Urinary tract infections are a common concern, impacting an estimated 50-60% of adult women. If left untreated, bladder infections may progress to something more serious like a kidney infection, so identifying the symptoms and getting support quickly is key.


Symptoms of UTIs may include: 


  • Pain with urination
  • Increased urinary frequency
  • Blood in urine
  • Back pain


Note, however, that in some populations, such as pregnancy - you can have a UTI without the classic symptoms. Therefore in higher-risk individuals (pregnancy, diabetes, etc.), this is something your health care provider should be screening for.


Diagnosis of UTI: 

Often the clinical assessment (i.e. your symptoms) are enough to warrant treatment without getting a urine analysis or dipstick. However, a dipstick and urine culture can confirm the presence of an infection if there is uncertainty. An untreated UTI can progress as mentioned, so if it’s an acute UTI with clear symptoms, often going straight to treatment versus waiting for test results (while infection can progress), may be considered.


Recurrent UTIs are defined as:

  • 2 UTIs in the last 6 months, or
  • 3 UTIs in the last 12 months


It’s important to consider why this may be happening and rule out other causes impacting bladder health that may look like a UTI but is something else.


Other things that may look like a UTI but aren’t:


Overactive bladder

This presents with increased urinary frequency, urinary urgency and frequently waking in the night to pee. There is an absence of pain or blood in the urine.


Vaginal changes related to menopause

Low estrogen during menopause can lead to anatomical changes in the vagina, leading to thinning of the tissue and thus irritation during urination, which can mimic a UTI.


Note: menopause can also be a risk factor for recurrent UTIs (disproportionately higher than in other populations) due to changes to the urogenital microbiome which are directly influenced by reproductive hormones. As those hormones decline in menopause, this can increase the risk of infections. Treatment with vaginal estrogen can significantly reduce the number of UTIs per year in this demographic. 


Painful bladder syndrome (formerly known as interstitial cystitis)

The cause of this condition is unknown but involves alterations to the bladder lining causing pain. Symptoms are comparable to UTIs but often persist after treatment of UTI (because there is no infection here). Diagnosis typically requires a bladder scan.


Treatment considerations


First-line treatment for active UTI

Acute non-recurrent UTIs are typically treated with antibiotics. In recurrent cases, we want to ensure we have the right diagnosis and thus treatment. The role of the urogenital microbiome should be considered.


What about cranberry and D-mannose? 

These are tools effective at the prevention of UTI. They work by preventing the adherence of E. coli to the bladder wall.


Does diet impact UTIs?

Yes! It may come as no surprise, but berries are helpful here. Other helpful dietary considerations are fruit, and fermented dairy products like yogurt (Kontiokari 2003)


Vaginal estrogen in perimenopause or menopause

Menopaused-related decline in estrogen can cause genitourinary anatomy and risk of recurrent UTIs. For those for whom estrogen therapy is not contraindicated, this tool can significantly reduce the rate of recurrent UTIs.



In health,

Dr. Ashley Damm, BSC, ND

Naturopathic Doctor- Vancouver, BC

Women's Health & Fertility



References:

  1. Williams G, Hahn D, Stephens JH, Craig JC, Hodson EM. Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews 2023, Issue 4. Art. No.: CD001321. DOI: 10.1002/14651858.CD001321.pub6. Accessed 13 December 2023.
  2. Fu Z, Liska D, Talan D, Chung M. Cranberry Reduces the Risk of Urinary Tract Infection Recurrence in Otherwise Healthy Women: A Systematic Review and Meta-Analysis. J Nutr. 2017 Dec;147(12):2282-2288. doi: 10.3945/jn.117.254961. Epub 2017 Oct 18. PMID: 29046404.
  3. Sanyaolu LN, Cooper E, Read B, Ahmed H, Lecky DM. Impact of Menopausal Status and Recurrent UTIs on Symptoms, Severity, and Daily Life: Findings from an Online Survey of Women Reporting a Recent UTI. Antibiotics. 2023; 12(7):1150. https://doi.org/10.3390/antibiotics12071150
  4. Christmas, Monica M. MD, NCMP; Iyer, Shilpa MD, MPH; Daisy, Cassandra; Maristany, Sumiko; Letko, Juraj MD; Hickey, Martha MD, MBChB, MSc. Menopause hormone therapy and urinary symptoms: a systematic review. Menopause 30(6):p 672-685, June 2023. | DOI: 10.1097/GME.0000000000002187