Urinary tract infections (UTI) affect women more than men mainly due to the shorter length of the urethera. Bacteria has a shorter distance to travel to reach the bladder lining where it can cause infection. The most common pathogen that causes a UTI is Escherichia coli (e.coli). E. coli is actually a part of our normal (good) flora, but certain strains or overgrowth of the bacteria has the potential to cause harm. Additional risk factors for UTI in women include vaginal dryness. Dryness can cause recurrent UTI because as vaginal tissue loses moisture, there is less of the good flora inhabiting the vagina. Good bugs, like lactobacillus species that are found in the vagina in large amounts, keep the bad guys in check. Less moisture means pH changes and the good bugs thrive in an optimal pH of around 4. To prevent a UTI from occurring, there are a couple of strategies to consider:
- Lactobacillus supplementation: lactobacillus species are good bacteria found in the gut and vagina. I believe that keeping the gut healthy will in turn keep vaginal flora healthy. In fact, when I see anyone with interstitial cystitis, I often quickly suggest we do a stool culture to assess the amount of good and bad bacteria they have living in their digestive tract. A recent study (1) suggests that certain lactobacillus species have the ability to block the bacteria that typically cause UTIs. The strains that showed most promising results were Lactobacillus salivarius and Lactobacillus acidophilus. Preventing UTI might be as easy as taking a high quality multi strain lactobacillus probiotic daily.
- D-Mannose: according to a 2014 (2) study, participants that had recurrent UTI were randomized to no treatment, nitrofurantoin (antibiotic) treatment, and D-mannose powder. They took the medicine, supplement, or placebo for 6 months. Turns out, the D-Mannose group and nitrofurantoin group were tied for preventative results, but the D-mannose group came out on top for less side effects. The side effect profile of nitrofurantoin is normally very low, but think about the side effects potentially happening in the gut that are not evident! Shifts in gut flora and antibiotic resistance are two factors to consider when deciding if antibiotic prophylaxis (for any condition) is a good idea. The dose of D-mannose used in the study was 2 grams per day, which is pretty good dose! This study shows that compared to daily antibiotic treatment, there is a safe and effective alternative.
- Vaginal estrogen: there are three types of estrogen that we make inside our bodies—estradiol (E2), estriol (E3) and estrone (E1). Estriol is the weakest of the three estrogens, meaning that it has weaker effects on the tissues and less likely to cause unwanted side effects of estrogen excess—such as breast or endometrial cancer (3). In menopause or perimenopause when there is a sharp decline in estrogen, estriol can be used as a tool to restore not only vaginal moisture, but prevent UTIs. A great study (4) demonstrated the powerful effects of estriol as a measure to not only restore moisture, but also shift pH and restore normal flora. The rate of UTI in this group was 0.5 per year with the estriol group and 5.9 per year in the placebo group! A very promising therapy for UTI prevention.
Ladies, if you have the annoying problem of recurrent UTIs, there are some great alternative ways to address the issue instead of relying on antibiotics! Prevention is key, so thinking about risk factors for UTIs is also important.