For many women (and some men) recurrent UTIs are a painful, debilitating and often unspoken about issue, that can majorly affect one’s personal life, social life, work life and more. In addition to stinging and burning on urination, recurrent UTIs can be associated with frequency, urgency, muscle aches, bloody urine and more. Many of these women end up on repeating courses of antibiotics to address the infections, in addition to having to take days off work, spends hours in the bathroom and deal with painful complications like kidney and bladder infections.
Often these patients have been to many specialists, have tried various supplements, drunk litres of cranberry juice, and yet are still suffering recurrent UTIs. They’ve heard all the usual pieces of advice like drinking plenty of water, urinating after intercourse, wearing cotton underwear and more, and yet again, the infections continue to occur. In such cases, our aim is to investigate, understand and piece together their case history, to identify predisposing factors and implement strategies to increase resistance to infection, support immune function, reduce inflammation in the urinary tract, support mucosal integrity, cultivate a healthy vaginal microflora and of course, prevent further recurrence.
Identifying Predisposing Factors
Identifying underlying risk factors is integral to managing recurrent UTIs, as it allows us to account for and/or minimise factors that may predispose an individual to recurrent infections. Such risk factors fall under many categories and each need to be addressed in their own way. Some examples include:
- Nutritional deficiencies (e.g. of iron, zinc, vitamin D, vitamin A and more)
- Fluctuating blood sugar levels
- Dehydration
- Intestinal dysbiosis (e.g. an overgrowth of E.coli that may increase one’s risk of infection)
- Urinary tract abnormalities
- Poor immune function
- Certain types of birth control
- Hormonal changes (e.g. during pregnancy or menopause)
- Use of certain feminine hygiene products
- Personal hygiene habits
In all cases, it’s also essential to identify the micro-organism responsible for the UTI (via a urine sample), as this can give us some insight into the cause of the infection and thus the best course of treatment.
Increasing Resistance to Infection
Once potential risk factors have been identified and accounted for, our aim is to increase the body’s resistance to infection, to reduce the likelihood of recurrence. This is an ongoing process and one that is tailored to each individual patient’s situation. In general, this might involve:
- Making dietary changes to balance blood sugar levels, as every time blood sugars spike, resistance to infection decreases.
- Ensuring adequate dietary intake of nutrients like zinc and vitamin A, to support the health and integrity of the mucous membranes in the urinary tract.
- Correcting nutritional deficiencies (in particular, of nutrients like iron, vitamin D, zinc and vitamin A, due to their role in immune function and urinary tract health).
- Supporting immune function with specific immune-stimulating herbal medicines, like echinacea and andrographis.
- Using prebiotics and probiotics to cultivate a healthy microbiome and reduce potentially pathogenic micro-organisms (see below for more details).
Reducing Inflammation and Supporting Mucosal Integrity
UTIs are associated with inflammation of the urinary tract, which can contribute to symptoms like burning, pain and irritation. In cases of active (or recurrent) infection, reducing inflammation in the urinary tract is integral to alleviating symptoms and helping ease any associated discomfort. Often this involves using anti-inflammatory and demulcent herbal medicines to soothe the inflamed tissue and reduce inflammation. We also use specific herbs and nutrients like vitamin A to support mucosal integrity, as the mucous membranes lining the urinary tract are an important physical barrier designed to prevent infection in the area.
Cultivating a Healthy Vaginal Microflora
Like the gastrointestinal tract, the vagina has its own diverse micro-ecosystem made up of many species of micro-organisms. These micro-organisms play many roles, and one of which is to prevent the growth of potentially pathogenic species. For example, a healthy vagina is home to many species of Lactobacilli, such as Lactobacillus iners, Lactobacillus crispatus and Lactobacillus jensenii. These Lactobacilli produce anti-microbial compounds like hydrogen peroxide and lactic acid, which acidify the vagina, helping prevent infection by pathogenic species like E.coli and Staphylococcus aureus. For this reason, vaginal dysbiosis (an imbalance in the types of micro-organisms found in the vagina) is associated not only with increased risk of UTIs, but also increased risk of other vaginal infections, such as thrush and bacterial vaginosis.
There are many factors which can contribute to a dysbiotic vagina, such as antibiotic-use, spermicide-use, hormonal changes, new sexual partners, smoking and more, so identifying and rectifying the cause of dysbiosis is integral to treatment. In addition to addressing causal factors, we use prebiotics to promote the growth of healthy bacteria, along with probiotics and dietary changes to help support the process.
Preventing Recurrence
All of the steps we’ve described above are designed to reduce risk factors, increase resistance to infection and support the body’s natural defences, so as to limit the risk of UTI recurrence. After all, for patients who have suffered recurrent UTIs for months or years, preventing further infections is the ultimate goal of treatment. This is why we embrace a holistic and multi-faceted treatment approach that examines and addresses underlying drivers of the condition, so we can address not only the symptoms, but the cause of the condition as well!
