Why Do I Keep Getting UTIs?

Urinary Tract Infections (UTIs) suck. They make you feel like you constantly need to rush to the bathroom and cause you pain when you get there. But what sucks even more? Getting them over and over again. 

If this endless cycle of making up and breaking up with your urinary tract sounds a little too familiar, here’s what you need to know about your vaginal microbiome, it’s role in recurring UTIs and what to do about it.

Spoiler alert: there’s more to it than cranberry juice.

What Are UTIs? 

UTIs are infections of the urinary tract. They generally occur when microbes invade the urethra (the bit that pee comes out of), set up camp and set off your body’s inflammatory response. They usually aren’t a cause for alarm but they do need to be treated promptly to prevent the infection from spreading to your kidneys. On rare occasions, infections can lead to more severe symptoms and even life-threatening sepsis.

Commonly, the microbial culprit is a bacteria called E.coli and often this is the first microbe your health practitioner will suspect you have if you present with UTI symptoms. However, if you have symptoms but get a negative test result for E.coli, this doesn’t mean you don’t have a UTI. This is because UTIs can also be caused by other microbes that include:

• Other bacteria (such as Staphylococcus saprophyticus, Proteus mirabilis, Alloscardovia omnicolens, Enterococcus spp., Klebsiella spp., Mycoplasma spp., Pseudomonas spp. and Serratia spp. to name a few)
• Fungus
• Viruses such as HSV-2 and 
• Parasites such as threadworms and flukes

You’ll always want to make sure that you’re tested comprehensively for the right thing so that you can be treated for the right thing, don’t be afraid to advocate for yourself here!

Who gets UTIs?

Generally speaking the prevalence of UTIs increases with age and while both men and women can get UTIs, they’re definitely more prevalent in women and people with vaginas. In fact, women are 30 times more likely to develop UTIs than men. What’s more is that a large proportion of women,  27% to be exact, will have recurrent UTIs (defined as at least two UTIs within six months).

If you’re a UTI veteran, you’ll have heard repeatedly that the reason women and people with vaginas end up being more susceptible to UTIs is because they have shorter urethras than men. But, there’s actually much more to it. Medical issues, plain old genetics and your vaginal microbiome - the ecosystem of microbes living in your vagina - are all key players  in UTI occurrence and recurrence. 

How Does the Vaginal Microbiome Cause UTIs and Recurrence?

Your vaginal microbiome is the community of bacteria, yeast and other microbes living in your vagina. Normally, these microbes are vital for your health as they work together to protect you against infections. But when your vaginal microbiome is not in it’s optimal state, the microbes in your vaginal microbiome can lead to both vaginal infections and increased susceptibility to UTIs. Research shows that there are 2 ways in which the vaginal microbiome causes this increase in UTI susceptibility.

A disrupted vaginal microbiome can lead to both vaginal infections and increased susceptibility to UTIs.

Firstly, your vaginal microbiome acts as a reservoir for E. coli and other UTI causing microbes. These microbes are not typically found in any significant quantity in a healthy vagina, but when your vaginal microbiome is disrupted, they can take hold and thrive. As your vagina and urethra are remarkably close in proximity (seriously, grab a mirror and take a look), these microbes repeatedly contaminate and re-seed your urethra, causing UTIs again and again.   

Secondly, your vaginal microbiome contains other UTI-priming microbes that also transit to your urethra because of this proximity. Although these microbes are not regarded as UTI causing, repeated exposure of your urinary tract to these UTI-priming microbes create a favourable environment for the UTI-causing microbes to take hold or flare up. 

Losing protective bacteria 

Changes in your vaginal microbiome – such as a decrease of the protective bacteria Lactobacillus – will leave you more vulnerable to UTIs. 

Lactobacilli are a group of bacteria that protect the vagina from invading species that find their way into the vagina such as E.coli from the bowel. This protective group of bacteria stops both invading UTI-priming and UTI-causing microbes from using the vagina as a reservoir from which to invade the urinary tract. Maintaining good levels of lactobacilli in your vaginal microbiome is therefore beneficial for fighting off recurrent UTIs. Decoding your vaginal microbiome to assess your levels of Lactobacillus – as well as any harmful bacteria present - and implementing a restorative wellness plan accordingly can serve as an effective preventative strategy against recurrent UTIs. Depletion of this good bacteria can be caused by a number of things that include: 

Douching

Vaginal douching depletes good Lactobacillus bacteria and opens the door for some pretty nasty microbes. In general, it comes with a lot of risks, so avoid this unless specifically advised by a medical professional. Your vagina is mostly self-cleaning and you don’t need to do anything other than gently wash the skin around your vagina daily using water. 

Antibiotics

Antibiotics are quite literally life saving. However,  broad spectrum antibiotics deplete all bacteria including Lactobacilli, not just the bad ones. It’s important to use the right one for your infection, to use them correctly if you do use them and to use them alongside a Lactobacillus probiotic if you can and your health practitioner agrees. 

Sexual Activity

Sexual activity - whether that involves penises, fingers, tongues or toys -  can alter the vaginal microbiome significantly, too. This mixes up the bacteria down there making it more likely to end up in the wrong places. The stability of the microbes living in the vaginal microbiome are especially disrupted by the friction and movement involved in penetrative sex. Barrier contraception, peeing after sex, empyting your bladder fully and, if you’re engaging in anal and vaginal play, ensuring that you’re not cross-contaminating between the two areas, are all super useful ways of helping to avoid depletion of Lactobascilli and reducing your susceptibility to UTIs.

Menopause

Hormonal changes involved in menopause lead to a problematic decline in important, protective Lactobacillus bacteria in the vaginal microbiome, as well as changes to the urinary tract itself, leaving menopausal people unprotected against UTIs. Some women who are particularly affected by recurrent infections will consider hormone replacement therapy. 

What Can I Do About It? 

Avoiding UTIs and breaking the cycle of recurrent UTIs takes a multifaceted approach. Here are the key things you need to do:

Get the right tests

• Make sure that your urine is tested comprehensively for the right UTI-causing microbes so that you can be given the appropriate treatment the first time instead of after multiple rounds of trial and error. 
• Test your vaginal microbiome to understand what you’re working with if you have recurrent UTIs, and create a preventative strategy with your physician or wellness practitioner that takes into account your unique composition. 
• Get an overall health test. Sometimes recurrent UTIs are a symptom of endocrine disorders such as diabetes so it’s definitely worth making sure that you’re in the clear with this.

Get the right treatments

Use antibiotics correctly  

Antibiotics are health practitioners’ go-to treatment for UTIs. They’re used to treat an infection once you have it and also prophylactically to prevent subsequent ones. You need to make sure that: 

• You do indeed need antibiotics. Antibiotics only work for bacterial infections, they don’t work against fungus or parasites
• You use the right kind of antibiotic for your bacterial infection
• If you do take antibiotics you finish the whole course to avoid creating superbugs that are resistant to antibiotics
• You avoid over-using antibiotics;  you have an even higher chance of developing a UTI in the weeks following antibiotic use
• You use a reputable probiotic along side your antibiotic course if your health practitioner agrees 
  

Consider probiotics 

Probiotics are live microbe supplements and can help restore and maintain a healthy vaginal microbiome. However, as probiotics aren’t regulated, not all probiotics on the market will do the good that they claim. Therefore, probiotic research hasn’t quite reached a consensus but there is a significant proportion of the medical community and body of evidence that supports the use of quality probiotics. You’ll need to be savvy when selecting yours and make sure it’s the right one for your vaginal microbiome! Pay attention to the microbial strains used, whether the microbes are alive, the CFU count, whether you're able to insert it vaginally and how you use it in your UTI prevention plan. 

The Good Stuff from Cranberry Juice 

The jury’s still out on whether or not cranberry juice is actually effective for treatment or prevention. Some research goes against this popular remedy and warns that the high sugar content of store bought cranberry juice could be harmful (especially if you’re diabetic!) but says that ingredients from cranberries are effective when extracted. 

The key takeaway is that extracted Cranberry juice ingredients like D-Mannose, Proanthocyanidins and 72 mg PAC-A are effective for managing UTI symptoms during infection, and preventing future ones. Rather than drinking store-bought juice in excess, you can ask your health practitioner about these ingredients.

Make lifestyle changes for a healthy urinary tract

Diet

• Drink plenty of fluids, especially water, to help flush out the bacteria and ease some of the painful symptoms
• Consider going vegetarian. This research comparing UTI issues in vegetarians versus non-vegetarians has suggested that a vegetarian diet could aid the prevention of UTIs

Sex

• Pee. After. Sex. Every. Single. Time.
• Don’t “half pee” – some people don’t empty their bladder fully when they go to the bathroom. Take your time and ensure you’re fully peeing before leaving the toilet
• Use other forms of birth control instead of a diaphragm or spermicides 
• Don’t switch back and forth between vaginal and anal play in the same session
  

Hygiene 

• Take showers rather than baths
• Gently wash the skin around your vagina and anus daily using water. Don’t use soaps, scented deodorants or perfumes around your vagina/urethra
• No douching
  

Re-test to confirm your treatment has worked

It can be a good idea to double check that your interventions are working by re-testing and adjusting them accordingly. This is especially useful when you’re doing this as part of a preventative strategy for breaking the cycle of recurrent UTIs. 

It may feel like there’s no end in sight when you have recurrent UTIs but there’s definitely hope. So much of women’s health is currently about trial and error. It doesn’t have to be.