Urinary tract infections (UTIs) are a common issue, especially for women. How many times have you had that “oh shit” feeling? Oh you know the one. You start to feel that sensation and pressure, and then your brain locks into "this is not a drill! Give me cranberry juice NOW. The countdown to DEFCON 1 is a GO." It’s a fact (used for dramatic effect only) that these things always happen on a Friday, on a holiday weekend, or at night when you're going to bed, knowing that you now have to mission impossible your way through the next day to get to the doctor.
All jokes aside, there are many potential contributing factors to UTIs. We did mention that this could be UTI season, which leads to one possible contributor: warmer temperatures. Warmer weather can lead to more outdoor activities, like swimming and outdoor sports, which create environments where bacteria such as E. coli thrive. This increase in bacterial activity may contribute to a rise in UTIs during these months.
You know Fortify Health Coaching well by now and if you are new here, Welcome. We think bigger and broader! Yes, a UTI could be due to these summer time activities and being in a wet bathing suit too long but we would also hope that your body would be in a good position to fight off any bacteria to prevent overgrowth which brings us to consider deeper connections and why we encourage you to not dismiss any UTI you have had over the last 24 months. UTIs go beyond summer time fun and could be a finger point to your digestive health and maybe your hormonal health! Maybe that UTI that did not culture was not a UTI!?!
It is important to highlight the signals our body may be giving us when UTIs go from a one-time occurrence to a frequent or even common issue within a 24-month period. As humans, we tend to normalize things, and what we perceive as rare may actually be more routine than we think. Conversely, a rare occurrence could also provide insight into changes happening in our bodies.
A UTI is not pleasant and can leave us focused namely on just getting rid of it, and rightly so as opposed to making any other considerations. This may lead you to run to your nearest urgent care or even pharmacist just to get treatment quickly to which it is then out of mind.
Did you know that in many places (not all countries, states or provinces) your pharmacist can assess and prescribe treatment for what they feel is "uncomplicated urinary tract infections (UTIs)"? According to the Canadian Pharmacist Association, a typical encounter might look like this: "I am prescribing Nitrofurantoin, also known as Macrobid, to be taken twice daily for five days. You had this medication in the past and it resolved your infection, so I believe this is our best option." They are trained to review a list of red flags to where a referral is indicated, including:
No previous episodes of UTI diagnosed by a physician and/or first UTI
Previous episode of UTI within the last 4 weeks
2+ UTIs within 6 months or 3+ within 12 months (may still prescribe for this infection)
Immunocompromised (due to disease state or medications, e.g., allopurinol, danazol)
Abnormal urinary tract function or structure
Male
<16 years of age or >75 years of age
Long-term care patient
Pregnancy
Breastfeeding with an infant <1 month
Uncontrolled diabetes
Renal impairment
Spinal cord injury
History of interstitial cystitis
One would hope that if someone falls within these red flag guidelines, a referral would happen but you can see where perhaps something falls between the cracks including the individual actually proceeding with the referral or by the person seeing a different provider, going to an urgent care vs your doctor, etc. If the referral does happen it is our hope that through reading this you can have a meaningful discussion that may surround your digestive health and/or hormonal health. One last example that may hit home for some is we have heard of clients being given extra pills for a “just in case” scenario... if we are having any scenarios bigger discussions should be happening!
Because of innocent normalization (we're all human), we specifically ask on our new/returning client intake form and consultation form how many times someone been on antibiotics or had any infection within the last 24 months. This one question can be eye-opening for the client and helpful for us as coaches.
The What and How of UTIs
Urinary tract infections (UTIs) are caused by an overgrowth of bacteria, primarily a strain of E. coli. As we mentioned earlier, there can be many contributing factors, such as seasonal influences from warmer climates and participation in outdoor sports or activities like swimming, which can create perfect UTI conditions. A few contributing factors to UTIs may include:
Sexual activity, including items used or lubrication used
Birth control methods such as spermicides and diaphragms
Transference via touch
Not changing menstruation products frequently
But there are also other associations you may not be aware of. We will list out a few but will only be focusing on the #1 today with a little dash of #2:
Digestive Health
Low and/or Declining Sex Hormones
Adrenal Health
Thyroid Health
The Connection Between Gut Health and UTIs
Have you ever had a urine culture that wasn’t culturing the ‘right strain”? We have heard that SO many times. This is probably a good time to mention that other conditions such as sexually transmitted diseases and yes, even yeast infections can have similar symptoms to a UTI. When we hear that someone has had frequent UTIs and/or it wasn’t cultured for E.coli we do begin to think about digestive health (including yeast). If you have ever had a GI Map you may or may not have seen a bacteria called Citrobacter. Cirobacter can mimic a UTI! So that ‘UTI that wasn’t able to culture’ may not actually be a UTI but overgrowth of citrobacter.
Your gut microbiome, a community of teeny tiny organisms (microorganisms) in your digestive tract, plays a significant role in overall health, including the health of your urinary tract. Here’s how gut health influences UTIs:
Immune Function:
A healthy (Imagine a garden that is not overrun and also not a desert stripped of lush life… we want lush) gut microbiome supports a robust immune system, which is crucial for fighting off infections, including UTIs. Dysbiosis, or an imbalance in gut bacteria, can weaken the immune response, increasing the risk of UTIs.
Dysbiosis and Its Implications:
Definition of Dysbiosis: Dysbiosis is the term used to describe an imbalance in the microbial communities in the gut, where harmful bacteria outnumber beneficial ones. Technically if someone had a deficiency in good bacteria and no massive overgrowth of bacteria when overgrown is considered harmful is also a state of dysbiosis. This imbalance can be triggered by various factors such as poor diet, stress, antibiotic use, and infections.
Impact on Immune System: Dysbiosis can compromise the immune system (cue the thyroid, adrenal, and ovary connection) by disrupting the production of immune-modulating compounds. Beneficial gut bacteria produce short-chain fatty acids (SCFAs) that have anti-inflammatory properties and support the immune system. When these beneficial bacteria are reduced, the immune response can become less effective.
Inflammatory Responses: Dysbiosis can lead to chronic low-grade inflammation, which weakens the immune system's ability to respond to infections effectively. This inflammation can affect the urinary tract, making it more susceptible to infections.
Healthy gut bacteria produce beneficial metabolites that support the integrity of the urinary tract lining and overall immune function. Dysbiosis can result in the production of harmful metabolites that weaken the urinary tract's defenses, increasing the risk of UTIs.
Gut-Estrogen Axis:
Estrogen Metabolism: Certain gut bacteria, collectively known as the estrobolome, are involved in metabolizing estrogen. A healthy gut microbiome ensures proper estrogen metabolism, which can help maintain appropriate estrogen levels, supporting both vaginal and urinary tract health.
The Connection Between Sex Hormones and UTIs
Estrogen, progesterone and testosterone significantly influence genitourinary health. For the sake of your time and interest we are going to only mention a few ways that estrogen alone can be a big contributor to UTIs
Vaginal Flora:
Support of Beneficial Bacteria: Estrogen helps maintain a healthy balance of beneficial bacteria, particularly Lactobacilli, in the vaginal flora. These bacteria produce lactic acid, which keeps the vaginal environment acidic, deterring overgrowth of bacteria
Urinary Tract Health:
Mucosal Lining: Estrogen maintains the mucosal lining of the urinary tract, making it more resistant to infection. Lower estrogen levels, especially during menopause, can lead to thinning of this lining, increasing susceptibility to UTIs.
Low estrogen levels can contribute to Urethral Atrophy: Similar to the vagina, the urethra's tissues are also estrogen-sensitive. Low estrogen can cause the tissues to thin and weaken, leading to urethral atrophy. This can result in discomfort, a burning sensation, or pain during urination. Thin tissue can increase susceptibility to UTIs and symptoms of urethral atrophy can mimic UTIs
Low estrogen can contribute to changes in Urinary Frequency and Urgency: With lower estrogen levels, there can be changes in the sensation of needing to urinate. Some women may feel the need to urinate more frequently or experience a sudden, strong urge to urinate.
Okay because we feel guilty for not giving the peanut butter to estrogen’s honey any love let’s just mention that progesterone modulates the immune response, potentially affecting the body's ability to fight infections; during pregnancy, when progesterone levels are high, the immune system is naturally suppressed to prevent fetal rejection, making pregnant women more susceptible to UTIs. It also plays a role in smooth muscle but we are going to have to leave you in suspense on that one.
You can now see a “run-of-the-mill UTI” could be a red flag, or in some cases, you might have gone from a red flag to a white flag with smoke signals indicating other areas needing attention. Here are four action items to consider to mitigate UTI risk and address areas that may be overlooked but truly fuelling the fire:
Nutrition:
A diet rich in diverse foods, fiber, prebiotics, and nutrients supports a healthy gut microbiome. Foods like vegetables, fruit, resistant starches (e.g., cooked and cooled potatoes, rice), and protein help nurture a robust microbiome and support immune function.
Hydration and Bladder Care:
Ensure adequate hydration to help flush out bacteria from the urinary tract. Proper bladder emptying can reduce the risk of infections, especially during times when progesterone levels are high, such as pregnancy.
Hygiene Practices:
Maintain good hygiene practices to prevent bacterial transfer from the gut to the urinary tract. This includes wiping from front to back and urinating after sexual intercourse to help clear any bacteria from the urethra.
Tracking, Testing, and Further Treatment Considerations:
Track the frequency of potential or full infections.
Recognize the links to your digestive and hormone health and proceed with necessary testing.
Address any digestive health concerns, such as low digestive capacity or dysbiosis, and explore deeper connections (e.g., thyroid issues).
Recognize connections and changes in your hormone health that can have direct implications on genitourinary health. Seek necessary testing and treatment which may include hormone therapy.
By assessing hormone health, supporting a healthy gut microbiome, and following preventive measures, you can reduce the risk of UTIs. If UTIs persist, consult a healthcare provider to explore underlying causes and contributing factors. If this writing sparked your curiosity about your health journey, we would love to support you!