Are you struggling with a urinary tract infection (UTI) that you can’t seem to shake, or frustrated by one that keeps coming back over and over despite multiple rounds of antibiotics? Do you know how to separate fact from fiction regarding natural or “at home” ways to treat or prevent UTIs? In this article, we’re taking a deep dive into all things UTI.
Why do women get UTIs?
About 5,400 people Google “Why do I keep getting UTIs?” every single month—and there’s a good chance that most of them are women. Anatomically, women are more predisposed to UTIs because the urethra is shorter and closer to the rectum in women than it is in men.
In women, urinary tract infections most often occur in the bladder, referred to as having cystitis, or in the urethra, referred to as having urethritis. More than 50% of women will experience at least 1 urinary tract infection (UTI) in their lifetime.
As indicated by the sheer volume of the search “Why do I keep getting UTIs?” some women suffer from recurrent or persistent UTI. Recurrent UTI is when you get ≥2 infections in six months or ≥3 infections in one year. Persistent UTI is when the same infection comes back soon after finishing a course of antibiotics.
What causes UTIs?
UTIs generally occur when bacteria enter the body through the urethra, migrate upward, and reproduce like crazy. The body has natural defenses in the upper and lower urinary tract, which, along with naturally-occurring good bacteria in the vagina called Lactobacillus, should prevent UTIs from occurring. Still, sometimes those defenses are breached.
Cystitis, a UTI in the bladder, is often caused by E.coli, which you might have heard of in connection to outbreaks in food. E.coli is an expected bacteria in the gastrointestinal (GI) tract, but it causes problems when it enters the urinary tract. 80% or more of UTIs are thought to be caused by E.coli, and many times E.coli is introduced through sexual intercourse.
Urethritis, a UTI in the urethra, is often caused by GI bacteria that spreads from the anus to the urethra, or from the vagina to the urethra, as with sexually transmitted infections (STIs) like herpes, gonorrhea, and chlamydia.
What are the risk factors for UTIs?
Having a new sexual partner and/or having multiple sexual partners increases a woman’s risk of contracting a UTI (as well as STIs).
Because they disrupt the natural flora and fauna of the vagina, certain forms of contraception such as spermicides (like the Phexxi female contraceptive gel), cervical caps, and diaphragms also significantly increase a woman’s risk of developing a UTI.
Hormonal birth control can also negatively impact your gut health, which may contribute to poorer health and/or increased susceptibility to infection overall. And although evidence is mixed about the connection between hormonal birth control and frequent UTIs, we know that hormonal birth control use is associated with a significantly higher risk for the development of interstitial cystitis, a chronic bladder condition resulting in recurring discomfort or pain in the bladder or surrounding pelvic region.
You might have a UTI if….
The possible signs and symptoms of a UTI include:
- A strong, persistent urge to urinate
- A burning sensation when urinating
- Passing frequent, small amounts of urine
- Urine that appears cloudy
- Urine that appears red, bright pink, or cola-colored—a sign of blood in the urine
- Strong-smelling urine
- Pelvic pain, in women—especially in the center of the pelvis and around the area of the pubic bone
What is the treatment for a UTI?
You might be thinking, “UTIs are so common, they can’t be a big deal. What’s the worst that could happen?” Well, an untreated UTI that spreads to the kidneys or the bloodstream can actually cause major complications. These include permanent kidney damage from untreated pyelonephritis (UTI in the kidney), higher risk of low birth weight and preterm (early) delivery for pregnant women with untreated UTIs, and even sepsis, a potentially life-threatening bloodstream infection. Fortunately, most treated UTIs will not go on to cause serious complications.
Antibiotics are the firstline treatment for urinary tract infections. While a small percentage of UTIs will clear on their own, many do not. A general rule of thumb is: go to the doctor if you have UTI symptoms for more than 24 hours. A course of antibiotics for an uncomplicated UTI, meaning one that does not progress to one of the major problems listed above, generally lasts for just a few days. Taking every dose on time and completing the entire course, even if you feel better after the first day or so, is crucial.
If symptoms persist after the antibiotic course finishes, a second antibiotic may be necessary. Overprescription of antibiotics has led to antibiotic resistance for certain strains of E.coli in particular, meaning that UTIs caused by E.coli may prove harder to treat and/or require multiple rounds of antibiotics to cure.
Unfortunately, antibiotics can kill the good bacteria in the gut or vagina along with the bad bacteria that caused the UTI. Fortunately, taking probiotics containing Lactobacillus at the same time as and following antibiotic use can help counteract this side effect by encouraging regrowth of good bacteria in the gut and vagina.
Besides an antibiotic, your doctor may also start you on something like Pyridium to help with UTI-related pain.
Finally, if you are experiencing recurrent or persistent UTI, this might be an indication that there is something more going on than just a typical, occasional UTI. There could be incomplete emptying of the bladder, kidney or bladder stones, or some other problem with anatomy. If you are getting recurrent or persistent UTIs, then referral to a specialist (such as an Urologist or a Gynecologist) might be appropriate.
Preventing UTIs with good hygiene
The first thing you can do to reduce your risk of developing a UTI is inexpensive and easy—drink enough water each day! Drinking around eleven cups of water daily ensures that you’re urinating often, which helps flush bacteria out of the urethra and therefore out of your body. Other hygienic practices that can reduce your UTI risk include:
- Emptying your bladder fully every time you go to the bathroom
- Avoiding douching or using sprays or powders in or around the vagina
- Always wiping from front to back to minimize the introduction of bacteria from your rectum into your vagina or urethra
- Urinating after sexual intercourse to help decrease the spread of bacteria
- Learning a method of fertility awareness for family planning or reproductive health monitoring, rather than relying on contraception that can increase your UTI risk.
Are there supplements for preventing UTIs? (In other words, does cranberry juice actually work?)
Have you heard that drinking cranberry juice can help prevent UTIs? While there is some evidence that cranberries have a property that helps prevent E.coli from adhering to the walls of the bladder, in reality the evidence for effectiveness is not cut and dried. Websites like the Mayo Clinic generally point out that supplementation with unsweetened cranberry juice or cranberry extract is not harmful, and individuals are welcome to consume it if they like so long as they are not drinking high-calorie sweetened juice.
While previous research on probiotics and UTI prevention was inconclusive, recent research like this 2017 study supports the idea that taking probiotics, specifically those containing Lactobacillus, can help prevent recurrent UTIs (more than 2 UTIs in a six month period or more than 3 in a year). Probiotic use appears to specifically encourage repopulation of the vagina with good bacteria after antibiotic use. Probiotics occur naturally in fermented foods like kefir and kombucha and can also be taken as supplements, typically in capsules. While some yogurt contains probiotics, generally the amount of yogurt you’d have to consume to achieve significant probiotic intake is far more than the average person would eat.
Upping your Vitamin C intake, especially through fruits and vegetables, cannot hurt and may help your immune system stop UTIs before they start. While there is little research on this topic, shooting for the National Institutes of Health (NIH)’s daily recommended intake of 75 mg of Vitamin C each day is one way to boost your immune system (foods high in Vitamin C can be found here). Unfortunately, we know that hormonal birth control can deplete a woman’s body of key nutrients, including Vitamin C.
Vitamin D supplementation might also decrease your UTI risk by enhancing your immune system. One 2013 study showed that premenopausal women with lower levels of Vitamin D had a higher risk of recurrent UTIs. However, further research is needed to explore the real-world impact of Vitamin D supplementation on UTI risk. Finally, limited evidence suggests that a simple sugar called d-mannose could be a promising treatment for or preventative against recurrent UTIs.
If you’ve had a UTI before, take a look at your personal modifiable risk factors like contraceptive use and sexual hygiene, and aim to also incorporate as many of the preventive practices listed above as you can. Consider adding a probiotic to your daily health and wellness routine and increasing your intake of Vitamins C and D. Finally, if you do develop another UTI requiring antibiotic treatment, make every effort to take all of your pills and to take them on time.
Last updated on April 22, 2022.
Additional Reading:
How to Intentionally Promote Better Gut Health After Getting Off Birth Control
Hormonal Birth Control Depletes Your Body of Key Nutrients
The Startling Ways that Birth Control May Impact Gut Health and lead to IBD
The Surprising Connections Between PCOS, Dysbiosis, and Gut Health
How Fertility Awareness Helps Detect Vaginal Infections Before They Get Worse
Unexpected solutions: A doctor explains cycle-aware approaches to treating women
A Breakdown of the Recent FDA Citizen’s Petition Concerning Hormonal Contraceptives
