermicide in condoms, diaphragms and IUCD such as the Mirena can cause UTIs by changing the vaginal microbiome which is of course next to the urethra. Don’t forget the gut, the vagina and the urinary tract are all linked. 
7. Avoid tight fitting clothing and non-natural ‘breathable’ fabrics – make sure you’re knickers are cotton for example. Occasionally you need to walk around ‘commando’ style i.e. get some fresh air circulating around your nether regions!
8. It’s tempting to hold that wee in but don’t!  If you need to go then go –  holding it in will increase your risk and don’t stop drinking water because you don’t want to urinate – that will increase your risk too. 
9. Have showers instead of baths – but don’t over wash your nether regions. Douching can make it worse,
10. Always wash your hands after touching ‘down there’ – I know you’re a women and therefore I am talking to the converted but still it needs to be said 🙂
11. Too much sex can increase the risk (sorry men – you’re welcome ladies:))  (2-3) 

 

Other treatments:

• Lowered oestrogen can increase the risk for recurrent UTIs so peri or post menopausal women may need to consider a topical vaginal oestrogen cream. There are some good studies to show this can be really effective at reducing the risk (more than oral oestrogen) and has relatively low health risks. (4) 
• Cranberry juice or capsules may reduce the risk although the studies are inconclusive. It looks like powders and capsules are more effective than juice. Juice with lots of sugar will exacerbate and increase the risk. Some studies showed a reduction in risk by 47% but the concentration of cranberry had to be high (more than 18%). Although a therapeutic dose has not been found as yet.  Taking cranberry capsules at night might be more effective. Don’t use cranberry if you are taking warfarin as the two interact. (2, 5-7).
• D-Mannose may stop bacteria from adhering to the wall and setting up home causing the infection. A recent meta-analysis in 2020 found D-mannose to be as effective as antibiotics at preventing infection by E.Coli. The study concluded that the most effective (and safe dose) is 0.15 g/kg so in a woman of 77.4kg the daily dose would be about 11.5g of D-mannose which is a higher dose than found in studies where it was found to be ineffective. (8) 
• Probiotics may also be useful as a preventive measure. Studies are also not conclusive but there are studies that show that Lactobacillus spp. especially L. rhamnosus (which is the most studied) can reduce the pH of urine and out compete E.coli for space and food. Current recommendations are 108 CFU per capsule. It also appears that taking intravaginally rather than orally made the difference  (decreasing the risk by 12%). There are no specific vaginal probiotics recommended currently. (9)

What is an ‘irritable bladder’?

This is when the function of the bladder is not working properly.  It can cause similar symptoms and is usually caused by abdominal or pelvic trauma including during birth, chronic infection, nerve damage, medications and certain fluids.

If you have been diagnosed with this condition then you might it beneficial to reduce or avoid coffee (sorry), tea and carbonated drinks, alcohol, spicy foods, acidic fruit such as citrus, tomatoes and fruit juices. Vitamin C and calcium supplementation may help with symptoms. (10) 

TENS (electrical stimulation) (11-12) and hypnotherapy (13,  have been found to be beneficial alongside pelvic floor exercises given by a qualified women’s health physio.  

 

Are you pissed off?

And now it’s time for the ‘woowoo hippy shit’ as my son likes to call it.  I have had UTIs twice in my life – the first time I was a young adult having ‘lots of fun’ – we don’t need to discuss that any further and the 2nd time was when I was nominated for an award that I really wanted and didn’t get. I was absolutely gutted and got a UTI that day…it went away and guess what it came back the day of the award ceremony.  I realised it was because I was ‘pissed off’.  I have seen this many times in my clinical practice too. 

 

Louise Hay, in her book ‘You can Heal your Life’ suggests that UTIs can be caused by being ‘pissed off’ especially in relationships or ‘blaming others’.  She provides an affirmation to change your thoughts – ‘I release the pattern in my consciousness that created this condition. I am willing to change. I love and approve of myself.’  (16)

 

Take time out to reflect if this resonates and make an agreement with yourself to let it go, forgive the situation and move on. You might think it’s nuts but it’s free and has only positive side effects. 

 

References

1. https://bpac.org.nz/2021/uti.aspx
2. https://www.nature.com/articles/nrmicro3432
3. https://www1.racgp.org.au/ajgp/2021/april/recurrent-utis-and-cystitis-symptoms-in-women
4. https://pubmed.ncbi.nlm.nih.gov/18425910/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370320/
6. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1213845
7. https://pubmed.ncbi.nlm.nih.gov/23076891/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395894/
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134985
10. https://pubmed.ncbi.nlm.nih.gov/21444148/
11. https://www.scielo.br/j/ibju/a/BY5nNDpbkqs6HcYkKFkS8rx/
12. https://www.cochrane.org/CD010098/INCONT_non-invasive-electrical-stimulation-overactive-bladder-adults
13. https://www.tandfonline.com/doi/abs/10.1080/00207144.2019.1612671?journalCode=nhyp20
14. https://www.ajog.org/article/S0002-9378(20)31271-0/fulltext
15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575591/
16. Louise L. Hay. (1999). You Can Heal Your Life. Hay House Inc. Carlsbad, California. ISBN 1-561-70-628-0

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