Why is it that some people never get them no matter what they do?
Why is it that you sometimes go years without one and then suddenly start getting them every couple months?
Is there a method to the madness?
The Usual Suspects
If you’ve had UTIs before you’ve probably heard the usual advice at some point:
- Wipe front to back
- Pee after sex
- Wash yourself down there before and after sex
- Drink more water
- Don’t hold it
But if you’ve already tried all the usual fixes and still keep getting UTIs, why is that?
Well it’s hard to say for sure, but we can make some educated guesses.
Your immune system is what prevents infections, so makes sense to start there, right?
Well turns out our immune systems are more complicated than we thought: we actually outsource a lot of the work.
Our bodies are totally covered top to bottom and inside out with mostly harmless bacteria and viruses all the time from the moment we’re born. They’re invisible to the naked eye, but you wouldn’t want to see what it looks like under a microscope.
All those fun little bugs that are on us are actually our friends. They evolved right along with us over hundreds of thousands of years. Our bodies are the planets they call home and if we’re good to our peeps they can actually help us fight off bad bacteria and viruses that aren’t supposed to be on our skin (or our privates).
Our bacteria don’t like to share their home, so they actually make antibiotic substances to attack and kill off invaders (1). You can think of them like your own private army.
Lately though we’ve been sending a lot of friendly fire their way. From childhood most of us are exposed to multiple courses of antibiotics which wipe out our little friends. And the few remaining survivors can take 9 months or more to multiply back up to full healthy levels (2).
(What complicates things is that it’s not just antibiotics that can have antibiotic-like killer effects on our healthy bacteria: it’s also painkillers, acid reflux meds and steroids (3).
So when you take an antibiotic for a UTI you kill off whatever has gotten into your bladder, but at the same time you might also be killing off those healthy bacteria that would have prevented the next UTI from happening. This can turn into a vicious cycle if you take antibiotics every year or even more frequently, with the healthy bacterial army never fully recovering.
If we change the environment some of the good guys can starve and die off that way and other bad actors can start multiplying on our skin. The body is like a rainforest ecosystem, it’s in a sensitive state of balance and a lot of things can throw it off leading to recurrent infections like UTIs:
- Birth Control
- Personal care products
- Thyroid problems
Seems like there isn’t much we don’t try to pin on stress. But it’s true, stress can cause all sorts of illnesses, often by reducing immunity (4).
A regular stress management practice is basically essential for anyone in the modern world who hasn’t already achieved enlightenment or given up and retreated to the live with a tribe in the Amazon rainforest.
- Uva ursi and dandelion – often combined in one pill.
- Rosemary, lovage and centaury – sold together as Canephron.
If interested in herbal treatments it’s safest to consult an expert in herbs to be sure you don’t harm yourself by choosing an inappropriate remedy or by over-dosing, because although herbs seem harmless there are definitely dangers if they are misused.
It seems so easy and convenient. A pill, an IUD, an injection once in a while. What could go wrong?
Well again, there’s the whole fine-tuned balance thing – messing with your hormones is inviting all sorts of trouble, the least of which is altered populations of healthy bacteria and recurrent UTIs (5).
The worst of it ranges from increased risk of breast cancer, heart attack, stroke, migraines, gallbladder and liver problems, weight gain, yeast infections, bacterial vaginosis (BV), depression, anxiety, blood clots, micronutrient deficiencies, and thyroid problems (sounds like a whole other blog post) (6).
What’s a girl to do? Well you could take a look at the copper IUD (paraguard) or the good old rhythm method, upgraded for the digital age of course with handy apps and thermometers.
Personal Care Products
We’re talking about soaps, lotions, creams, perfumes, you name it. These are full of all kinds of unnatural chemicals, including the antibacterial agents in some soaps (you can be too clean), and often-times laced with hormones like estrogen (7).
The stuff smells good and makes you look good, but not even the companies making and selling this stuff have any idea of everything their ingredients might be doing to us.
FDA, where you at?
Say what? OK this is probably the most speculative, but hear me out.
It’s not the easiest change to make avoiding receipts, but it might be one of the most important (beyond UTIs). Receipts are our most concentrated source of exposure to BPA, a xeno-estrogen, which disrupts regular estrogen metabolism in your body (8).
Estrogen is one of the most important hormones for preventing UTIs (9). It helps keep the vagina and bladder healthy and decreases the amount of UTI causing e. coli in and around the vagina and urethra (10).
The instant you touch a receipt you get exposed to 12,000 times the levels of BPA you would get from drinking out of a plastic bottle. And it’s injected directly into your bloodstream.
No one has yet studied the possible connection between BPA and UTIs, but we all know BPA is bad, so avoid those receipts anyway.
It turns out those pesky invaders that cause UTIs can sometimes hide out in little nooks and crannies on our bodies. There is evidence to suggest that even a full course of antibiotics doesn’t always kill them off completely (11).
We might wipe out 99% of them, but a few tough old bugs can retreat deep into certain glands in our genitals and bladder, then when the coast is clear, make a surprise come back (12).
You could address all the other issues raised in this post after which your own immune system might just be able to root them out on it’s own.
But for some people the only answer might be a longer course of antibiotics than usual.
Rebels Stick Together
UTIs aren’t caused by lone gunmen and Rambo wouldn’t survive a minute in your bladder. Bacteria secrete a gooey substance called biofilm to help them stick to your bladder wall and to help them evade antibiotics (13).
Some of them break free and cause UTI symptoms and then get killed off by antibiotics, others remain behind in the biofilm and can grow back and eventually send out more troops for the second assault – presto 4-16 weeks later you’ve got another UTI (14).
This is where home remedies like D-mannose can help – they disrupt bacterial ability to create biofilms, so they all get flushed out when you go pee (15).
Rebel Super Soldiers
No, we’re not talking about a Captain America sequel. These are souped up, resistant buggers in your bladder.
90% of the time the bacteria causing the problem is e. Coli and it is sensitive to the antibiotics being used (16), but sometimes there is a different bacteria or the e Coli has become resistant. Then a urine culture can help, allowing the correct antibiotic to be chosen.
But in even rarer cases some unlucky women may be harboring one of those dreaded “superbugs”, resistant to multiple, or even all antibiotics known to man. Bulletproof bugs are no joke, thankfully they aren’t that common (yet).
In other cases there may be an unusual or rare bacteria (like an Eskimo in the Sahara) that can’t be detected with regular techniques in which case even a urine culture will come back clean and a doctor might tell you that you don’t have an infection (16), or misdiagnose you with something like interstitial cystitis.
In those cases of rare and unusual bacteria there are a few advanced diagnostic options that test DNA found in the urine and can detect all kinds of unusual and rare infections and tell your doctor exactly which antibiotic to use in order to wipe them out for good.
It’s not a UTI
Finally if you’ve covered all your bases and gotten the advanced tests done and you still keep getting what feels like a UTI, then it probably isn’t a UTI, and you’re reading the wrong blog post (sorry). It could be interstitial cystitis, an autoimmune condition caused by the body attacking the bladder, which feels just like a UTI (17).
Ah, toilet paper, that gift of the gods. Who could live without it?
And yet … dare we say it?
Maybe, just maybe it can cause recurrent UTIs.
So you may not want to know this, but every time you wipe tiny microscopic bits of toilet paper are left behind on your genitals, bringing with them bacteria and chemicals that can cause UTIs, yeast infections and BV.
Bim Bam Boo toilet paper (made from bamboo) may be a natural solution.
Too Much Sex
One last thing to file under “didn’t want to know” and also possibly “don’t care”.
Studies show that having sex more than 3 times a week increases your risk of getting a UTI by 5 times (18).
So if you’re one of those lucky few, either join the rest of us prudes or just live with it. What’s a little ole UTI now and then?
Clean up your act – “better living through chemistry” is the problem not the solution.
Maybe change your toilet paper.
If you have sex more than 3 times a week – it’s your own fault.
If all else fails get some advanced testing done and figure out if you’ve been harboring a superbug.